Recovery and Pain to Expect During Breast Implant Replacement?

Question

My Breast implants were done in the early 80's. I just found out that they are both ruptured. I am very concerned about the removal of the silicone which has leaked.

	However, I would also like to know if I can have them replaced, and is this going to be a very painful procedure? How long will I expect my breast implant recovery and pain to last? I have a very physical job.

Young R. Cho, MD, PhD · Answer

Thank you for your question. Discomfort is normal and it will depend largely on what is needed for your procedure and where the silicone rupture is contained to.  The procedure could be a simple hour procedure if the silicone is limited to the capsule, versus many hours if it has infiltrated your breast tissue or beyond.There are many things that can make your post-operative pain tolerable:1) Injectable numbing done at the time of surgery (some can last for several days)2) Muscle relaxants so your muscle is not as tense3) Narcotics to help address pain. Usually more effective if you stay ahead of it4) Non-narcotic medications (e.g. anti-inflammatories such as Advil)You often find that discomfort does correlate with size of the implant and the degree of stretching of the soft tissue of the breast.I would also revisit with your plastic surgeon if you are experiencing discomfort despite their post-operative measures.

Larry S. Nichter, MD, MS, FACS · Answer

Yes, if you have ruptured silicone implants, the standard of care is to remove them and the surrounding capsule. Most will elect to have new implants placed.Silicone nodules in the breast should be removed as best as possible and biopsied if needed to confirm the lump to be silicone and not cancer. If silicone has spread in large amounts into the breast, chest muscles, arm pit, lymph nodes, or other sites, the patient and surgeon must decide on how “aggressive” the operation should be as there will likely be greater deformity and potential complications. The risks of trying to remove all silicon are generally worse than the benefit; so some silicone will remain. If silicone is in your lymph nodes then follow up with a general surgeon may be required. If the implants are ruptured or more than 10 years old, consideration should be given to replacement. New implants are made from a highly cohesive gel. These “gummy bear” implants have less problems and retain their shape even when the outer shell breaks. The procedure is an outpatient operation performed under oral sedation, IV sedation, or general anesthesia depending upon the length and complexity of surgery Patients will feel sore and tired during the first 48 to 72 hours following surgery. During these first few days, the patient should engage in light activities, refraining from lifting or raising the arms above the head. Swelling and bruising will subside during the first week after surgery and will be controlled by pain medication. The initial surgical tapes will be removed a few weeks after surgery during a post-operative visit. Patients typically may return to a work a few days after surgery,only a light workload during the first two weeks, 6-8 weeks  for more physical jobs.  Your plastic surgeon will guide you. Most of my patients tell me it is less painful thought a more involved surgery than their original breast augmentation.

Asif Pirani, MD, FRCS(C) · Answer

It really depends on a few factors.  Adequate pain control is likely the most important.  Individual pain tolerance differs greatly.  I find that women who have had children generally have less post-op pain, as they have a much higher pain tolerance. From a surgical point of view, there are several things the surgeon/anaesthesiologist can do to decrease your post-op pain.  I generally perform breast blocks prior to making any incisions with a mix of short- and long-acting local anaesthetics.  I have found this greatly reduces post-op pain.  I also encourage patients to take the prescribed pain killers regularly every 4 hours especially for the first 24-48 hours. If you don't stay on top of the pain in the immediate post-operative period, it is extremely difficult to "catch-up".  Most of my patients experience very little post-op pain after breast augmentation.Of course, the type of augmentation you have will also determine your post-operative discomfort.  Larger implants, and subpectoral implant placement will also increase post-op discomfort.  This doesn't mean you shouldn't get large implants, or place them under the muscle - you simply need to know what to expect.  Many women also experience difficulty with sleeping in the first few weeks after augmentation due to the weight of the implants on their chest.  This is more significant in back-sleepers.To answer your question about time off work, my experience has been that there is a huge  range.  I have patients that go back to work the next day (against my advice), and I have had patients take as much as 2 weeks off of work.  It really depends on what you do for work, and how you feel.  As for taking care of your kids, if your implant is placed under the muscle, it will be a few weeks before you feel comfortable enough to pick them up.As for scars, I tell patients it will take a year to see the absolute final result.  Practically, however, by 3-6 months the scar will be very close to the final result.  I suggest 3M paper taping, and have a specific scar massage protocol I use to help speed scar resolution.I hope this helps.  Good luck!Sincerely,

Armando Soto, MD, FACS · Answer

Hi there-
The recovery experience you should expect will depend a great deal on the details of the operation you and your surgeon decide on after review of your current situation, your goals for appearance, and the alternatives available.
Generally speaking, if you had the existing implants removed and new ones placed into the existing pockets, the pain and disability should be significantly less than you experienced with the initial procedure for their placement.
Should you and your surgeon decide other maneuvers are necessary, such as a breast lift, conversion to another pocket location, or pocket reconstruction, you would need to expect a bit more recovery. With regard to the specific limitations and your ability to perform at your particular job, you would need to review these with your surgeon after making decisions regarding the procedure itself and your desired timing.
Having said all of that, I would certainly recommend that if you have older silicone implants and know they are ruptured that you have them removed as soon as possible to avoid silicone migration and other potential issues.
Good luck!

David Shafer, MD, FACS · Answer

In most cases, the breast implant exchange procedure is much less involved than your original surgery. If your implants were placed under the muscle, then you may have had some discomfort after your original surgery from the muscle stretching. Since the muscle is already stretched, then you will not have this same discomfort. However, if you have contracture or scar tissue that needs to be resected then your recovery may be more involved. Good luck with your surgery.

John LoMonaco, MD, FACS · Answer

Implant exchange is usually not a very uncomfortable procedure, but he leaking gel may make the surgery more involved, and cause more discomfort.  Some docs prefer to use drainage tubes as well, so ask about this possibility. 
I agree with the other docs in that the implanty placement procedure is usually the most uncomfortable.

Farbod Esmailian, MD · Answer

This is becoming a more prominent problem as a lot of the silicone implants placed earlier on are rupturing and patients are presenting for removal.  Usually the scar tissue that surrounds the ruptured implant remains intact, at this can be removed all en bloc. 
On occasion I have had rupture of the silicone implant outside the capsule or scar tissue which results in silicone infiltrating into the breast tissue.  This may require more time and pain overall.  Also it depends if the breast implants are in front or behind the muscle, that will also change the recovery.
But yes, new implants can be placed during the same time.
Good luck.

Otto Joseph Placik, MD · Answer

Much of this depends on the extent of the rupture and whether the implants were placed under or over the muscle. Generally the pain of the first procedure tends to be associated with the stretching and surgical release of the muscle.

Pablo Prichard, MD · Answer

Dear Butterfly,Thank you for your post.  In general, if the implants are not too wide and a capsulorraphy or suturing of the capsule on the side is not needed, then your recovery will be short.  In a revision where the implants are removed, or implant material in the case of a ruptured implant, the pockets are revised slightly in order to accommodate the new implant.  Since most of the pocket is already formed, the healing process is quit, and pain is low.Best Wishes,Pablo Prichard, MD

Kenneth R. Francis, MD, FACS · Answer

Butterfly,
Your question may be more complicated than it sounds.  Since the implants are both leaking you will likely require total capsulectomies (removal of the entire scar capsule and implant) on both breasts.  This can be a technically demanding surgery, with extensive dissection and a rough recovery depending on how adherent the capsules are to the muscle, ribs and surrounding structures.  A consult with your board certified plastic surgeon will give you a better idea of how much and how complicated your surgery will be.  Good luck!

Recovery and Pain to Expect During Breast Implant Replacement?

Answers (14)

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