Recovery and Pain to Expect During Breast Implant Replacement?

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.

Doctor Answers 14

Breast implant exchange

Generally, breast implant removal, even if ruptured, can be done with tolerable discomfort. The real discomfort comes if you need to convert from above the muscle to below. Even that discomfort however is only about the same as a first time under the muscle patient. I generally use drains in cases like yours and these can be in for about a week depending on the volume of drainage.

Recovery after Breast Implant Replacement

Recovery after Breast Implant replacement will vary significantly, depending on where the initial implant is (over or under the muscle) and the amount of spread of the silicone into the surrounding tissues. If the implant is under the muscle, the recovery will be longer, especially with a physical job. If over the muscle, recovery should only be a few days. The biggest question is how you discovered the ruptured implants. If this was by pure chance (a routine mammogram or study not related to symptoms), there may be no reason to replace them. As long as the silicone is fully within a scar capsule, it is generally quite safe. I have followed many such people for years with no problem. If, however, symptoms led to the discovery, and there is diffuse silicone within the tissues, more cutting of the tissues is required, and thus, there is more post operative discomfort and longer recovery.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast Implant Rupture

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.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 65 reviews

Implant rupture and replacement

Your question about post-operative pain is difficult to answer because the amount of infiltration of the silicon into the surrounding muscle and/or breast tissue as well as the presence of granulomas needs to be considered. It may be a very quick and easy replacement with mild pain, or more significant if extensive removal of tissues is required. Did you have an MRI (with or without contrast)?

Theodore Katz, MD, FACS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 7 reviews

Expectations and Recovery after Ruptured Breast Implant Replacement

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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 104 reviews

Pain after revision breast augmentation

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 tense
3) Narcotics to help address pain. Usually more effective if you stay ahead of it
4) 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.

Recovery after revision augmentation

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

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 38 reviews

BBA Recovery

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,

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 34 reviews

Recovery expectation after Breast Implant Replacement

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!

A complicated question

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!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.