What Revision Can Be Done to Get Rid of Buckling of Cohesive Gel Implants?

I am age 50, 5'5", 126 lbs, fit, thin-skinned. Eight months ago I had 375 cc saline implants replaced with cohesive gel implants of 425 cc. A visible round lump can be seen and felt on my left breast at about 10 o'clock. I had it checked out and it's benign. The plastic surgeon believes it is buckling due to the weight of the larger implant, my skin sagging with age and pocket size. This breast does sits slightly lower. Options offered were to ignore it or have a breast lift. Should the surgeon have checked the problem more thoroughly?

Doctor Answers 7

Rippiling Of The Implant?

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Thank you for your question!  It is hard to tell without an examination of your breasts.  I suggest you go see a board certified plastic surgeon and discuss it with him or her.  The implants may need to come out.  Best of luck!
Dr Dhaval PatelDouble Board Certified Plastic SurgeonChicagoHoffman EstatesOak Brook

Rippling and palpability of breast implants

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Thank you for the question.
Palpability  and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability  of the implants.  Deflation of the implants will also increase the rippling/palpability of the implants.

Having discussed these issues,  PREVENTION of rippling/probability is of critical importance.

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” and "feel" will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.  Make sure you're working with a well experienced board-certified plastic surgeon.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome,  including the presence of rippling/palpability  of the implants.

 I hope this helps.


Revision and implants

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Without an exam it is difficult for me to comment because I amnot really sure what this bump is?  As for a lift, usually this can be determined before the augmentation surgery...but not always.

Buckling of cohesive gel implant

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These are implants that, if shaped must adhere to the surrounding tissues in order to maintain their proper shape and rotation. If fluid builds up around the implant despite the use of proper techniques at the time of surgery, the implant can rotate or buckle. This can be visible using imaging studies.

Breast Implant "Buckling"

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I think the best way to explain your situation is the old line : "For every complex situation, there is a simple solution which is usually - wrong".

Without an examination, much less photographs you are putting us into a situation of a car mechanic asked to repair an engine he cannot feel nor see.

The term COHESIVE is thrown about rather easily today. In fact, it should only be used to describe stiff, FORM STABLE implants which are not available for wide use in the US. When held upright these implants do not thin at the top - IR buckle. Instead, they always maintain their shape. While they look good, they tend to feel stiff and require precise pocket dissection. From what you describe, I doubt these were the implants used in your case.

If the breast sagging bothers you, it cant be readily fixed but would require additional breast scarring. The buckling issue needs to be resolved and I would suggest a MRI which is the most breast diagnostic tool these days. It will tell you exactly what is going on. With a fixed trouble point at 10 o'clock, I would want more critical information than "had it checked out and it's benign"

Peter A. Aldea, MD
Memphis Plastic Surgeon

May need more tests to get at root of problem

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This doesn't really make sense to me.  For example do you have textured implants?  if so, you may want to switch to smooth implants.  You may want to look into an MRI or even ultrasound, to see if there is perhaps an implant rupture.  I don't understand why you would be sagging, so this needs to be explored and clarified to my satisfaction.

Revision breast augmentation usually works.

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Hard to know exactly what's wrong, but your cohesive breast implant may have flipped around. The pockets have to be perfect. That is why we don't use these breast implants for revision breast augmentation, where there is already a pocket. But, in any case, if this really bothers you, it can probably corrected.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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