I have had silicone implants for 30 years. I have hardening. I want them removed and replaced with a lift. A Dr told me to do this in 2 procedures/surguries because of risk of loss of blood supply to the nipples. What do you think??
How Many Surgeries Needed for Breast Implant Replacement and Lift?
Doctor Answers 20
Breast implant removal reimplant and mastopexy
Excellent question. Whether it is done in 1 stage or 2 depends on the surgeon's experience ',comfort zone",type and age of implants and patient's age and condition. The type of mastopexy also plays a very important role.
I did a single stage proceedure on a pt. with 26 year old implants 3 wks ago who is doing very well. There is no "right" answer.
Breast implant removal (explantation) and lift in two surgeries
Performing a removal and capsulectomy in one operation followed by staged lift of the breast is a reasonable and conservative approach to this problem.
Appropriate timing of breast implant exchange with a lift
There really is no absolutely correct answer here... The recommendation you get is going to correlate most strongly with the surgeon's experience and comfort level with these operations.
I would disagree with the belief that it is somehow unsafe or wrong to do these procedures together (in fact, I do them together at least once or twice a month), but know that some prefer to separate them.
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Replacing old gel implants with a lift
The doctor you saw is spot on. There are times when it is safe to proceed with a replacement and lift at the same time, but this can only be determined with a physical exam. The explanation is difficult. I usually draw pictures with this particular conultation type to enhance the patient's understanding of the issues we face.
Put simply, if the original surgery was over the muscle the risk of loss of blood supply to the nipple with a mastopexy (breast lift) is high, whether you put a new implant in or not. It is higher with an implant, especially if you are foolish enough to place the new implant over the muscle again :(
Here are the important factors that weigh on my decisions in these cases:
1. NO SMOKING. PERIOD.
2. How much native breast tissue is there to work with. the more the safer.
3. Make sure patient knows that if at time of sugery, in these 30 yr old, probably gel, probably leaking implants, that I reserve the decision to back out. i.e. not place an implant if the tissues are too vascular from chronic inflammation, or by the process of removing granulomas of silicone there is too much oozing.
4. Whether we place the implant or not (always under the muscle in my shop) I will proceed with the lift.
5. if one does the implant and lift at the same time some surgeons place either all saline or saline/gel adjustable implants so that if the nipple or flaps don't look good postop one may reduse the volume of saline thereby decreaqsing the pressure. Most of the time one can judge preoperatively who might fall in this category. Then it is the sage plastic surgeon, interested in your health that simply says you are best treated with a two stage operation.
6. How large an implant are you choosing to place as a replacement.
7. How much of a lift do you need? What type of lift?
8. These can turn into one heck of a mess when they go bad. Hence, look for a surgeon that is careful and thoughtful.
Breast implant hardening
There is usually no reason why you could not do both procedures, removal of implants and an uplift at the same time. You have to be concerned about what type of uplift to do and whether all the scar tissues needs to be removed, whether the implants are broken. Just make sure you realize that it would be a big change to remove implants totally, esp depending on what size you are.
Expect to need a revision
In my practice, this is done in 1 surgery, but there is certainly a higher chance that a revision may be needed. Sometimes this is to better position the implant and sometimes to get the breast shape better. This surgery is very technically challenging and requires someone with a lot of experience with it to avoid major complications. I ask that my patients be very conservative in choosing the implant size as well because it usually involves removing the old implant from on top of the muscle and making a new pocket under the muscle. There's not much room under there so the smaller the implant the better!
Implant exchange and a lift
A breast implant and exchange with a lift can certainly be done at the same time, but there are some doctors who prefer to stage them.
Breast Lift and Augmentation
If you have breast hardening, then you may in fact have a caspula contracture. In that case, a capsulectomy (or removal of the capsule) may be necessary before placement of another implant. If your breast tissue is thin, the surgeon may prefer to do the lift in another stage since the capsulectomy may compromise the blood supply to your breasts to some degree.
Revision breast augmentation and breast lift can be done in one stage.
Plastic surgery is to a large extent an art, and there seldom is just one right way to do things. And of course I haven't examined you. But the surgeons I know who do a lot of breast surgery replace breast implants and do a breast lift at the same time in most women.
Two stage is safer and more predictable
You should be happy that your surgeon is more concern with the result and your safety than just you signing up for the surgery. Most patients like the combined lift and implant exchange. When a surgeon offers the two stage for implant exchange and lift, there is a strong indication. The result of the surgery depends on the patients condition and surgeons skill.