Breast augmentation is performed around the world with enormous success. The most common types of breast implants used in the United States and abroad are made of a silicone shell with either saline or silicone within the implant itself. If you are considering surgery for breast implant revision or for your breast implant complication, schedule a consultation with Dr. Karamanoukian.
Saline and silicone breast implants have a very high safety profile. However, as in all medical devices, breast implants have some risk when placed within the body. These risks are both patient-specific and implant-specific (saline or silicone breast prosthesis).
The fact that a patient needs breast revision surgery does not imply that something went wrong with the surgery itself or that there is anything wrong with the patient's health. Often, breast revision surgery is indicated in patients who are otherwise healthy, but who have developed changes in their breast shape due to aging, pregnancy, the effects of gravity, capsular contracture, or progressive scar formation.
Dr. Raffy Karamanoukian is a board certified plastic surgeon who specializes in primary breast augmentation, breast lift surgery, breast reduction surgery, and breast reconstruction. Often, patients present to his office in need of corrective breast surgery to repair an undesirable breast shape as a result of previous breast augmentation surgery.
Patients may have excessive scarring, asymmetry of the breast, poorly placed breast implants, hardening of the breast implants, and other poor cosmetic results as a result of surgery.
Expertise in Breast Revision Surgery
Given his expertise in reconstructive breast surgery, Dr. Karamanoukian performs breast implant revision procedures with meticulous attention to detail. Breast implant revisions require precise surgical planning, close discussion, timely follow-up, and meticulous surgical technique that adheres to gold standards in surgical reconstruction and cosmetic breast surgery.
The basic goal of breast revision surgery is to achieve beautiful aesthetic contour and symmetry of bilateral breasts. This can be achieved with corrective surgery that can be performed using local anesthesia, intravenous sedation, or general anesthesia. If you are concerned about the cosmetic appearance of your breasts, or are worried about breast abnormalities as a result of breast implant surgery, please schedule a consultation with Dr. Karamanoukian.
Breast implant surgery is known to be a safe cosmetic procedure to enhance the volume and shape of the female breast. Breast implants are most commonly made of silicone or saline and are theoretically inert within the body. However, changes in hormones, age, weight, and the influences of occupation and the environment may take a toll on the overall shape of the female breast. In most cases, corrective breast surgery can be performed on an outpatient basis.
During your consultation, it is important to bring in all relevant documents including original breast implant documentation, breast implant size, breast implant serial numbers, operative notes, and medical records, if they are available. Dr. Karamanoukian will carefully review these documents and propose a corrective surgery that addresses the individual needs of your breasts.
In addition, Dr. Karamanoukian works closely with breast surgery experts, cancer experts, and primary care physicians to address the medical needs of his patients from a safety perspective. If you do not have any medical records from your previous surgery, Dr. Karamanoukian may request more definitive diagnostic examinations such as MRI, mammogram, or ultrasound. Do not be intimidated by these examinations. The utility of these added diagnostic examinations is to improve the overall appearance of your breast and to maximize the aesthetic and long term outcome of your corrective breast surgery.
Capsular Contracture of the Breasts: Capsular contracture may occur spontaneously or progressively in patients with breast implants. Both silicone and saline breast implants may cause capsular contracture and we are unsure as to what actually causes the breast implant capsules to harden. Capsular contracture is a progressive disorder and the onset and duration of capsular contracture may vary from person to person. Hardening and thickening of the breast implant capsule with associated pain and itching may occur with severe capsular contracture of the breast. Capsular contracture may also be associated with calcification and displacement of the breast. This may result in breast implant malposition, hardening of the breast, pain, itching, and poor aesthetic results.
Breast Implant Capsular contracture is common and there are several ways to minimize the risk and severity of breast capsular contracture. If you reside in Los Angeles, Santa Monica, or Southern California, schedule an appointment with Dr. Karamanoukian to discuss your options for capsular contracture. In the acute setting, it is important to follow your postoperative breast implant instructions and to keep your incision site clean as infection is thought to increase the risk of capsular contracture. In the case of late capsular contracture, there are several surgeries to treat the fibrous breast implant thickening.
- Capsulotomy - surgical dissection and division of the thick fibrous breast capsule. This can be performed surgically or using a closed technique.
- Capsulectomy - surgical removal of the breast capsule. This usually requires formal surgery under anesthesia.
- Replacement of the breast implant with capsulotomy or capsulectomy.
- Explantation of the breast implant.
Patients who have recurrent capsular contracture may also be candidates for breast implant revision. In some cases, leukotriene inhibitors may be used to prevent or decrease the rate of capsular contractor or breast implant capsule formation.
Scarring of the Breast: Scarring is one of the most common complaints among women who have had breast implant surgery or cosmetic breast enhancement. Some patients may have temporary scarring which may occur along the incision site, around areola, or underneath the breast. These scars may be darkly pigmented or hyperpigmented as a result of a poorly placed incisions, sun exposure, hormonal pigmentation, or post-inflammatory pigmentation. In some cases, the scars may be thickened, hypertrophic, or keloid scars. In all of these cases, the scars can be addressed by corrective surgery, TAC injection, topical treatments, and laser treatments.
Breast Implant Rippling: Saline breast implants have a higher rate of rippling and wrinkling along the lateral and anterior aspects of the breast. Patients with visible wrinkling or rippling may be embarrassed with the condition in certain positions, or when wearing certain bikinis or outfits. The visible wrinkling may make the implants more noticeable and less esthetically pleasing. In this situation, Dr. Karamanoukian will often advise patients to replace the implants with silicone prostheses that are more viscous and less likely to visibly ripple. In patients with thin breast parenchyma and minimal overlying breast tissue, the discussion may involve downsizing the implants or placing autologous tissue to avoid rippling and wrinkling along the lateral and inferior edges of the breasts.
Ruptured Silicone Implants
Ruptured breast Implants: Silicone and saline implants can become ruptured and this may cause immediate grief among patients as they develop asymmetry of the breasts. Implant deflation can be immediately noticeable in patients who have saline implants or can be missed among patients who have slowly progressing silicone implant rupture. In either case, diagnostic examinations such as ultrasound, mammograms, MRI, and CT scans can help Dr. Karamanoukian visualize the implant rupture and gain perspective on how to address it most appropriately. Breast implant rupture can occur as a result of capsular contracture, trauma, blunt trauma, external compression, or an unknown cause. The majority of implant ruptures occur spontaneously and without any cause whatsoever. In patients with saline implantation, the contents of the implant are rapidly absorbed in the body, while patients with silicone prosthesis may experience slow leaking of the silicone within the implant. The silicone may slowly leak into the breast implant capsule or through the capsule into the breast parenchyma.
Dr. Karamanoukian will evaluate your breasts objectively with a breast examination and recommend immediate or delayed replacement of the silicone or saline implants. In most cases, patients use this condition (ruptured implants) as an excuse to reevaluate their cosmetic needs and perhaps address bilateral breasts together with replacement of bilateral implants and the addition of any corrective type surgery to lift the breasts.
Correction of breast asymmetry and uneven breast implants: Asymmetry of the breasts is a very common complaint among women who have had cosmetic breast enhancement. A study in the journal Plastic and Reconstructive Surgery showed that up to 89% of women have significant asymmetry of the breasts preoperatively. Often, the breast asymmetry may be enhanced or highlighted after breast implant surgery. If you are concerned that one breast is completely different than the other, the asymmetry may be a result of preoperative differences in the size and shape of your breasts. Other causes of breast asymmetry include differences in surgical technique on the right and left breast, capsular contracture, scarring of one breast, hardening of the breast, or unilateral parenchymal swelling and edema. Breast implants may be lower on one side or higher on the other as a result of breast implant malpositioning. In general, Dr. Karamanoukian will examine you in the anterior-posterior, oblique, and lateral perspective to gain insight into the degree of breast asymmetry and the underlying cause of the condition.
Breast asymmetry is a common condition affecting the majority of women. If you feel that your breasts do not look alike, you are not alone. A recent study published in Plastic & Reconstructive Surgery Journaldemonstrated that close to 90% of women has breast asymmetry. The factors to consider when discussing cosmetic surgery of the breasts, or surgical correction of breast asymmetry, include the following physical characteristics of the breast.
Breast Shape: There is no one ideal breast shape or size. Breasts can develop in a variety of ways, all of which are aesthetically pleasing. More important than breast shape is the symmetry of the two breasts. If there is significant difference in the shape of the breast, this may cause significant emotional or physical embarrassment to the patient. The factors to consider are the overall shape of the breast, the presence of an inframammary fold, the medial and lateral dimensions of the breast, the size of the areola, and the position of the nipple relative to the other breast.
Breast Size: The size of the female breasts is important for most women and there is no ideal size. Rather, most plastic surgeons would agree that an ideal aesthetic breast works in harmony with the anatomic proportions of the body. Size differences between the two breasts can be corrected with a reduction of one breast or enhancement with breast implants in the other. Dr. Karamanoukian will discuss these options with you during your consultation.
Nipple Position: Nipple position can be assessed by examining the nipple and breast relative to the inframammary crease. Nipples tend to sag and drop with age, pregnancy, and breast feeding. The correction of nipple position and nipple symmetry is an important aspect of any cosmetic breast surgery and should be discussed during your consultation with Dr. Karamanoukian.
Areolar Size: The areola is the pigmented pink or brown area surrounding the nipple. The size of the areola can vary from person to person and from breast to breast. Areolar hypertrophy, or large areolas can cause significant embarrassment if they are completely asymmetric or disproportionate with the overall breast size. Dr. Karamanoukian performs areola reduction in an outpatient surgical center and can perform some corrections under local anesthesia.
Tubular Breast Deformity: The tubular breast deformity occurs when there is a disproportionately wide areola in the presence of a narrow tubular type breast. The inframammary crease is tight and constricted and does not allow the breast to assume a normal contour. Dr. Karamanoukian performs surgery to correct this condition in an outpatient surgical center. Tubular breast surgery often involves the placement of a breast implant and reduction of the areola.
Implant Droopiness - Low lying Breast Implants: Implants that are placed submuscularly or in a dual plane may be exposed to premature inferior displacement. In this situation, the implant may have no underlying support and may begin to descend below the level of the inframammary crease. In these situations, the breast and nipple seem to be disassociated from the implant itself. Surgery involves the placement of underlying core sutures in the breast crease in order to retain strength along the lower portion of the breast and secure the breast implant into the right location. This may be done on one side or bilaterally.
Breast Implant Removal
Breast implants can dramatically improve the volume and shape of the breasts. However, in some cases breast implants may be related to pain, discomfort, recurrent scarring, unwanted attention, capsular contracture, implant rupture, or other complications. Breast implant removal is an option for those women who feel that they no longer want or need breast implants. Whether you have saline or silicone breast implants, breast implant removal may be the option for you.
FAQ: Can a ruptured breast implant be removed?
A breast implant rupture is one of the most common reasons for removal and replacement of a breast implant. Not all ruptured breast implants are clinically evident on examination. You may not know that you have a ruptured implant unless there is a physical change in your breast shape. A small subset of patients may have a 'hidden rupture' in which there are no physical signs of rupture seen in your breasts. A mammogram or ultrasound can sometimes be used to identify your breast implant rupture.
FAQ: Do I need a mammogram before implant removal?
There are national guidelines for all women aged 30 and older for mammograms. Most women should undergo an interval mammogram regardless of breast implant removal options. If you suspect a rupture of your breast implant, then an examination and possibly a diagnostic study such as a mammogram or ultrasound may be indicated. Begin with an examination.