Are your Breast Implants Causing Recurrent Problems?
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.
Expertise in Breast Implant Revision Surgery in Los Angeles
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. 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.
Breast Implant Asymmetry and Displacement Correction
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. 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 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.
Breast Implant Capsulectomy in Beverly Hills, Los Angeles
Breast implant capsular contracture is one of the most studied and discussed complications in aesthetic and reconstructive breast surgery. Although modern breast implants are designed with advanced materials and improved surface technology, capsular contracture can still occur in a small percentage of patients. An evidence-driven, proactive approach to diagnosis and management is essential to restoring comfort, appearance, and long-term breast health.
Capsular contracture develops when the normal scar tissue capsule that forms around every breast implant becomes excessively thickened, tight, or distorted. The human body naturally creates a fibrous capsule around any implanted device as part of a normal healing response. In most cases, this capsule remains soft and flexible, allowing the implant to move naturally within the breast pocket. However, in capsular contracture, the capsule tightens and compresses the implant. This can lead to firmness, breast distortion, elevated implant position, asymmetry, discomfort, and in more advanced cases, pain.
Clinically, capsular contracture is often classified using the Baker grading system. Early stages may present with mild firmness but no visible distortion, while more advanced stages involve obvious shape changes and discomfort. Prompt recognition of progressive firmness or asymmetry allows for earlier intervention, which may prevent worsening symptoms and more complex revision surgery.
Several theories attempt to explain the development of capsular contracture. One leading theory involves subclinical bacterial contamination and biofilm formation. Even in the absence of overt infection, low levels of bacteria may adhere to the implant surface, triggering chronic inflammation and excessive scar formation. Other proposed contributing factors include hematoma (bleeding around the implant), seroma (fluid accumulation), implant rupture, radiation exposure, and individual variations in immune response. Surgical technique and implant placement may also influence risk. Submuscular implant placement, meticulous sterile technique, and careful pocket irrigation are associated with lower rates of contracture in multiple studies.
When capsular contracture occurs, treatment typically involves surgical correction. The two primary operative strategies are capsulotomy and capsulectomy. The choice between these approaches depends on the severity of contracture, patient goals, implant condition, and whether the patient desires implant removal or replacement.
Capsulotomy involves surgically releasing or scoring the tight capsule to relieve constriction. This can be performed as an open capsulotomy during revision surgery, allowing the surgeon to directly visualize and carefully incise the capsule to expand the implant pocket. By releasing tension, the implant can return to a more natural shape and position. Capsulotomy may be appropriate in selected cases of moderate contracture where the capsule is not excessively thick or calcified. It can be combined with implant replacement to refresh the implant device and optimize the pocket environment.
Capsulectomy, by contrast, involves partial or complete removal of the scar capsule surrounding the implant. In a total capsulectomy, the entire capsule is excised. In certain cases, an en bloc capsulectomy may be performed, in which the implant and capsule are removed together as one unit. Capsulectomy is often recommended in more advanced contracture, recurrent cases, or when there is implant rupture, calcification, or significant capsule thickening. By removing the fibrotic tissue entirely, capsulectomy addresses the pathologic scar response more definitively.
Breast Implant Removal vs. Replacement During Capsulectomy
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.
Both capsulotomy and capsulectomy can be performed in the context of breast implant removal or implant replacement. For patients who no longer desire implants, removal combined with capsulectomy can relieve tightness and discomfort while restoring a softer chest contour. In some cases, additional procedures such as a breast lift may be recommended to reshape the breast after implant removal.
For patients who wish to maintain or improve breast volume, implant replacement can be performed at the same time as capsule treatment. During revision surgery, the implant pocket may be modified, reinforced, or converted from a subglandular to a submuscular plane to reduce recurrence risk. New-generation implants with advanced cohesive gel technology may be selected to enhance long-term outcomes. Careful pocket preparation, antibiotic irrigation, and refined surgical technique are critical components of reducing recurrent contracture.
Early management of capsular contracture is important. When firmness and distortion are addressed promptly, surgical correction is often more straightforward. Delayed treatment can lead to further tightening, implant malposition, and secondary tissue thinning. Patients who notice increasing firmness, shape changes, or discomfort should seek evaluation from a qualified plastic surgeon experienced in breast implant revision.
Raffy Karamanoukian is a highly experienced plastic surgeon specializing in breast implant revision surgery in Santa Monica and Beverly Hills. With extensive expertise in both cosmetic and complex revision cases, Dr. Karamanoukian takes an evidence-based approach to diagnosing and treating capsular contracture. He carefully evaluates implant history, surgical technique, imaging findings when necessary, and patient goals before recommending either capsulotomy or capsulectomy.
Dr. Karamanoukian’s experience allows him to tailor surgical plans to each patient’s unique anatomy and concerns. Whether performing implant removal with capsulectomy for patients seeking a natural look, or executing detailed pocket revision and implant exchange to restore symmetry and softness, he emphasizes meticulous technique and long-term stability. His comprehensive understanding of scar biology, implant technology, and aesthetic balance supports consistently refined outcomes. Breast implant capsular contracture can be physically and emotionally distressing, but it is treatable with appropriate surgical management. Through timely evaluation and expert revision techniques, patients can regain comfort, confidence, and natural breast contour. In Santa Monica and Beverly Hills, Dr. Raffy Karamanoukian provides advanced solutions grounded in surgical precision, scientific understanding, and individualized care.
Correction of Breast Implant Rippling in Santa Monica, Beverly Hills
Breast implant rippling is a condition in which visible or palpable folds develop along the surface of a breast implant, creating an uneven texture or wrinkled appearance of the breast. Rippling may occur for several reasons, including implant deflation, displacement of the implant within the breast pocket, or insufficient breast tissue and fat covering the implant. Patients with thin breast tissue or implants placed close to the skin may be more likely to notice rippling along the sides or lower portion of the breast. In some cases the rippling may only be felt when touching the breast, while in other cases it may be visible through the skin.
Correction of breast implant rippling typically involves breast implant revision surgery designed to restore smooth contours and natural breast shape. Surgical treatment may include replacement of the existing implants with a different type or size of implant that provides improved structure and support. Fat transfer to the breast can also be performed to add a layer of natural tissue over the implant, helping to camouflage visible folds. In other cases, breast implant pocket surgery may be recommended to reposition the implant into a more favorable location, such as beneath the chest muscle, to provide additional tissue coverage and reduce the appearance of rippling.
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.
Saline Breast Implant Rupture and Replacement
Saline breast implant rupture is a known but manageable complication that can occur years after augmentation. Unlike silicone gel implants, saline implants are filled with sterile saltwater enclosed within a silicone shell. When rupture occurs, it is typically due to disruption or weakening of the outer silicone shell from natural wear, implant aging, trauma, or capsular contracture. Once the shell is compromised, the saline solution safely absorbs into the body, leading to a noticeable and often rapid deflation of the breast.
In Santa Monica and Beverly Hills, board-certified plastic surgeon Dr. Raffy Karamanoukian brings extensive experience in the diagnosis and management of saline implant rupture. Clinical examination often reveals visible volume loss and asymmetry, and ultrasound imaging can be used to confirm shell collapse and evaluate the surrounding capsule. Dr. Karamanoukian carefully assesses implant integrity, pocket condition, and patient goals before recommending treatment.
Surgical management involves removal of the deflated implant through the existing incision whenever possible. The implant pocket is inspected, and if necessary, the capsule is adjusted or treated. A new implant can then be placed during the same procedure, restoring symmetry and contour. With meticulous surgical technique and personalized planning, Dr. Karamanoukian ensures safe removal and seamless replacement, helping patients regain confidence with natural-looking results.
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.
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?
A: 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.