Already have breast implants?
General overview
The vast majority of women have successful breast augmentation surgery and are pleased with their results for decades. An important goal is to have as few surgeries over a lifetime as possible. Below are scenarios that may or may not be valid reasons for considering more surgery.
Do you really have to change your breast implants every 10 years?
As a general rule of thumb: if the breasts look good and both are soft there is no need to change them.
Saline implants (rarely used in Lebanon) usually show flagrant asymmetry if they deflate, in that case, implant exchange is warranted. If somehow they do not deflate for ten years, they will probably last another ten years, or even more. Even if minimal rippling is present but the overall result is excellent a change is not recommended. It is better to wait until one finally deflates, if it ever does.
Silicon implants are filled with a new generation ultra-cohesive gel, therefore, even if the outer shell layer breaks, the implant gel will keep its form and not leak around. It is very hard, practically impossible, to diagnose implant rupture by clinical exam alone.
The FDA recommends screening your breast implants starting five years after your breast augmentation by ultrasound or MRI and every 3 years thereafter. Although implant rupture can cause various symptoms, some women with ruptured implants experience no symptoms, which is why routine screenings are critical.
If you have unaesthetic breast implant-related side effect such as rippling?
Women who are very thin or had large implants placed may exhibit significant rippling on the side of the breasts with easily felt implants on the bottom of the breasts. If the breasts have remained soft and there is no intention to make them even larger then changing to silicone implants is a low risk option to eliminate rippling and easily palpable implants. Sometimes fat grafting may be warranted to camouflage implant edges.
If you want a bigger size?
Breast dimensions usually accommodate a certain limit in implants’ size. It is not recommended to go over that limit as this causes rippling, tissue atrophy (thinning and loss of volume), skin stretch marks, and bottoming out (the breast implant will descend on the thoracic wall). In other words, to exceed these limits may improve the effect in clothes but often at the cost of harmonious aesthetics when undressed.
If a size increase is needed, many women need to go a 100 cc (about a half cup size) over the last implant volume to make it worth it. If you already have a large implant (beginning with “4” or “5”), then adding a 100 cc generally causes more problems over time and this may not be a good idea.
Most importantly, if you have had a successful breast augmentation procedure, undergoing more surgery just for a size increase flirts with developing a problem that you do not have presently, and one that could lead to needing yet another procedure for correction. If you are mostly happy with what you have it is better not to go larger.
If you want to go smaller?
Usually downsizing is better and easier than upsizing. Less adjustments need to be done internally, the soft tissue stress and long-term problems are reduced. You may need a breast lift if a noticeable drop in your nipple position has occurred
If you had two or three pregnancies, had a great result but now it’s gone?
Pregnancies and breastfeeding may take its toll on breast tissues after breast augmentation. In fact, breast atrophy and a deflated appearance is the rule, not the exception. Coupled with a large volume implant, these problems become more common.
If the implants have remained soft it is not complicated to place larger ones to fill out the skin and restore shape and tone. However, if the breasts have fallen more significantly, or the nipple position went downwards, a lift with inevitable scars (that heal well) may also be required to improve appearance.
If your breasts are firm and look bad?
Capsular contracture refers to abnormal thickening of the capsule layer that naturally forms around the implants inside the body. This makes the breasts feel hard, painful and may distort their appearance.
This is a known 5% of capsular contracture in one or both breasts when having breast implants.
Since the unaffected side has shown normal healing capabilities, this problem is more advantageous when only one side is affected. In these situations, surgical treatment is typically successful. A higher biologic response to the implants is seen when this process happens on both sides. In this case, surgical repair is less predictable and contracture frequently returns. It is generally preferable to leave the implants alone if the appearance is satisfactory despite the firmness of both breasts. Unless the problem is connected with chronic pain, it is rarely a good idea to remove them completely.
If your implants don’t seem to be in the right place?
Occasionally, one implant may appear to be too far out to the sides when lying down, or both may have stretched the skin and sit too low. Sometimes, one implant may be higher or lower than the other. With the exception of situations where both breasts sit too medially toward the midline, implant malposition can be treated with an extra surgery and have a good success rate. This is especially true if there are no other co-existing issues, like capsular contracture.
To sum it all up?
Correction of capsular contracture, repositioning one or both implants, and changing implant size all at once, for example, makes the procedure longer, more complex, and with a higher chance of either developing a complication or inadvertently causing a new problem.
