The Procedure

Implant Replacement

Replacement of breast implants after leakage of either saline or silicone gel devices is a fairly common procedure that we perform at Raleigh Plastic Surgery Center.  Many of these patients had silicone gel breast implants placed in the 1970’s and 1980’s when they were known to have a very high leakage rate.  Often, the patients desire for either larger or smaller implants, or perhaps a change from saline to silicone gel is the reason for exchange.  From 1992 to 2006, only saline implants could be used for primary breast augmentation in the US.  Now that silicone gel implants are widely available, many women have chosen to exchange their saline implants to silicone gel to achieve a more natural feeling breast.  Silicone gel implants tend not to have as much rippling and palpability as a saline device.  Replacement frequently involves the removal of the scarred capsule that forms around an implant-a procedure called a capsuletomy.  Replacement of the implant in this situation is not straightforward and many times requires the placement of the new implant in a new location under the muscle or on top of the muscle or in a new pocket.  Frequently other materials are required to reinforce the implant position such as allograft acellular dermal matrix, also known as, AlloDerm, Flex HD, or Strattice.

Capsular Contracture

Capsular contracture is the pathological response to an implant that occurs when your body forms excess scar tissue around it causing it to be more palpable, distorted in appearance, painful, or a combination of these three problems.  Capsular problems may involve total removal or partial removal of the offending capsule and replacement of the implant to a new position.  Frequently, additional reconstructive materials such as allograft, acellular dermal matric, or other dermal matrices are necessary to achieve an optimal result.

Implant Malposition

Implant malposition occurs when implants fall outside of the normal pocket and lead to an unattractive appearance, often causing discomfort.  The position of the implant may be too low, too far lateral, too medial, and could also be high riding.  All of these malpositions usually require some degree of advanced re-positioning and support of tissue, particularly in a very thin patient.  These are difficult cases and many times involve patients who have had multiple attempts at correction. Recently, a new surgical mesh called Seri has been found to be beneficial.  It is made of silk which is a natural material and has the ability to be resorbed.  Your own tissues will grow into it and replace it with improved strength and ability to maintain the position of the implant.

Dr. High and Dr. Purzyski are experienced board certified plastic surgeons with over 20 years of experience each.  They not only perform a great deal of cosmetic surgery of the breast but breast reconstruction for women suffering from cancer as well.  This additional experience is valuable in allowing them to be experts in the field of Breast Implant Revision surgery.  Recently, a new surgical mesh called Seri has been found to be beneficial.  It is made of silk which is a natural material and has the ability to be resorbed.  Your own tissues will grow into it and replace it with improved strength and ability to maintain the position of the implant.

Rippling or palpable implants

Breast implants that are easily visible through the skin or very unnatural to the touch can result from the use of saline implants with inadequate coverage (such as muscle coverage), in very thin patients, or in patients who have had multiple surgeries.  Correction of this problem can be relatively simple or very complex.  Change from a saline device to a silicone gel device may significantly improve the appearance and palpation of the implant, however this alone is not always effective.  The use of reconstructive materials such as allograft, or surgical meshes, may be necessary to reinforce the breast tissue to allow for a less noticeable implant which is more natural in appearance.