Failed Implant Breast Reconstruction: What Are Your Options

By: Dr. Minas Chrysopoulo and Courtney Floyd

Blogs
June 09, 2016

The most commonly performed method of breast reconstruction today uses tissue expanders and breast implants. This can be a great option for many women, but not all women are completely happy with their results, or worse yet, the reconstruction doesn’t work out because of ongoing implant-related problems. For these reasons, PRMA Plastic Surgery provides options to help restore natural breast appearance after failed implant reconstruction.

What are the most common problems women can have after breast reconstruction with implants?

Infection

Infection after an implant reconstruction can happen at any time, but is most common within the first 3 weeks after surgery. Signs of infection include redness of the skin and breast swelling. Antibiotics are used to treat the infection initially, but unfortunately this is not always successful. If antibiotics don’t cure the infection, the implant should be removed.

Visible implant rippling and “breast animation”

The remaining breast skin envelope after a mastectomy can be quite thin and lead to visible implant “ripples” when there isn’t enough tissue covering the implant. This can be particularly bothersome in the cleavage area. To decrease the amount of rippling, most plastic surgeons prefer to place implants under the chest (“pec”) muscle to maximize the amount of tissue over the implant. Unfortunately, this often creates a very unnatural breast movement when patients use their chest muscle – as the muscle contracts, it squeezes down on the implant and temporarily deforms the breast. This doesn’t cause any harm and the breast returns to normal when the muscle relaxes, but patients quickly learn which movements to avoid in public.

Capsular contracture

Capsular contracture is caused by tightening of the breast tissue and scar capsule around the implant. When this occurs, the breast becomes firm and hard. This can be very painful and can cause significant breast asymmetry.

Implant displacement or asymmetry

No two breasts are alike, so slight differences will always be apparent, but sometimes breast implants can shift or become displaced causing dramatic asymmetry, even in the absence of capsular contracture.

Feeling cold

The goal of a mastectomy is to remove as close to 100% of the breast tissue as possible. As already mentioned, the remaining breast skin envelope after a mastectomy can be quite thin. This means that in many cases there isn’t a great deal of tissue covering the implant. For this reason, coupled with the fact that the implants themselves don’t have a blood supply, many women complain of their reconstructed breast(s) feeling cold.

Chronic pain

Causes of chronic pain after implant placement can be caused by numerous factors but the most common cause is capsular contracture. Living with chronic pain can dramatically reduce quality of life.

Implant rupture

A rupture occurs when there is a tear in the breast implant causing the saline or silicone to disperse. Ruptured implants need to be replaced.

Implant exposure

Wound healing problems can occasionally happen after a mastectomy that can lead to breakdown of the incision site, or even a new wound. This can lead to exposure of the tissue expander or implant. Some women can also experience skin thinning over time, especially if they have had previous radiation, which can lead to implant exposure some time after completion of the reconstruction.

Problems because of radiation therapy

Radiation therapy and implants do not mix well. Radiation either before or after implant reconstruction significantly increases the risk of infection, wound healing problems, capsular contracture, breast tightness, chronic pain, implant exposure, need for implant removal and reconstructive failure.

What can be done?

After a failed implant reconstruction, we typically recommend removal of the implant and surrounding scar tissue, and further reconstruction using the patient’s own tissue (an autologous “flap”). There is no better substitute than new, healthy tissue to recreate a “natural”, soft, warm breast. Our preferred flap technique, and gold standard in Breast reconstruction in general, is the DIEP flap procedure. The DIEP, which is the most advanced form of breast reconstruction available today, uses the patient’s abdominal skin and fat to reconstruct a natural, warm, soft breast while completely preserving the underlying abdominal muscles. Saving the abdominal muscles means patients experience less pain, enjoy a faster recovery, maintain their core strength long-term, and have a lower risk of complications.

The surgeons of PRMA specialize in correcting failed implant reconstruction. If you are unhappy with your implant reconstruction, or have had ongoing problems with your implants and would like to learn more about your options, please fill out our free virtual consultation form today!

Learn More About DIEP Flap Breast Reconstruction

4 Comments

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  • Vianeyblance

    Hello the reason I’m writing is because I want to remove my silicon breast implants. I have always had trouble with them and I am looking for the most experienced surgeon to reconstruct my breast and make them look natural and with not so much scaring. If you can help me I will be waiting for your response. Thank you

    Reply
  • PRMA Plastic Surgery

    I am so sorry to hear you are experiencing pain with your implant and can understand why you would want them removed. You have come to the right place. The surgeons of PRMA Plastic Surgery specialize in failed implant reconstruction. Please give us a call at 800.692.5565 and we will gladly set you up with a consultation! Have a wonderful day!

    Reply
  • E Conyngham

    Hello. I had a terrible “reaction” of some sort ot my expanders which filled with 300ml of fluid. The resulting pocket ws way to big for the 270cc implants inthe exchange. The implants are now sliding down my ribs and under my arms. I want them out with a GAP flap reconstruction. I don’t have enough tummy fat to do a DIEP. Is this possible?

    Reply
  • PRMA Plastic Surgery

    It is hard to say specifically what our surgeons would recommend for you without a consultation to review your needs in more detail. GAP or TUG flap reconstruction are usually good options for women who do not have enough tummy tissue for their desired breast size. If you are interested, you can fill out our free virtual consultation form at http://prma-enhance.com/patient-forms/virtual-consultation and one of our board-certified plastic surgeons will review your case and provide you with their surgical recommendations.

    Reply
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