Failed Implant Breast Reconstruction: What Are Your Options

By: Dr. Minas Chrysopoulo and Courtney Floyd

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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 (or “animation”) 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. 

Breast animation is a difficult problem to treat. Several surgical techniques can be used, often in combination: fat grafting to increase the soft tissue padding over the muscle and implant (also the primary method used to camouflage implant rippling); weakening some of the pectoral muscle attachments so contractions aren’t as powerful; and changing the location of the implant from below the muscle to on top of the muscle (pre-pectoral). 

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. Surgical treatment involves extensive release (“capsulotomy”) or complete removal (“capsulectomy”) of the scar capsule, usually in conjunction with implant replacement.

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. Revision surgery can reposition the implant and reinforce the pocket supporting it to decrease the risk of further displacement. 

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. Fat grafting can help by increasing the amount of soft tissue “padding” over the implant(s). More than one session of fat grafting is often required for noticeable improvement. 

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. Revision surgery can help but in our experience, implant removal and complete capsulectomy are often required for complete relief especially following radiation. 

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?

Some implant complications can be adequately addressed with revision surgery. However, multiple attempts at salvaging a problematic implant reconstruction are often only met with further failure, especially after radiation.

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

14 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
  • Tammy

    Doubke mastectomy done in 2008. Due to ibs and family hx of breast cancer.  Thighs tug reconstruction done 2009. Now gave 3 epidermal cysts. What are ny options now?  Breasts have shrunk and no longer same size. Biopsies of larger if the 3 cycsts. Showing dx. Implants option?  Please help. Thank you.

    Reply
    • PRMA

      Hey Tammy!  It is difficult to give personalized recommendations without evaluating your needs in person or via our free virtual consultation (found at https://prma-enhance.com/schedule-a-consultation/)

      Adding implants may be an option as well as fat grafting to help add volume. 

      Please feel free to give us a call at 800-692-5565 or you can fill out the above mentioned virtual consultation form and we will gladly be in touch to discuss your options

      Reply
  • Julia hilton

    I explanted last July. Looking at options.

    Reply
    • PRMA

      So sorry to hear you are having to go through this Julia!  If you are interested, you are welcome to fill out our free virtual consultation form at https://prma-enhance.com/schedule-a-consultation/.  Once received, one of our surgeons can review your needs and provide you with their surgical recommendations.

      Reply
  • Linda

    I had a left skin and nipple sparing mastectomy September 2017. My expander became infected and was removed less than 2 weeks after insertion. I just finished 6 rounds of chemo for IDC, there is a 1 mm microsopic cancer on my chest wall. Surgeon wants to go in and get a clean margin along with plastic surgeon attempting another expander under the muscle with Lattismus dorsi flap. My questions are should I even attempt another expander? I think it would be better for surgeon to attempt clean margins before reconstruction, if they are not clear radiation will be given to only that area marked with clips. I had breast cancer 20 years ago so full dose radiation is contraindicated. Thank you in advance for your advise.

    My tumor was 1.8 cm, er +, pr + Her -. No lymph nodes were taken as so many removed 20years ago, MRI WAS CLEAAN EXCEP FOR TUMOR.

    Reply
    • PRMA

      We are so sorry to hear you are going through all of this Linda! The best thing for you to do in this situation is what you and your doctor feel is best for you.  Have you brought up these concerns with your surgeon yet?  If not, we highly advise you to do so!  There is no deadline for breast reconstruction, so there is no need to feel rushed or pressured into it.  If radiation is in your future, we do not recommend implant reconstruction.  We also typically delay reconstruction until about six weeks after radiation treatments are completed.  Sadly, radiation and breast reconstruction with implants do not mix well.  Likewise, undergoing radiation after a LAT flap could permanently damage the tissue resulting in further surgery later down the road.  For patients needing radiation therapy, we strongly recommend tissue flap reconstruction procedures (like the DIEP flap).  About 1 in every 3 implant reconstruction procedures fail following radiation.  DIEP flap reconstruction offers a safe, natural alternative to implants with an over 99% success rate in experienced hands. 

      We would be more than happy to review your needs in more detail to provide you with our surgical recommendations.  You are welcome to fill out our FREE virtual consultation form at https://prma-enhance.com/schedule-a-consultation/.

      Reply
  • Sandra Glover

    I have been through a failed implant surgery. That has left me both emotionally and physically scarred. I have applied for the TV show Botched. I just hope and pray I can find someone that can make me feel whole again. When I look at my chest I feel disappointed. It would be a true blessing if you can help. Thank you in advance for your time.

    Reply
    • PRMA

      We hate to hear you are going through all this Sandra! We would be more than happy to evaluate your needs and provide you with our recommendations!  You are welcome to fill out our FREE virtual consultation form at https://prma-enhance.com/schedule-a-consultation/

      Reply
  • Marian Roell

    I gained 50 lbs in 3 years and recently lost the 50 in about 4 months.  I have saline implants done in the early 80’s.  Never had a problem till now.  My left breast implant is still in place under the muscle.  Unfortunately, my actual breast hangs down below it, looking deformed.  My right breast has ruptured and is leaking into my chest area.  It’s painful and is noticeable when I lie down.  I’m looking at my options.

    Reply
    • PRMA

      So sorry to hear you are going through this Marian! Please know we would be more than happy to help in any way we can.  There are many options available to correct failed implant surgery.  You are welcome to fill out our free virtual consultation form at https://prma-enhance.com/schedule-a-consultation/

      Reply
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