Failed Implant Breast Reconstruction: What Are Your Options
By: Dr. Minas Chrysopoulo and Courtney Floyd
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 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 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.
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.
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.
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.
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!