Change of Implants

The old implant is removed through the existing scar in the crease under the breast. Either a capsulectomy or capsulotomy is performed, when the old breast implant is removed and exchanged for a new one. The implant is placed in the same pocket created by the previous breast augmentation, either in front or behind the muscle, or a combination of the two (dual plane). Occasionally the pocket can be changed to correct specific problems.

The replacement implant can be the same size, slightly larger or smaller depending on your preference. This can be an opportunity to correct any asymmetry present after the previous augmentation.

If you have increased laxity of the breast, you may wish to consider an increase in the size of the implant. This will fill out lax breast tissue and can lift the nipple by approximately 2 cm. However, if the breast tissue needs further tightening, then a mastopexy procedure may be required in addition to the augmentation.

The procedure takes approximately 45 minutes to perform under a general anaesthetic (you will be fully unconscious during the procedure). Providing there are no complications, you can expect to go home on the day of surgery.

Breast implants are available in a variety of types, with different shapes and sizes. Some are round and some are teardrop shape (anatomical). Implants are made of an outer casing of silicone or polyurethane and filled with a silicone gel. For more information, please see my guide on implant selection.

Selection of the correct size and shape of implant will be done with you at your first appointment.

Using simulation software, we can create a 3D image of your chest and you can see yourself to compare simulations of what you may look like after surgery. This allows you to compare how the different implant sizes and shapes of implants will look on you. You can also use the sizing kit to confirm this.

It is important that you take your time in deciding what shape and size of implant you would like. I will help guide you with this decision, but ultimately the final choice is very personal.

Breast implants are not lifetime devices. As per FDA guidance, the older the implants are, the more likely they need replacing.

Fortunately, the risk for implant rupture is now as low as 1-2% per year, given the advances in silicone implant technology over the last decade. Thanks to their improved cohesiveness, in the event of a rupture, a silicone implant´s filling material may bulge out of its shell but it will remain contained within the breast capsule.

I only use implants that carry a guarantee from the manufacturer. However, should the implants require replacement in the future, this guarantee only covers the cost of the replacement implants but not the cost of surgery.

Having cosmetic surgery should be a very positive experience and decisions about surgery should never be rushed.

Complications are infrequent and usually minor. However, all surgery has risk and it is important that you are aware of the possible complications. All the risks will be discussed in detail with you at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me.

These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

• Unintended intraoperative awareness, which is very rare.
• Dizziness and nausea.
• Sore throat.
• Damage to teeth or mouth.
• Nerve injury due to body positioning.
• Allergic reaction or anaphylaxis.
• Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: These are hidden in the crease under the breast and normally settle remarkably well, so that the scars are barely perceptible. However, some patients heal with thick, thin or stretched scars which, can be noticeable.

Bruising and swelling: A degree of swelling and bruising is normal, and this may take approximately 3 weeks to settle.

Haematoma: This is a collection of blood in the pocket created by the implant. It occurs in between 1% to 4% of women who undergo a breast augmentation procedure. It tends to occur within 1 to 3 days post-surgery.

Any increase in swelling or pain should be reported immediately for assessment. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.

Infection: The risk of infection is inherent with any surgical procedure; this can be either:

• Superficial (does not involve the implant) and should respond to oral antibiotics.
• Deep (involves the implant) and requires temporary removal of the implant.

The deep infection risk is less than 1% but on the rare occasion, when infection occurs, the breast implant may have to be removed to allow the antibiotics to work effectively for the infection to settle. The implant will be replaced once the infection has resolved.

I use a no touch technique during surgery with Keller funnels to introduce the implant and minimise any possible infection risk.

You will also be given antibiotics when you are put to sleep and post-operatively to reduce the risk of infection.

Numbness, reduced sensation or oversensitivity:  A reduction in nipple sensation may occur, which may improve to some degree with time. However, in up to 15% of patients, this may be permanent.

Wound healing problems: Wound healing problems are very uncommon with implant exchange, but it is possible to have areas within a scar that take longer to heal, and this could risk exposure of the implant.

Asymmetry: Each breast is slightly different and will continue to be following surgery; remember, “they are sisters and not twins”. However, if you have noticeable asymmetry before your surgery then this will be corrected as part of the surgery and will be discussed with you.

Stretching of your breast tissue:  The larger the implant you choose, the more likely it is that your skin will stretch with time, and you may require an uplift at a later stage. Occasionally breast augmentation is associated with stretch marks, which are permanent but fade with time.

Rotation/displacement: Occasionally implants can sit in the wrong position or may move in the post-operative period. A further procedure may be required to correct this.

Implant rippling or wrinkling:  This can be more prevalent in very slim patients or those with very little breast tissue. This is reduced if the implant is placed behind the chest muscles, or a fat graft is performed to increase the soft tissue cover.

Rupture: The implants I use are all guaranteed. However, as a medical product, they can still fail. If an implant is known to have ruptured, then it should be removed. The ruptured implant is contained within the capsule of scar tissue so it will not ‘spill out’ into your breast tissue.

Sebbin Implants have a rupture rate of 0% at 5 years and the risk of rupture of is 1.7% after 5 years.
Motiva have similarly low rates for implant-related complications with a rupture rate of less than 1% after 5 years.

Capsular contracture: Following breast augmentation, the body makes a capsule of scar tissue around the implant. Sometimes this tissue can shrink and contract (capsular contracture). If this happens, it can make the breasts feel abnormally hard and may require further surgery to remove the capsule.

Many studies show that the risk of this is approximately 20% after 10 years with silicone implants.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

Anaplastic Large Cell Lymphoma (ALCL):  In January 2016, the United States FDA announced a possible association between breast implants and the development of ALCL, a rare type of non-Hodgkin’s lymphoma.

According to the World Health Organization, BI-ALCL (or ALCL) is not a breast cancer or cancer of the breast tissue; it is a lymphoma, which is a cancer of immune cells. Women with breast implants have a very low, but increased risk of developing ALCL. In women with breast implants, ALCL is generally found next to the implant itself and is usually contained within the fibrous capsule that the body forms around the implant.   The exact risk of ALCL is unknown and health organisations from around the world are pooling data to try and establish this risk.

An observation of reported cases indicates a predominance of textured device involvement. The association with breast implants is likely multifactorial and is currently being extensively studied. There are only 2 cases reported with the Sebbin microtextured implants and they were both in patients who had previously had Allergan textured implants, and they are likely to have been caused by the Allergan implants.

Most of the breast implant patients found to have ALCL were diagnosed after they sought medical treatment for implant-related symptoms such as pain, lumps, swelling, or asymmetry that developed after their initial surgical sites had fully healed. In most cases, the ALCL was treated with surgery to remove the implant and surrounding scar tissue. Some patients also received radiation therapy, chemotherapy or both and 36 patients worldwide have died of the condition The condition has a very good prognosis and a high probability of cure if it is treated appropriately.

I recommend that you seek medical help if you notice swelling, fluid collection or sudden and unexpected changes in breast shape either from myself or another suitably qualified healthcare professional. If you require more information, then please feel free to contact me at any stage.

For more information on what is known about BI-ALCL please visit these useful links from the American Society of Plastic Surgeons or the FDA website.

FDA Patient Information - Breast Implant Complications

Joint ASPS ASAPS Statement On Breast Implant Associated ALCL

Breast Cancer: There is no evidence linking silicone or saline filled implants to breast cancer. You will still be able to examine your breasts, with the implants in place and have a mammogram/ultrasound as normal. Breastfeeding is still possible with implants, as the implant sits behind the breast tissue, leaving all the milk ducts untouched.

All the risks will be discussed with you in detail at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss these with me. Decisions about cosmetic surgery must never be rushed and requires personal research.

Your incisions will be closed with dissolvable sutures, which do not require removal.

I use a waterproof dressing which will be removed after 1 to 2 weeks following surgery. You can shower as soon as you like after surgery, and you will be given spare dressings in case they become wet and need changing.

I will prescribe you 7 days of antibiotics to be taken after surgery to reduce any risks of infection as the incision heals.

I recommend that you wear a support bra for 6 weeks and that you purchase 2 bras, so you have one to wear and one in the wash. These are worn day and night for approximately 6 weeks post-surgery, before returning to any bra of your choice. You will need to purchase these prior to your surgery, and I will provide the relevant details in clinic. Details can also be found in the compression garment guide below.

Initially, your breasts may seem larger than you expected. This is normal and it is partly due to swelling and it takes time for you to get used to your new appearance.

Before you leave the hospital, you will be given a follow up appointment to see the nurses at one week to check your incisions and an appointment to see me in 2 weeks. You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you. If you have any concerns during this period, do contact the clinic for advice.

Scar advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from Silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.
The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

When you return home, you should take it easy for the first 2 weeks or so. Most people take approximately 1 to 2 weeks off from work. You should be able to start driving after 2 weeks, return to the gym for lower body exercises at 4 weeks, and begin upper body workouts at 6 weeks.

To help shape and support your breasts as they settle, you will need to wear your support bra day and night for 6 weeks.

Surgical fees are a combination of the hospital costs, the surgeon and anaesthetic fees and any consumables, such as implants. In non-cosmetic breast surgery, the fees are normally cover by your health insurance, however most patients have a co-pay of 20% and certain policies only cover one breast and half of the other breast. This means you are likely to have to pay towards the cost of your surgery. Any fees will be calculated, and you will be informed of the potential fees at your consultation.

Capsulectomy - Nicotine and Surgery

Capsulectomy - Post-Op Bras

Capsulectomy - Pre-Op Instructions

Capsulectomy - Post-Op Instructions