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Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery |
Body Contouring |
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| Breast Augmentation Revision Surgery | |
| Saline Breast Implant Failure with Deflation |
Saline Breast Implant Deflation:
| Though saline breast implants are carefully pre-inspected, and made of strong and durable silicone polymers, they cannot last indefinitely. To the benefit of the breast implant recipient, all breast implants currently available in the US are backed by a lifetime manufacturers' replacement warranty, and in the first 5 years after placement, Mentor implants provide for a $1200 reimbursement toward the OR and anesthesia costs of implant replacement. Failure causes are numerous, but certain general facts are known. Thinner walled implants seem to be more long-lasting than thicker | walled implants. Smooth breast implants tend to last longer than any textured wall implants (they are also thick-walled). Situations where there is excessive implant folding or wrinkling, as in placement in a constricted (too-small) pocket, lead to failure by causing stress fracturing of the silicone polymer shell at the fold points, and thus the potential benefit of vertically oversized pocket development and massage pocket maintenance. Implants which are filled below the least nominal volume for which they are rated tend to wrinkle and fail prematurely, as well. | |
| Case 1: A 32 year old Asian woman who underwent breast augmentation 2 years earlier with round textured Mentor saline implants was to be seen for correction of too-high placement of implants. She had a spontaneous implant deflation about 4 weeks prior to the proposed revision, and photos reveal the result of the deflation, now revealing the original breast shape, prior to the first breast augmentation procedure. |  |
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Photos show the three day post-op appearance of the breasts after pocket revision and replacement with smooth saline implants of a larger volume, and correction of the high fold levels, by internal lowering of the native folds to provide the proper breast proportion with centering of the implant mounds behind the nipple-areola complexes. These early post-op photos show upper pole fullness which persisted for several more weeks after the revision surgery. Later post-operative photos are currently pending. |
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Note the abnormal fullness of the upper breast pole on the left, associated with failure to properly lower the native fold of the breast at the time of breast implant placement, and and the corrected breast proportion after lowering the folds at the time of revision, despite the use of larger smooth saline implants. | |
| Photos at right show the extent of the new pockets, and the early ability of this patient to fully displace the implants into the upper poles of the implant pockets to maintain pocket volume at 3 days. Minimal skin bruising is seen despite complete implant capsule removal at the time of the implant exchange. |  |
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White
skin tapes cover the access incisions which were made
through the original breast crease incisions.
See: Implant Massage
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| Case 1 Problems | Analysis of Cause | Correction |
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Saline Implant deflation |
Though no breast implants will last forever, the placement of implants in adequately oversized pockets will help to relieve internal fold stresses on the implants, and probably prolong implant shell integrity. I do not advocate use of thick-wall textured implants, as they are inherently more prone to earlier failure in my experience, and they also promote formation of a constricting adherent peri-implant capsule, not only leading to an unnatural firmness, but also leading to potential earlier failure of the implants if the resultant constricted pockets cause internal folding of the implants in a too-small space. I do not see any compelling evidence of textured saline implants having a significant effect on reducing incidence of capsule contracture occurrence, though that benefit may be seen with the use of textured silicone gel implants in certain circumstances. | Exchange the deflated implant under the benefit of the lifetime implant replacement warranty offered by the manufacturer, and remove, or release, constricting scar around the implant which may have led to premature failure by promoting internal folding of the implant in the too-tight space. |
| Prevention: | ||
| Avoid use of textured saline implants and placement of implants in too-small pockets which may lead to premature implant failure because of internal implant folding in the adherent constricted pockets that are often seen around implants. Utilize the over-sized vertical pocket concept to maintain implant softness, and avoid internal implant folding. |
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| 3974 Springfield Road | ||
| Glen Allen (Richmond), VA 23060 | ||
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| ©Copyright 1997-2007 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr., MD., FACS Revised: October 29, 2007 04:06:09 PM |