The Question
Many people don’t realize this, but breast implants are generally not considered to be permanent. Depending upon the type, size, patient’s medical history and state of general health and activity, implants can generally be expected to last between 5-10 years. In extreme cases, such as the subject of this week’s Ask Dr. Pane segment, it is not unheard of for implants to last 20 years or more. However, another issue with leaving implants in place so long is, the body adapts to them. This is expected and desirable behavior…unless you want or need to replace them. Our viewer this week asks, “I want to have my 20-year-old breast implants replaced with new ones that go over the muscle. I want an augmented appearance and do a lot of weight training. Is this possible, and what should I expect?”
The Case
The viewer included pictures to review, as well as a schematic medical history. Working from this information, Dr. Pane formed his opinion of how best to proceed for this patient.
The Answer
In this particular case, the implants actually look surprisingly good for having been in place for 20 years and no obvious abnormalities or difficulties are apparent. However, because the patient is a bodybuilder, there are a lot of thick muscles and very thin overlying tissues. Because of this, the patient can expect many different opinions and suggestions on what to do, depending upon the relative skill and knowledge of the surgeon in question, so it will be particularly important for this patient to partner with a surgeon with a great deal of experience in breast implant revision.
In this case, because the implants were originally placed under the muscle and the patient is a bodybuilder, she is a lot more likely to get good results with another submuscular implant. This is largely because while the pocket in which the current implant is resting may need to be altered or enlarged, it is far easier to work with an existing pocket than to remove the implant, seal up the existing pocket and create a new one. It is not impossible by any means, but the extra effort is far less likely to garner a desirable result for the patient.
Dr. Pane says another potential complication is the thin tissue over the muscle. If the patient was having a first-time implant, placing the implant over the muscle would generally not be an issue. In this case, where the patient has already had submuscular implants placed and because of the decreased supramuscular tissue thickness, the implants would not feel as natural and may be more prone to problems if they were placed over the muscle.
However, Dr. Pane notes that there are options for offering a more augmented appearance to the patient’s bust line without placing the implant where it may be problematic. One option is to place a larger implant, adjusting the existing tissue pocket to fit. Another involves closing the incision laterally, which will augment the bust profile. In either case, for optimal results the patient may wish to consider a breast lift in order to counter sagging and skin stretching caused by the existing implants, which have been in place for around two decades already.
One of the most crucial factors to consider is the experience of the cosmetic surgeon performing the procedure. According to Dr. Pane, not as many cosmetic surgery providers as one might think are comfortable with performing revision and correction procedures. Further complicating the matter, many surgeons are “married” to specific methodologies which may or may not deliver the results the patient desires. For this reason, an in-person clinical evaluation is beneficial and even essential to both the patient and the surgeon, as both of them can evaluate the situation and their relative comfort levels with the proposed solution, as well as offering far more detail in terms of both medical history and potential methods of resolving the issue.
If you’ve had a burning question about cosmetic surgery which you weren’t sure who to ask, Dr. Pane and the staff of Atlantic Coast Aesthetics welcome any questions, comments, concerns or points of interest you might have. Simply call us at (561) 422-4116, follow us on Twitter or contact us through our website at https://acplasticsurg.com. Your question might even become the topic of ACA’s next Ask Dr. Pane segment, answered live in a Google Hangout by Dr. Pane live and in person, which allows us to address your interests and needs while assisting others who may also want to know. Remember, at ACA, we believe the only bad question is the one you don’t ask!