Before and after bilateral breast revision in a 59-year-old woman. Her breast implants were 20 years old, and the left side had contracted, causing deformity and pain. She knew she wanted to keep an implant but wanted to look a little smaller and more natural.
If the implant pocket does not need major revision, implant exchange can often be done in the office operating room under local anesthesia, with the patient participating in the sizing process. If there is a scar already in the fold under the breast, it can be reused to access the implant space.
In this case, the patient elected to have awake surgery under local anesthesia with an oral anti-anxiety medication and inhaled laughing gas to take the edge off the numbing. The inframammary fold scar was excised, the old implants were removed, and the pocket was inspected.
We look for signs of acute inflammation such as redness and “granulation tissue”(superficial blood vessel proliferation inside the breast implant capsule) which indicate a risk for recurrent capsular contracture. A small specimen from the internal capsule is sent for microbiological analysis to see whether any bacteria are present. If bacteria are detected, we usually prescribe two weeks of an appropriate antibiotic and encourage our patients to start early implant massage to avoid the risk of recurrent capsular contracture.
A temporary sizer is used intraoperatively to determine the best implant size and projection for each breast. The sizer is filled with saline, the volume is adjusted upwards by adding more saline and downwards by removing saline, enabling the patient to see what her breast would look like with different implant volumes and projections. We sit our patients up and have them look in a mirror when they are awake so that they can actively participate in breast implant sizing. This experience is immensely empowering and fun for our patients!
New smooth round silicone gel breast implants were inserted after the patient chose her desired breast implant outcome. Follow up photos are shown 9 months after surgery. She is very pleased with her natural looking result, and elated to hear that she does not need to have any future surgery unless she has a complication or if she would like her implants removed (also offered awake under local anesthesia).
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
