“I WOULD RATHER HAVE A SMALLER IMPLANT.”

If you have the feeling after a breast augmentation that the implants are too big and smaller ones would be nicer, this is also possible – however, the following must be taken into account: the skin mantle and the “implant pocket” inside the breast have been overstretched by the implants that are too big. If a smaller implant were to be inserted, it would not be held in place and would not heal well. When changing from “large to small”, the following therefore applies: first the implants are removed in a small operation. After that, it is necessary to wait for about 3-6 months to give the body the opportunity for the breast tissue to contract and heal. Then, in a follow-up procedure, the new, smaller implants can be placed. Depending on age and tissue condition, the new augmentation may be possible with or without breast lift.

Overstretched mammary gland tissue:
If the breast has not receded sufficiently even after removal of the implants,

• either a lift around the areola or
• a lift by means of a T-cut is necessary.

This is the only way to achieve an aesthetically pleasing result. Changing round implants to anatomical implants is not recommended in most cases due to the high risk of rotation.

“MY IMPLANT IS DEFECTIVE.”

You have had an ultrasound or MRI and the result shows a defective implant. Implant rupture is rare, but still possible. Often, patients feel that one breast feels softer than the other. In principle, defective implants should be replaced as soon as possible so that any leaked silicone does not remain in the body for too long. In the course of this operation, the ruptured implant is carefully removed and the implant pocket is completely cleaned. If there is also capsular fibrosis, the defective implant can also be removed “en bloc”.

“MY BREAST FEELS HARD AND FIRM, I HAVE CAPSULAR FIBROSIS.”

Capsular fibrosis is a very rare complication following breast augmentation or breast lift surgery. It occurs in less than 1 percent of all patients during our surgeries and describes the excessive formation of a hard, connective tissue-like capsule around the implant. A distinction is made between grades 1 – 4, with pain only being felt from grade 3. In grade 4, there is also a deformation of the breast. First, an attempt can be made to burst the capsule manually (in twilight sleep) by applying pressure from the outside – if this is unsuccessful, the implant, including the implant, must be removed. capsule can be surgically removed. A new implant can then be inserted.

“I FEEL LIKE THE IMPLANTS ARE MAKING ME SICK – BREAST IMPLANT ILLNESS.”

In some cases, there are patients for whom, instead of an increased body awareness, the complete opposite manifests itself after breast augmentation: they feel chronically tired since the implants, suffer from inexplicable symptoms such as hair loss, headaches, sleep disturbances, muscle pain, etc. – and see the cause of these complaints as their body’s reaction to the implants. This phenomenon has not yet been scientifically proven – however, we take these warning signs very seriously and recommend the complete removal of the implants in cases of suspected “Breast Implant Illness”, as we have observed a disappearance of the symptoms in almost all patients. The best diagnosis of Breast Implant Illness is made by observing symptoms that reappear immediately after the first surgery. Patients who turn to us with this phenomenon have already dealt intensively with the subject and often want the “en-bloc” removal of the implants, which is often mentioned in Internet forums. In this case, not only the implants but also the capsule surrounding them should be completely removed. During the operation we do our best to remove all easily accessible parts of the capsule – however, in the position “under the muscle” the capsule is firmly attached to the rib muscles and removal of these segments can lead to a so-called “pneumothorax” (= accumulation of air in the lungs), with dire consequences. Therefore: in case of any suspicion of Breast Implant Illness we perform a removal of the implants as well as a capsulectomy (= the removal of the capsule) – however, we refrain from the forced removal of firmly fused tissue with the costal arch due to the health risks.

“MY CHEST HAS CHANGED A LOT SINCE THE SURGERY AND I DON’T LIKE IT ANYMORE.”

Large weight fluctuations, pregnancy or the associated breastfeeding period, or even the wrong implant selection, implant position or surgical technique can mean that the result of the breast is not aesthetically pleasing and patients no longer feel comfortable with their breast.

– Waterfall deformity
In this case, the implant often has no connection to the mammary gland (as it lies completely under the muscle) and the patient’s own breast tissue “slips” over the implant. This effect is also seen after pregnancy and breastfeeding, when the breast tissue has become soft and empty and slips over the implant. In some cases, a so-called “tier change” is sufficient. This means that we allow the implant to make contact with the mammary gland at the lower pole using a “double layer technique”. If the tissue is very soft and empty, a breast lift using a T-incision is necessary to restore a satisfactory shape.

– Double-Bubble Deformity
The cause is usually incorrect implant selection. If the implant is chosen larger than the natural breast base allows, this becomes visible in a so-called double-bubble deformity: the natural underbust crease appears at the top and further down a new crease with the end of the implant, which can no longer be covered by the patient’s own breast tissue. The implants must be removed and the original underbust crease is reconstructed. Smaller implants – which now match the natural base of the breast – can then be inserted.

More info on Youtube.

**** For every request for an implant change or implant removal, the medical possibilities and risks as well as the course of treatment and healing are discussed together with Dr. Rolf Bartsch.