Plastic and cosmetic surgeons use the term breast augmentation to describe the surgery that involves placing breast implants.
Breast augmentation isn’t considered permanent. In fact, most plastic surgeons and manufacturers recommend replacing breast implants every 8-10 years because of normal wear and tear, the possibility of leak or rupture, and contracture of scar tissue. Of course, many patients don’t have problems with their breast implants in the first 10 years and keep them in place for a longer period of time.
The surgical procedure to switch out breast implants is called breast revision. As a Houston, Texas medical malpractice lawyer, I’ve come to know that breast revisions carry significantly more risk than breast augmentation. The reason for this is that a breast augmentation procedure alters the patient’s original anatomy.
Surgeons performing a breast augmentation can reasonably expect to find nerves and blood vessels in a normal location.
In the process of performing the breast augmentation surgery, though, the surgeon must create pockets for insertion of the implants. Additionally, after the surgery, scar tissue forms, which plastic and cosmetic surgeons refer to as the capsule. By forming a pocket on each side of the chest, the surgeon alters the location of nerves and blood vessels. Similarly, formation of the scar tissue capsule also can move or entangle nerves and blood vessels.
When a patient returns to a surgeon eight, 10, or more years after a breast augmentation to have a breast revision procedure, the surgeon isn’t encountering virgin tissue. In other words, there is an increased risk of damaging or lacerating a nerve or blood vessel during a revision surgery.
According to plastic surgery experts, most women who seek consultations for a breast revision procedure request to increase the size of their implants. In my experience as a Houston, Texas medical malpractice attorney, I’ve found that some plastic and cosmetic surgeons give bad advice when it comes to selecting over-sized implants for revision procedures. If you think about it, there’s only so much room for implants to be placed in a person’s chest.
A reasonable increase isn’t usually a problem because implants tend to “bottom out” over time, meaning that the bottom part of the pocket becomes a bit looser. There is a significant risk, though, in moving forward with a dramatically increased size during a revision procedure.
The main measurement that should guide a surgeon’s selection of a breast implant size—or approval of a patient’s request for an implant size—is the patient’s breast diameter. If the revision implant is too large for the patient’s breast diameter, then the surgeon will have to cut through the scar tissue capsule to enlarge the pocket that’s necessary to accommodate the new implant. This procedure is called a capsulectomy.
A capsulectomy involves cutting through the scar tissue capsule on the lateral (outside) sides of the breast area. This procedure can be risky, though, because a revision surgeon may be going in rather blind, not aware of the altered anatomical location of blood vessels and intercostal nerves. In fact, those blood vessels and nerves can be entangled in the capsule that the surgeon is cutting through. If a nerve is damaged, that can lead to permanent, intractable pain.
Another risk of using a revision implant size that’s significantly too large is that it will be impossible for the surgeon to close the surgical wounds or incisions without tension. A wound closed under tension has a big risk of opening (called wound dehiscence), which can lead to nasty infections and other complications.
If you’re considering a breast implant revision surgery, or even a first-time breast augmentation procedure, here are some patient safety pointers that you should consider when consulting with a plastic or cosmetic surgeon:
• If you aren’t using the same surgeon for the revision as you did for the original breast implant surgery, provide your new surgeon with a copy of the operative report from your augmentation. The surgical technique and pedicle design for the augmentation surgery provide useful information to the new surgeon about where vascular and nerve structures may be located. This is important to protect them.
• Make sure that your surgeon takes and documents detailed breast measurements including, at a minimum, sternum to nipple distance, nipple to inframammary fold distance, and breast diameter.
• When selecting an implant size, ask to see the implant manufacturer’s sizing guide. Currently, there are two manufacturers of breast implants that are approved by the U.S. Food & Drug Administration: Mentor and Natrelle. Both companies publish sizing guides that provide plastic and cosmetic surgeons with guidance on what implant sizes will work for a patient’s breast diameter. If you are considering an implant size that exceeds the manufacturer’s guidelines, ask your surgeon to explain what specifically about your physical exam indicates that the implant size is safe for you as a patient.