Background: Breast implants have been placed for over fifty years and the most common aesthetic indication is for small breasts. But the concept of small breasts is relative and can vary from a completely flat chest to breasts that have developed involution and have some sagging. In either case implants can be placed for their enlargement. But what happens over time to the shape of the breasts that have been implant enlarged with the effects of pregnancy, weight loss/gain or gravity is often not appreciated.
An important concept in the effects of long-term breast implant surgery is the ratio of implant to that of the natural breast tissue present. In the breast that is augmented with very little breast tissue present, it has a high implant/tissue ratio and its shape will remain largely stable over time. But when increasing natural tissue volumes and a lower implant/tissue ratio exists, the breasts will change shape over time. The larger amount of breast tissue that was once on top of or in front of the implant will slide off, resulting in the development of breast sagging or increased sagging if it existed before. This is because the implant does not change position but the breast tissue does.
The change in the shape of the breasts and/or change in the implants (rupture) result in the frequent need long term for breast implant replacements, removals and/or the need for breast lifts.
Case Study: This young female, who weighed 98lbs at the time, had silicone gel breast implants placed. Because she had some natural sagging, but did not want a breast lift at that time, larger implants were used to fill out the lax breast tissues. This created fuller breasts but breasts that were also positioned low on the chest wall.
Fifteen years later she presented with a desire to have her implants removed and a breast lift done. She now weighed 115lbs and her breasts had not only gotten bigger over the years but also developed more sagging. She was tired of their size and weight and the inability to find clothes to fit. She was ready for smaller breasts that were more uplifted and the scars were now acceptable.
Under general anesthesia the breast lifts were initially partially performed and the old inframamamary incisions opened. Upon entering the capsule of each implant implant ruptures were evident with substantial free silicone gel present. All loose gel and implant shells were removed, partial capsulectomies done and the inframammary folds elevated by capsular plication. The breast lifts were then completed.
The shape and the condition of the breasts over time can change after implants are placed. Breast tissue can sag and the implants may loose integrity. Interestingly in this case the patient never had any symptoms of implant rupture and was completely asymptomatic in both breasts. They remains soft and pain free.
1) Implants placed in breasts that already have significant tissue over time can get larger or develop increased sagging.
2) Silicone breast implants placed decades ago can develop ruptures which may or may not have been caused by their method of insertion.
3) Removing loose silicone gel can be done by compression, suction and irrigation before implant replacement.
Dr. Barry Eppley