Background:Breast augmentation is entering its fifth decade of human use. In fact, the first breast augmentation patient is still alive and is 82 years old. Over that time, much has been learned about the procedure and the implants themselves have undergone a lot of design and structural changes. With each passing decade of use, breast augmentation continues to be an improved and more predictable procedure.
But at the heart of breast enhancement is the implant. The procedure is not possible (with the exception of fat injection breast augmentation which is still in its infancy and is but for a limited number of women) without the implant and both its immediate and long-term success depends on it. But breast implants are not forever. These are medical devices with limited lifespans. While there is the euphoria of the initial operation and the immediate change, the future reality is that one will eventually be having more surgery to replaced a failed or failing breast implant. Best estimates place that occurrence of somewhere between 10 and 20 years, on average, after the initial implantation.
But even when the implant does not fail, most breasts will still undergo some physical changes in appearance and shape. Just like the breast that does not have an implant, time and gravity work to pull the breast downward.While an implant does provide support and helps keep the breast tissue higher on the chest wall over time, some women will still develop sagging of their breasts off of the implant. I have seen lots of women who are now 15 to 20 years after their breast augmentation (without failed implants) and I have been amazed at how much breast sagging that they have developed. While this is not true for all implanted women, it seems to be particularly for those women who have gained a lot of weight over the years.
While an implant pushes outward on the breast tissue, how long it will be supported in an upright and sometimes uplifted position depends on numerous factors.A major factor is the quantity of breast tissue one has to start with or acquires over time. The more tissue that sits in front of the implant will have a definitive tendency to fall or sag 10 to 20 years later.
Case Study: This 53 year-old woman desired to replace her breast implants. She originally had silicone implants placed under the muscle 26 years ago. This is a long time to have such indwelling implants given that most of these type implants has been removed and replaced in the 1990s due to leaks or concerns that they might leak. She had no specific problems with these implants other than they felt a little firm and not soft like they used to. In addition, she did not like the sagging that had occurred and made her feel that her breasts had actually gotten smaller over the years. She was unsure of her original breast implant volume but thought they might be in the 300cc range.
Under general anesthesia, she had her original implants removed which were silicone and 350cc in size. One implant was intact and the other implant had a small tear in the implant shell with limited extrusion of the silicone material. She did have thick and hardened capsules but with minimal calcifications. Her implants were replaced with 550cc high profile silicone gel breast implants.
When replacing old implants with age-related breast sagging, considerations must be given to management of the breast shape. Larger implants will help fill out loose skin and the size increase must be at least 50% to give an effective filling effect. Thus with 350cc implants, for example, the increase must be to at least 500cc. The loose breast skin will engulf much of the implant’s volume so one shouldn’t be afraid to go significantly bigger.
Depending on the amount of breast sagging and the nipple position, an implant alone regardless of size increase may still not provide enough of an adequate lifting effect. Consideration should be at least given to a superior nipple lift. While this should not be confused with what a true breast lift can obtain, it in combination with a larger implant may be just enough for the ‘older’ patient to achieve a satisfactory breast shaping that hopefully will last her the rest of her life.
· Due to age and gravity, the implanted breast will lose shape and position over time Usually the breast tissue that sat in front of the implant goes south.
· Most women will undergo elective or forced replacement of their implants due to failure after 15 to 20 years of implantation.
· To restore breast volume or shape with implant replacement, a larger implant size is needed.
Dr. Barry Eppley