Revision and Removal of Breast Implants in Toowoomba, Brisbane & the Gold Coast

breast revision - Dr Magnusson

Breast Implant Removal/Explant or Revision

The level of satisfaction from breast implant surgery is very high indeed however breast implants are not life devices and eventually will require review and revision. Implants last longer than 10 years for most women before additional surgery is required however one in 100 women will require surgery each year as a general rule of thumb.

The reasons for requiring revision breast implant surgery are many and varied. There are a number of general reasons for implant revision or removal and these can relate to complications of the original surgical procedure, problems with the breast implants, changes in the breast tissue and even a desire for a change in size. Although most women are very pleased with the outcome of breast implant surgery, there are also a small number of women who don’t sit comfortably with their breast implants and choose to have them removed because they no longer wish to have implants for a variety of reasons.

Associate Prof Magnusson performs a lot of revision breast implant surgery incorporating many different surgical techniques according to the problems facing an individual woman.

 

Reasons for considering implant removal:

  • Early surgical complications: these are very uncommon but can include
    • haematoma (bleeding into the breast implant pocket following surgery)
    • infection
    • poor outcome
    • breast asymmetry
  • Outcome problems from the original operation:
    • implants that are too large
    • incomplete or staged correction of developmental breast deformities such as tuberous breast or constricted breast
    • excessive animation with muscular contraction
  • Implant complication:
    • implant migration (movement out of position: down, out to the side or into the middle (synmastia)
    • capsular contracture (breast implant hardening, shape change and pain)
    • implant rotation (anatomical or shaped implants only)
    • implant rupture, breast implant seroma (swelling)
  • Natural changes to the breast tissue:
    • an increase in natural breast tissue volume
    • breast droop or ptosis
    • a reduction in natural breast tissue volume and problems such as visible rippling
  • Asymmetrythat is incompletely addressed or asymmetry that has developed subsequent to the surgery (different sized breasts)
  • A preference for an implant size change to increase or reduce breast size
  • A decision to have implants removed due to unusual symptoms that have developed since augmentation or a recognition that implants just don’t sit well in your body. Some patients refer to this type of concern as Breast Implant Illness (BII).

Rarely, Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)

 

First things to consider if you feel there may be a problem

  • Breast implant revision surgery is more complex than the primary procedure so you should check the qualifications of your original surgeon to ensure your surgeon is a fully qualified Specialist Plastic Surgeon who will be a Fellow of the Royal Australasian College of Surgeons (FRACS). A fully qualified surgeon is registered as a specialist with the Australian Health Practitioners Regulation Agency (AHPRA) and will have his area of training outlined as a Specialist Plastic Surgeon https://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx?q=MED0001382689&t=VgQBj14qMavnjWBF43p2
  • Alternatively, you can check if your surgeon is a member of the Australasian Society of Aesthetic Plastic Surgeons https://aestheticplasticsurgeons.org.au/find-a-surgeon/ who have practices focusing on aesthetic/cosmetic surgery and The Australian Society of Plastic Surgeons https://plasticsurgery.org.au/about-us/find-a-surgeon/
  • Initially, you should see your original surgeon for an opinion and an opportunity for them to remedy your concerns: complications and adverse outcomes can occur with all surgeons and a reputable and capable Specialist Plastic Surgeon will have the skill set to deal with problems that can arise from surgery and will want you to achieve your goals
  • It is important for you to clarify in your own mind exactly what your goals and expectations are so that they can be accurately assessed to determine how completely your concerns can be addressed
  • A second opinion from a fully qualified Specialist Plastic Surgeon may be useful to clarify what can be considered
  • The helpful staff in our clinic are available to help you with these queries and give you guidance if required

 

What are the surgical options for revision breast surgery?

There are almost always multiple options when considering revision breast surgery alt-hough occasionally considering implant replacement is not possible due to the significance of the current problem however, in general, there are 4 elements to consider.

• Breast volume:

◦ explant (breast implant removal only)

◦ breast implant removal and replacement

◦ substitute with fat grafting instead of an implant

• Breast ptosis/droop: a mastopexy may be worth considering for a nipple that is too low or the breast is overhanging onto the chest wall

• Capsule: neo-submuscular pocket, partial capsulectomy, total capsulectomy, en bloc capsulectomy

• Pocket stability: After dealing with the current problems will the current implant pocket be stable to hold the implant in position or does it need support with an “internal bra” using elements of the current capsule, excess breast skin, a tissue scaffold or acellular dermal matrix (ADM)

Many women have new implants inserted to maintain their current breast size (or perhaps increase it further).

Implants are not always replaced. Over time it is common for women to have gained a little weight and the breast has naturally increased in size compared to the breast size when implants were originally inserted and the additional volume of a breast implant may seem less important. The shape of the breast has frequently altered especially if there have been pregnancies or weight fluctuations and the nipple will frequently have dropped with the breast and the upper part of the breast will have become more empty.

A large number of women will choose to have their implants removed and not replaced (explant). Many women will want to have their implants removed and not replaced but will still consider additional elements of the surgery that can address shape change and preserve some volume. Mastopexy will address a low nipple position and a droopy breast which hangs onto the lower chest. Fat grafting can be used to address volume loss in the upper part of the breast, the cleavage and even provide a moderate enlargement of the breast without using breast implants. Fat grafting can’t generally replace the entire volume of a large implant in a single operative procedure but will occasionally be performed a second time for additional volume.

There are many surgical options combining the various technical elements of implant removal/replacement/fat grafting, mastopexy, “internal bra” and on top of this, the breast implant capsule is managed separately on its own merits.

The goal of Breast Implant Revision surgery is to return to beautiful, natural-looking results however sometimes the problems are so significant that explant alone is all that can be offered in the first instance with a possibility for further surgery at a later date. This occurs typically with severe extracapsular rupture, breast infections and rarely BIA-ALCL.

Whether you desire breast implant removal or replacement surgery a customised procedure is planned to best achieve your aesthetic goals and increase your physical comfort if there are associated symptoms.

The correct procedure for you will be an individualised for the problems that exist and your desired outcome.

 

Depending upon your individual concerns, revision breast surgery may offer the following benefits:

• Remove implants and the capsular tissue around them

• Allows you to change the size of your breasts

• Allows you to address breast droop and return a more youthful breast shape and contour

• Improve the symmetry of your breasts

• Corrects periprosthetic capsular contracture or other complications relating to breast implants

• Manage and improve symptoms relating to implant complications

 

Does Dr Magnusson perform total or enbloc capsulectomy?

Yes. This is a procedure he performs when required or upon request.

Most of the time the capsule is fine, thin and soft. In this circumstance, total capsulectomy isn’t usually required. In these instances, part of the capsule is frequently removed and if an implant is being reinserted, the rest of the implant is collapsed down upon itself and the implant inserted in a way that it is now in fresh tissue. This is called neopocket formation.

When the capsule is diseased or contributing to the progress of a problem such as a significant capsular contracture, significant extracapsular rupture or Breast Implant Associated-Anaplastic Large Cell Lymphoma it may be necessary to totally remove the capsule to limit the likelihood of recurrence and to control the problem.

There are patients who feel they fall into the category of Breast Implant Illness and may request capsulectomy beyond what appears to be clinically required especially if not having further implants. This procedure is more complex, takes longer and has a more un-comfortable recovery during the first week as the ribs are irritated where the capsule is attached to them if the implant was below the muscle. There is also a small increase in risks with surgery.

For these reasons, Dr Magnusson wouldn’t routinely perform this unless required or upon specific request.

 

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)

BIA-ALCL is a rare type of non-Hodgkin’s lymphoma that can occur adjacent to breast implants. It is not breast cancer.

There are more than 35 million women in the world with breast implants and at the beginning of 2019 fewer than 700 women are affected by this condition.

The condition appears to be associated with breast implants with a higher surface area (textured breast implants) that facilitate a greater growth of bacteria. If present the body may respond to the bacteria in a number of ways including the formation of capture contracture which is common all rarely a chronic inflammatory response may lead to the development of abnormal cells that can grow and become a lymphoma in susceptible individuals. With such a small number of patients affected worldwide international collaboration is required to collect information on this condition as efficiently as possible. Great inroads have been made but as yet these theories have not been proven definitively. There is evidence however in the published literature that employing antimicrobial strategies at the time of surgery seems to be associated with a reduced incidence of this disease.

Associate Prof Magnusson does treat this condition and all implant surgery he performs routinely includes antimicrobial strategies commonly called the 14 Point Plan as part of the surgical procedure.

The early stage of this disease is very slowly progressive and has an excellent prognosis if managed appropriately. The disease usually presents as a delayed and persistent swelling around the breast implant that occurs between 2 and 14 years following surgery and most commonly at about 7 years. Because of the visible nature of this presentation, the majority of patients are diagnosed at an early stage where the lymphoma is confined to the fluid around the implant and at this stage total en bloc removal of the breast implant capsule with the breast implant is complete management without the requirement for chemotherapy or radiotherapy. The small number of patients who are diagnosed in more advanced stages of the disease have generally had symptoms for much longer durations.

Most patients with delayed seromas do not have BIA-ALCL but have other reasons for fluid to collect around the implant. The diagnosis of BIA-ALCL is made by investigating the fluid around the implant which is removed under ultrasound guidance. There are very specific tests which need to be requested however when these investigations are performed it provides a definitive answer.

Associate Prof Magnusson is a member of national and international research groups exploring this condition and is a co-author on several publications. Associate Prof Magnusson is part of an Expert Advisory Board for the Therapeutic Goods Administration on BIA-ALCL and is part of a global research group pooling resources and investigating this disease from multiple angles concurrently. This work is referenced by the TGA https://www.tga.gov.au/alert/breast-implants-and-anaplastic-large-cell-lymphoma#reduce-risk

Patients who feel they may be affected in this way can be seen at the Diagnostic Breast Clinic at St Andrews Hospital Toowoomba (ph 1300 139 466) which is staffed by female GPs and does not require a referral. https://www.sath.org.au/services/clinics-outpatient-services/diagnostic-breast-clinic

Alternatively, patients can be seen by Associate Prof Magnusson in his private clinic but this requires a referral from your GP. The helpful staff in our clinic are available to assist you with these queries and give you guidance if required.

 

Breast Implant Illness

Associate Prof Magnusson has recently published an article in the scientific literature on breast implant illness in the plastic and reconstructive surgery journal. The key points of this research are that a link between silicone and systemic disease has been reported since the 1960s. The presence of these systemic symptoms in women who are exposed to silicone breast implants is now termed breast implant illness. Many studies have looked at either supporting or refuting its existence but the debate still continues.
recruiting.

We feel that the focus should be on the women and less so on the scientific debate because repair regardless of approvable link there are women who continue to struggle with real symptoms and worry about the implications for their health and their future.

In collaboration with other researchers, we have started systematic scientific research to see if we can clarify for these women and the likelihood of improvement with surgery and define further if there is a link.

The discussion about whether silicone implants are able to contribute to the development of systemic symptoms includes other diseases such as scleroderma, chronic fatigue, fibromyalgia or rheumatic disorders. This condition is referred to as Breast Implant Illness (BII) and is also known as Human Adjuvant Disease, Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) or Silicone Implant Incompatibility Syndrome (SIIS). There is still no definitive scientific link that has been demonstrated and no investigation that confirms its presence. This is what we’re trying to explore.

Many of these women have tried multiple modalities to address their concerns such as dietary restrictions to avoid potential allergens, “mould” free diets and natural remedies. For some of these women, they elect to have their breast implants out in the hope that this will help. It is a common request for en bloc capsulectomy to be performed. Associate Prof Magnusson does perform this procedure upon request and after a discussion about the pros and cons.

Patients who feel they may be affected in this way can be seen at the Diagnostic Breast Clinic at St Andrews Hospital Toowoomba (ph 1300 139 466) which is staffed by female GPs and does not require a referral. https://www.sath.org.au/services/clinics-outpatient-services/diagnostic-breast-clinic

Alternatively, patients can be seen by Associate Prof Magnusson in his private clinic but this requires a referral from your GP. The helpful staff in our clinic are available to help you with these queries and give you guidance if required.

Patients presenting to Associate Prof Magnusson with symptoms they attributed to breast implant illness will be asked to join the research project which will include comprehensive preoperative history and investigation and monitoring the response to treatment.

 

Women considering revision breast surgery

Patients who are unsure whether they require revision breast implant surgery can be seen at the Diagnostic Breast Clinic at St Andrews Hospital Toowoomba (ph 1300 139 466) which is staffed by female GPs and does not require a referral. https://www.sath.org.au/services/clinics-outpatient-services/diagnostic-breast-clinic

Alternatively, you should obtain a referral from their GP and schedule a consultation with Associate Prof Magnusson who will review your cosmetic concerns, the presence of complications and establish whether or not you are a candidate for surgery.

 

You may be a suitable candidate for Breast Revision Surgery if you:

• Have aesthetic problems with your breasts

• Have had changes to your breasts such as swelling, pain, hardening or shape change

• Want to address breast asymmetry or implant malposition

• Want to adjust the size of their implants

• Want to address shape changes that have occurred with the breast tissue such as droop or ptosis

• Wish to remove breast implants permanently

• Want to repair changes in the appearance of breast implants due to excessive weight gain, pregnancy and/or breastfeeding

 

Is there any Medicare and health fund assistance with breast implant revision surgery?

There is assistance from Medicare and Health Funds for some patients.

When breast implants are removed and not replaced there is support from Medicare.
Item number 45548: BREAST PROSTHESIS, removal of, as an independent procedure
Item number 45551: BREAST PROSTHESIS, removal of, with excision of the fibrous capsule

Replacement of your implant will have Medicare support if the original surgery also attracted Medicare and health fund support because of a developmental breast deformity (such as tuberous breast, constricted breast, Poland’s syndrome or significant breast asymmetry), or for reconstruction following breast cancer. If the original breast implants were inserted for cosmetic reasons then there is no support for breast implant replacement unless there is a substantial deformity as a result of implant removal alone.
Item number 45553: BREAST PROSTHESIS, removal and replacement with another prosthesis
Item number 45554: BREAST PROSTHESIS, removal and replacement with another prosthesis, with excision of the fibrous capsule

If an “internal bra” is required to support the breast implant or control the implant pocket and there is an item number for the replacement of the implant, there may be support for its use.

If a breast lift or fat grafting are performed as part of your surgery they don’t usually attract Medicare or health fund assistance.

 

Breast surgery forms the largest single part of Associate Prof Magnusson’s practice

• He performs all forms of breast surgery including primary cosmetic breast enlargement, breast asymmetry, congenital deformity like tuberous breast, augmentation mastopexy, revision augmentation/explant surgery and breast reconstruction for cosmetic and reconstructive problems.

• Associate Prof Magnusson uses fat grafting as an adjunct to breast surgery for many patients combined with mastopexy, implants and especially following ex-plant surgery or as part of breast reconstruction

• He is a concept champion for the 14 Point Plan for safer breast implant surgery

• He is on an Expert Advisory Panel for breast implant surgery for the Australian Government’s Therapeutic Goods Association (TGA)He is a member of an international research group investigating Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)

• He was run many meetings involving breast surgery education including his role as the scientific convener of the Breast Masters Symposium in Sydney, October 2018

• Associate Prof Magnusson is involved in research with and is a supporter of the Australian Breast Device Registry (ABDR)

• He has specifically researched and published on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant Illness (BII)

• He has delivered multiple talks on patient and implant selection, procedural planning and technique as well as many aspects of complex breast surgery at national and international scientific meetings

• All of Dr Magnusson’s breast implant patients have surgery which incorporates the 14 point plan and are registered on the ABDR.

 

Dr Magnusson

Dr Mark Magnusson

Quick Enquiry

Short on time? Simply send your enquiry here and we will get back to you with more information.

  • This field is for validation purposes and should be left unchanged.