Revision surgery for saline bag implant rupture

There are cases of saline bag implant collapsing and leading to revision surgeries.
When the cohesive gel implant collapses, the volume is not completely lost. You might or might not feel that the shape of your breast changed a little. But if the saline bag implant collapses, you will be able to know right away as the volume shrinks a lot.



Usually the saline bag type does not tear off and leak. There would be a very small hole when the water leaks making the size shrink.

When we use the saline bag type implant in the breast augmentation surgery, we try to makin the incision spot very small therefore we fold up the implant, put it into the pocket, and then fill up the implant with the hose. Many think that the connecting part between the hose and the implant is where there is a leakage (Refer to image above)

We do not know exactly why the saline bag type collapses or gets damaged at all times.
I think that if there is not enough water at the time when you fill up the implant, then there is a high possibility of rupture.

Whatever the type of the implant it is, whether it is saline bag type or cohesive gel type, if the implant is folded and put into the body, there will be a lot of friction on the implant and this causes damage and leakage. This happens often if the saline bag type implant is not filled up properly.


The MRI shows wrinkled surface of the silicone gel type implant that is not filled up properly. ( Hammond, Aesthetic Breast Surgery, 2009, Saunders, Elsevier)


If this happens, there is a high possibility of capsular contracture.
So if there is a collapse or you need a revision surgery, one would have to cover up the initial pocket, find a new one for the new implant. If the first surgery was done below the pectoralis muscle, the revision would be donve above the pectoralis muscle, vice versa.

A completely new environment for the new implant would help avoid the development of capsular contracture!!





If a patient had ‘very bad shrinking’ experience of the saline bag type implant, then she would not want to use the saline bag type again.
Usually, she would want to use silicone gel filled implant. Both round and anatomical type would be possible to use. (Revision can be done by the the anatomical implant)

Saline bag type implant can be used in the first and revision surgery. This is not a bad thing. But this would be similar to getting non-incision method for double eyelid that results in the eyelid resulting in becoming loose. Then, you might want to get double eyelid surgery with incision to avoid this.



The reason why many people choose cohesive gel implant over the saline bag type is because of the sense of touch. You can know just by touching, how close a silicone gel can replicate a huamn skin. Everyone can know that cohesive gel is close to the skin and is not comparable.
Cohesive gel is a must in the revision surgery.

Is there a high possibility of complications such as capsular contracture when changing from saline bag type to the cohesive gel type? There is no accurate answer to this question. There is no accurate data. I think that if the doctor does the surgery accurately then there would not be any differences from the first surgery.
Whatever implant is use, the most important factor is how the doctor conducts the surgery.

The core choices that you need to make is that the pocket plane of the implant needs to be changed and the incision should be done on the inframammary fold. This would lead to harmless revision surgery.

Most patients who come in for breast augmentation focus on the size, implant type, and the incision part. They are not aware of the ‘plane’. The depth of the plane is most important factor in the breast agumentation surgery.

Today’s content was on the saline bag type implant users who used the implant before the cohesive gel implant was approved in 2007 and needed a revision surgery. If you have any questions, please leave them on the homepage or send me notes. I will get back to you.

Thanks a lot.

Revision of anatomical breast augmentation _ Implant collapse

Today I would like to continue on the breast revision due to implant collapse.
What are the chances that the cohesive gel implant would collapse?
What causes the implant collapse?
How can you know the there is an implant collapse?
What do I need to do in such case?

Cohesive gel implant does not collapse even if a 5 ton truck goes over it. There are soft substance inside that makes the implant itself very flexible. The stimulant such as pressure, accident, and impact cannot cause the implant collapse.



But the product can still break down or collapse. It is very rare to see a cohesive gel implant break down. I have not seen any case like that on a cohesive gel.
It’s sad that there is no gathered date on the collapse rate of cohesive gel implants of different companies.

If a saline bag type implant collapses, it starts to leak quickly. The saline liquid leaks out therefore, the implant constracts and becomes simiilar to a ballon that lost air. The shape of the breast changes quickly and others would be able to notice it.
But, one cannot identify that easily with the silicone gel implant.

The inner substance leaks very slowly. It may take years for you to notice that something is not right.
If there is a leakage, most of the inner susbtances from the cohesive gel silicone implant reamin near the epithelium.
There is no evidence or proof that this leaked substance from the silicone causes damage or harm on the body. So you do not need to be worried if there is a silicone gel implant leakage.

You would need to take a MRI in order to know if there is an implant collapse or not. If you think that the new breasts are shaping differently, then you could be suspicious about the implant collapse.
It is not like the busting tire but air leakage through a small hole. “Cohesive” means sticky therefore, this highly dense substance do not leak easily through the hold and even can maintain its original shape.



Most of the reasons for implant collapse are due to the insertion of the implant during the surgery. The implant may be a defect but the status of the implant is checked byt the doctors before the insertion. So this is not likely. The implant collapse happens as this large implant gets squeezed in into a small insertion hole. If you are concerned about safety the, inframammary fold incision is the best approach.

Therefore, it is important that you choose a safe implant and secure breast augmentation procedure when using the implants that will be in your body for a life time. This surgery can lead to a very long period of complications.

If you are confirmed by the MRI that there is an implant collapse, the best thing you can do is to remove the collapsed implant. This removal is done usually through the inframammary fold approach. You need to move not only the implant but also the leaked substance therefore, you need good visibility.



Today, we reviewed on the cohesive gel implant collapse and breakage.
In conclusion, the fifthe generation cohesive gel implants that have been sold in the market since 2007 have very low incidence rate of collapse, breakage and leakage. If there is a collapse, there would be very low possibility of leaked substance harming the body.

But there are any complications such as capsular contracture that you could be worried about. This is not something that you should take lightly when deciding on the cohesive gel implant breast augmentation. You would need to get this surgery from a highly experienced surgeon who would take care of the safety as well.

Have a great day. Thank you.

Q. Which is better for the sagging breasts? Round type implant? Or the anatomical type?

I have shared before in the old post. Dual plane surgery is conducted for the sagging breasts.

Dual plane should be done through inframammary fold.
 




Implant put under the pectoralis muscle in a sagging breast looks like a lump on the breast. If the implant is put in through the dual plane, then the sagging breast would look natural and good with the implant.

If the implant is put on top of the pectoralis muscle, it would make the implant expose more because of the less amount of skin and its thin layer.
In answering today’s question, it is better to use anatomical type implant for the sagging breasts.

The image below is one that I shared in the past.



Round type implant when standing up looks smaller than anatomical implant that has the same volume. The top part of the implant is crushed downwards.

If you ask whether or not the round type implant maintains its round shape when put into the body, it does not.
As you see in the image above, the upper part crushes downwards. The same applies for the textured type as well. All the round type implants that are sold today are the same.
But a form stable implant maintains its shape eventhough it is standing up. Natrelle and Polytech anatomical implants have such stable form.

Sagging breasts means that there is not much volume on the upper breasts therefore patients with sagging breasts want to fill up the upper part.
There are many who think that the anatomical type implant is too thin to fill up the upper volume and want the round type.

However, this is not true in reality.
Round type when lying down is round as its name says so. But when it stands up, the implant crushes down.





If there are two implants with same volume, the one that fills up the upper volume of the breast is the anatomical type implant.  (Full height, ie. high standing anatomical type implant)

If a round type implant has a strong exterior surface that helps maintain its form, this might be better that the anatomical type implant.
However, the round type implant in the market today are produced with less stability than the anatomical type implants.



Today, we looked at which implant, round or anatomical, to choose for sagging breasts. Thank you very much.

Suspended sales of Silimed implants 

Silimed implants are produced in Brazil and are exported around the globe. Artificial products for breasts, thighs, and buttocks are some of the representative products.





It is estimated that more than 20,000 people around the world have gotten a surgery with Silimed implants.

In Europe, there is a certification organization named CE and you need to get its certification to sell implants that are used in the bodies. Silimed has this certification in Europe and also has an approval from Ministry of Food and Drug Safety in Korea.
In US, Silimed has FDA approval to sell breast and buttocks implants.




In September this year, an information tip-off has led to UK MHRA to investigate on Silimed’s production facilities and found out that there are some type of fiber on the surface of the implants.

Such finding of fiber can lead to high possibility of contamination therefore the implants are currently under a test. Also there is a temporary hold on the sales of these implants in Europe.

There is no problem with the implant in US, and people use it as usually.
In Korea, MFDS sent a warning notice on the Silimed implants. Since then, the importing companies voluntarily decided not to sell the products until the test results come out in Europe.



Safety and contamination of the implants are directly related to the health and illness of the user therefore, the safety related departments in each countries have reacted quickly to this sensitive issue.

UK’s MHRA is yet to announce its results on the Silimed implants and there is no information is the patients who used this implant have any health problems or not.
A representative from MHRA, John Wilkenson stated “This could be a result of the manufacturing process. We are looking into whether this indeed is a contamination or not.”

“As of now, we did not provide any information on what health issues the users can face and we are testing to find out what kind of problems might arise.”



We still do not know if the fiber found was only on that particular implant or on all the implants sold. The result of this testing could take about 3 months or more.




There are no problems with the Korean patients who have used Silimed products since 2012 when the products were first imported.

However, we need to stay alert for the result of this testing.
Thank you for reading. Have a great day.

Let’s look into something that you do not want to think about, but cannot completely say for sure that you can avoid it, that is side effects of breast augmentation surgery.
Before we start, let’s see if the term “side effects” is an appropriate word to use or not.



Side effect is a term used when something unexpected happens to the body due to some medication. The term ‘Adverse effect’ is also used.
But medically, we do not use the terms ‘side effect’ or ‘adverse effect’ for something that happens after a surgery.
What if your hair starts to grow after you start taking medication for high blood pressure? This is not a bad thing for you. Actually, it’s something better. It’s a side effect that you can be thankful for.
People think positively about such side effect. However, this is still a side effect. This is the reason why the term is not appropriate.
The word “complication” is the medical term used for something that unexpectedly happens to you after a surgery.
The problem is that there isn’t an appropriate Korean word for ‘complication’. Complication, for example, is when you suffer from retinopathies and another problem is added to it. It is not used for situations where you get double eyelid correction surgery but your eyes end up in original form, i.e. not double eyelid.
So, I will just use the term, ‘problems after the surgery’ although this covers a broad range of things.



Complications or problems that may be caused after breast surgery are,

1) Contracture
2) Can feel the implant
3) Visible ridges / Rippling
4) Implant moving / rotating
5) Implant collapse
These are the common complication. Today, I would like to look into these complications.

1. Contracture

This is one of the representative problems caused after breast augmentation surgery. It is different from one person to another, but contracture is caused mostly within 1 year of the breast surgery.

This is why, I check on my breast augmentation patients after 6 months and a year.
If the patient is found to have 1~2 stage contracture, then I talk with her and find out how bad it can get. If I find that it can’t get better, the solution is to conduct a simple procedure from the inframammary fold opening up the epithelium and making is a little larger.

If the patient is in 3~4 stage, then the patient and I plan on the revision. The epithelium is removed, at times completely, or one can change the location of the implant.




2. Can feel the implant 

It is possible to know whether one can feel the implant or not before it actually happens. This happens to almost everyone who is thin or have small original breasts. If you are fat or have large breasts, it would be difficult to touch and feel the implant.
If this case is bad and you want an improvement on it, fat transplantation is conducted on the parts where you can feel the implant.
The revision would be done with a smaller sized implant or artificial skin tissue can be sued to cover up the area.




3. Visible ridges / Rippling 

This happens because of the same reasons in the second case. It happens a lot to those patients who do not have much fat. Rippling happens when the breast is not filled completely and the implant wrinkles making it visible. Fat transplantation, replacement, or artificial skin tissue cover can be used.



4. Implant moving / rotating

Implant can move up, down, left or right. Also, anatomical implant can rotate clock-wise or anti-clock-wise. Small movement can be fixed with the correction bra but if there is contracture and a severe case of implant movement, then revision is necessary along with opening up the epithelium on the opposite side of the movement, finding a new location. This applies the same for the rotation. It is important to match the size of the pocket with the size of the implant so that there is no movement.

5. Implant collapse 

All the imported implants in our country are manufactured by multinational companies therefore you can be sure that all the products have life time warranty. If the implant is collapsed or damaged, you can get a replacement surgery. (This is very rare for cohesive gel implant, especially, the anatomical type)



If something unexpected happens to your breast, you might get into a panic mode. Whatever happens is not visible therefore, you cannot know what kind you situation you are in, and how to solve the problem. If you do not take any actions, but contemplate on it with the doctor for too long, you might get into a conflict with the hospital.
The problems that you might face after the breast augmentation can be divided into three groups.

First is the error or accident caused by the hospital. Some examples are paralysis after spine disk surgery or lose of sight after LASIK eye surgery.

Second is the problem caused without the error from the hospital. Getting into an auto accident after the breast augmentation can lead to opening up of the wound. Stitching up your head due to an accident, and you do not get good score on the tests.
Third is when you are not sure if the hospital is at fault or not.
There is one principle that applies to all three cases. Who is responsible for the problem caused after the surgery?




If it is clear that the supplier (i.e hospital) is at fault, then the hospital takes care of the related costs.
If the supplier is not at fault (i.e the patient is at fault or changes mind or does not follow directions given) then the patient covers the cost.
If it is difficult to determine whether the supplier is at fault or not (about 90% of all cases fall into this category), the some part of the cost is covered by the hospital and the rest by the patient.

Cases such as illegal or wrongfully done medical activity by the doctor, doctor being unaware of the patient condition, miscommunication within the hospital, missing the after surgery care are all part of the fault done by the hospital.
Cases such as misunderstanding or lack of understanding by the patient, simple change of mind, carelessness, lack to attention to guideline provided, accidents caused after the surgery are some of the faults caused by the patients.
However, it is difficult to know such clear conditions in all the problems. There are many variables involved and therefore, the supplier and the customer need to come into a conclusion.

Today, we looked at the complications (problems) that may be caused after a surgery, especially a breast cosmetic surgery. This is all for today.

Thank you very much. Have a great day.