Revision Surgery Following Breast Augmentation - The Low-down

Posted on the 08 September 2010 at 11:35

Breast augmentation is the commonest cosmetic operation in the UK and is usually a very satisfying procedure for the patient. There are however times when breast augmentation or enlargement surgery with silicone gel implants just doesn’t go to plan; so what do you need to be aware of?

When most people see a surgeon for a consultation, prior to agreeing to the actual surgery, the possible complications and ‘worst case scenarios’ should be well explained, both in terms of the impact on health and the possibilities for revision surgeries if something unexpected happens with the implant or an infection arises for example.

The initial consultation must be thorough and the decision to go ahead not taken lightly. You do get what you pay for and clinics and surgeons’ quality of care vary accordingly. I see initial patients for breast augmentation surgery for at least 45 minutes and then again usually without charge before they make a decision and book surgery.

Many people are confused about just what they’re buying when it comes to breast implants; it is important to remember that they are not a lifelong solution.

The guarantee offered by implant manufacturers, which is passed on by the surgeon to the patient, is usually against rupture and not that they will last 25 years as some people are led to believe. Most implants will need replacing after 10-12 years.

Although they appear intact macroscopically (i.e. to the naked eye) after 12 years they may have microscopic fractures in the surface, (this appears intact and is NOT a rupture), which makes the body form a capsule around it and the patient perceives firmness. There is no guarantee against this.

However, if there is macroscopic rupture i.e. the implant has burst, which can be detected by the presence of firmness around the implant or sometimes a lump (often the first reason why patients seek additional medical advice due to the association with cancer) or by an ultrasound or MRI scan, then the "rupture guarantee" means a new implant will be supplied free of charge (by the manufacturer) but you still have to pay for the revision surgery to be performed (i.e. the hospital and surgeon). This should be made clear to any potential patient in documents handed over and discussed during consultation, so it is important to read and understand  that this is a possibility and could mean you incur further, future costs if the implant fails, most patients however tend to think "it will not happen to me"!

The cost of replacement surgery without implants included (as these would be free from the manufacturer at this point) is around £3,000 - £5000, although some larger cosmetic surgery chains are able to offer a reduced rate due to economies of scale.
Another possible complication of breast enlargement surgery is capsular contracture, where the body forms a covering of scar tissue around the implant, known as a ‘capsule’, because it does not like having a foreign body inside it. This is a consequence of the patient’s biology and is not related to the surgery being substandard. Patients are counselled at the time of pre-op consultation that this can happen to between 5-6% of patients, typically between 3 and 4 years after the original surgery.

If this occurs they may need more surgery to take out the implant and the capsule but they are liable for the full cost as it is not a fault of the surgeon, hospital or breast implant.

It’s not nice if these things happen, but patients must realise such complications do occur, so the decision to have breast augmentation in the first instance should not be made lightly. When a patient who is a suitable candidate for surgery undergoes augmentation the result is usually excellent but careful screening to prevent patients having surgery who might not get a good outcome is essential. Also be sure to understand all the possible consequences of the surgery so there are no surprises that you did not know about.

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