Before and after bilateral breast implant revision in a 37 year old woman. She had large implants in for years; after having children and becoming more fit, she now felt they were too large for her frame. Given her children’s young ages, she wanted to limit her downtime after surgery. She considered having her implants removed, but ultimately chose to downsize her implants instead.
If there is minimal capsular contracture and the pocket has normal dimensions, then going to sleep (having general anesthesia) with its attendant postoperative grogginess, nausea, and financial expense is not always necessary! In-office implant exchange can be done under local anesthesia in many instances.
For this patient’s surgery, her existing inframammary fold scar was used to access the implant space. Her old implants were removed, inspected, photographically documented, shown to the patient and discarded. She helped to choose her new implant size using a temporary saline-filled sizer, sitting up and looking in a mirror at different implant volumes.
Once the new implant size was chosen, the pocket was washed out with antibiotic solution and the new implant was inserted using a Keller funnel. She was able to shower in 2 days and exercise in 2 weeks! Postop pain was minimal since the only incision was where she already had a scar, and no breasts tissue or muscle on the inside was traumatized.
We have nicknamed this procedure the “tip toe” implant exchange, as it truly is like tip-toeing around in the breast. No additional scar tissue is stimulated to form, and it is an easy recovery! Patients who have capsular contracture or old ruptured implants are not good candidates for this type of awake in-office implant exchange.
Follow up photos are shown 3 months after surgery.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
