Are your breast implants too old? [Adam Schaffner, MD, New York City]

Dr. Schaffner (00:00):
I'm Adam Schaffner. I'm a plastic surgeon. I'm located in New York City. We're on Fifth Avenue between 47th and 48th, two blocks south from Rockefeller Center.

Eva Sheie (00:11):
Today we're talking about breast revision surgery, and my first question for you is, what is the most common reason that someone seeks help getting a second breast augmentation or revision to a breast surgery?

Dr. Schaffner (00:22):
Breast revision surgery is extremely common and it can be performed for a variety of reasons. In my practice, one of the most common reasons is malposition of the implant, meaning that the implant is too far towards the center, too far below the fold, too far to the side, and it resulting in the nipple areolar complex not being in the desired location. Sometimes having a lack of upper pole fullness or cleavage. And in many cases it's desired size change, either because the person changed her mind, or more commonly due to a lack of communication between the doctor and the patient prior to surgery, due to a lack of time to consider the desired size, due to lack of use of sizers, lack of use of 3D imaging and simulations, lack of use of the rice test. So lots of reasons why there could be a desired for size change, and many times unfortunately, they're preventable. But all too often that type of thoughtful investment of time is not emphasized before surgery. And people just sort of say, oh, I'll just go ahead and get a set of breast implants without the doctor and the patient really giving thoughtful consideration to that size.

Eva Sheie (01:50):
So is the improper size the cause of the malposition, or is that something different?

Dr. Schaffner (01:55):
It's usually something different, though if something is way too big or way too heavy, that can be a contributing factor to a malposition.

Eva Sheie (02:07):
How long will breast implants last?

Dr. Schaffner (02:11):
Well, they're not designed, per the US Food and Drug Administration, to be a lifetime device. With that said, there are certainly many times where if a woman is happy with the appearance of the breast, there's no evidence of rupture or capsular contracture or any problems, it can become a lifetime device. But if in fact it does need to be replaced because of severe, like a Baker IV capsular contracture or because of the desired size change or because of rupture that can occur at any time. Warranties, depending on the implant company can range from 10 to 20 years, say for capsular contracture.

Eva Sheie (02:54):
What are the most common reasons that an implant fails and need to be replaced, needs to be replaced?

Dr. Schaffner (03:01):
So when we talk about device failure, there can be numerous reasons. It can be because the implant ruptures, and that can either be because of trauma to the breast, either through direct contact, such as someone squeezing the breast, from athletics, somebody's pressing up against the breast. It can be spontaneous, it can happen on its own. It can be from manipulation during a mammogram. So there's a number of reasons that you can have a rupture of the breast implant.

Eva Sheie (03:33):
I had a friend when I was much younger who was throwing a football and her saline implant deflated when she threw the football. Within an hour she had one big breast and one small one.

Dr. Schaffner (03:47):
Yeah. So if it is a breast implant that is filled with saline or salt water and there is a rupture deflation, you will see that very quickly. Although it is possible to have a ruptured implant from saline and that it is not that noticeable initially, and it could be a slow leak. With regard to silicone implant or a gel implant, it is possible to go ahead and have a rupture, but be a silent rupture, which is why it's important to do breast imaging. For example, to have an imaging of a breast three years after date of implantation and every two years thereafter, screening with ultrasound and if indicated, then proceed to MRI.

Eva Sheie (04:30):
Is that expensive and is it the responsibility of the patient to pay for that imaging?

Dr. Schaffner (04:35):
It depends on the insurance carrier, whether or not they have health insurance. So it varies patient by patient. My experience is is that many insurance carriers will cover the cost of that minus copay deductible, co-insurance.

Eva Sheie (04:50):
That's helpful. If your implant ruptures, is it an emergency? Do you have to get it taken care of right away?

Dr. Schaffner (04:58):
You should get it taken care of as quickly as possible. It is not an absolute emergency, meaning it's not something that needs to go to the emergency room and have a emergency surgery at two in the morning, but it is something where you should seek urgent consultation, have confirmation by imaging, and then if indicated, go ahead and remove the implant.

Eva Sheie (05:19):
And should you call the surgeon who put the implant in when that happens?

Dr. Schaffner (05:22):
Preferably yes. So because the surgeon will have the records and knows the most about that, but if that surgeon's not available for whatever reason or the patient doesn't desire to go back to that surgeon, certainly any board certified plastic surgeon who performs breast augmentation should be able to competently remove a breast implant that's been ruptured.

Eva Sheie (05:45):
How common is capsular contracture? You mentioned that earlier. When does that happen and why? Do we know why?

Dr. Schaffner (05:54):
There are many different reasons that a capsular contracture can occur. Certainly it can due to a multitude of issues that can cause inflammation. Whether if it's in the perioperative period, meaning it happens in the first four to eight weeks after surgery, that it is something where you can have inflammation from blood that was in the pocket where the capsule starting to form. You can have an infection such as oral surgery, cavity, sinus infection, pulmonary infection like bronchitis, urinary tract infection, any sort of infectious process, anything that causes inflammation can increase the risk of capsular contracture.

Eva Sheie (06:41):
Okay. Where can we find you on Instagram and what's your website address?

Dr. Schaffner (06:46):
So on Instagram, you can view us at Dr. Schaffner, Dr. Adam Schaffner, D-R-A-D-A-M-S-C-H-A-F-F-N-E-R, and our website, you can either go to drschaffner.com, that's D-R-S-C-H-A-F-F-N-E-R.com, or plasticsurgeoninnyc.com. That's P-L-A-S-T-I-C-S-U-R-G-E-O-N-I-N-N-Y-C.com. Or you can call us at (2112)688-6600.

Eva Sheie (07:15):
Thank you for your wisdom.

Dr. Schaffner (07:17):
Thank you very much.

Eva Sheie (07:20):
On this podcast, we bring you directly to the doctors who are, where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. If you're a board certified plastic surgeon and would like to be a guest or a sponsor of the show, go to wherebeforemeetsafter.com for more information. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.