Breast implant extrusion is a rare complication that occurs when the prosthesis comes through the skin. Typically, the underlying cause is poor wound healing or breast tissue weakness; hence, risk factors must be recognized and eliminated prior to surgery to achieve good results.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley has explained the fundamental guidelines to prevent or at least minimize risk of breast implant extrusion.
- Respect the patient’s underlying anatomies
Using breast implants that are too big for the patient’s anatomy, particularly relating to chest dimension and soft tissue coverage can lead to increased risk of breast implant extrusion, poor healing, rippling, palpability, and a wide range of problems.
To prevent most known implant-related complications, Dr. Smiley measures the breast and chest width to determine the most ideal breast implant size range, profile, and base dimension.
- Prevent or treat immediately signs of infection
Infection can lead to wound not healing/closing properly that the implant comes through the skin. Fortunately, there are several steps to minimize risk of infection such as irrigation of the breast pocket with antibiotic solutions prior to implantation, use of oral antibiotics a few days postop, and complete cessation of tobacco products and medications with blood thinning properties (aspirin and ibuprofen).
Patients should also know the telltale signs of infection such as increasing pain, persistent swelling, fever, nausea, vomiting, and/or diarrhea.
Radiation therapy has an effect on breast tissue and thus may increase the likelihood of breast implant extrusion. A good rule of thumb is to wait for the body to recover fully from its effects before reconstructing or augmenting the breast with synthetic prostheses.
- Meticulous closure of wound
To further minimize risk of breast implant extrusion, the celebrity surgeon closes the wound in several layers to protect the implants. Additionally, he ensures that the uppermost layer of the skin wound edges are just allowed to kiss each other to promote the best scar possible. Tapes or steri-strips are then used to hold the wound together and to minimize “superficial” tension, further promoting favorable scarring.
- Over-exertion during the initial phase of healing
Heavy lifting and strenuous exercise particularly involving the upper extremities must be avoided for a few months to prevent healing problems and breast implant extrusion.
Reducing tummy tuck bleeding at the time of surgery is one of the most critical steps to minimize risk of complications and promote quicker recovery, as suggested by leading Los Angeles plastic surgery expert Dr. Tarick Smiley.
In his recent Snapchat post, the celebrity plastic surgeon is seen injecting epinephrine before making a hip-to-hip curved incision, which is the standard tummy tuck technique.
(Note: This curved incision is positioned very low that the resulting scar is easily hidden by the patient’s underwear. Furthermore, it is almost always expected to fade significantly and blend in with the skin after about a year.)
By injecting epinephrine, Dr. Smiley can significantly reduce the amount of bleeding, as this drug works by constricting the blood vessels. Aside from tummy tuck, this medication is also helpful in reducing surgical trauma and blood loss during liposuction surgery.
Once the epinephrine takes effect, the surgeon creates a small circular or diamond shaped incision around the navel so it becomes separated from the surrounding skin, but still remains attached to the muscle. Then, he creates a hip-to-hip incision that will allow him to remove the excess skin and tighten the abdominal muscle.
When separating the skin and fat from the muscle, Dr. Smiley uses an electric cautery, which can further reduce bleeding by sealing off the blood vessels. The “separation” is performed up to the breastbone, allowing him to suture and tighten the pair of loose muscle.
Aside from epinephrine injection and meticulous tissue dissection, Dr. Smiley says certain preparations are also critical in reducing bleeding. For instance, in his practice he instructs his patients to avoid aspirin or any other medications that inhibit clotting and healing 2-3 weeks prior to tummy tuck.
Some herbal supplements, vitamins, and homeopathic remedies can also increase bleeding; hence, the patient must notify her doctor if she uses any of these.
Furthermore, patients with hypertension must control this condition through lifestyle change (e.g., weight loss, more exercise, healthier diet, etc.) or medications well in advance of the surgery to prevent bleeding and poor healing, warns Dr. Smiley.
Facelift revision cost will vary depending on the amount of correction one needs. Also, revisions do not always deal with botched results due to technical errors during surgery; occasionally, issues may arise because of poor healing and continuous aging.
Nonetheless, major revisions are rarely an issue when the surgery is performed by a board-certified facial plastic surgeon who conducts facelift and its ancillary procedures on a regular basis.
Due to differences in healing, some facelift patients may need minor revisions. Oftentimes, surgeons revise their own work for minimal fees, some even waive their professional fees, although they will still charge for the anesthesia and the operating room.
A good number of facelift revisions deal with improving the appearance of scars. It is important to note that the incision lines must curve around the ear’s contours and remain hidden behind the hairline. While scars generally fade and stay hidden, due to unexpected healing a few patients may have their scars slightly revised.
However, major revisions are almost always caused by poor surgical execution. For this reason, a prudent patient should select her plastic surgeon based on experience, training, and other relevant qualifications, as opposed to shopping around to get the cheapest bargain deals.
As of this writing, the average cost of facelift is $6,000-$7,000, although it could be more expensive when combined with other procedures such as fat transfer, eyelid surgery, etc.
When one charges way below the “standard price,” it is almost always a sign that patient safety has been compromised—i.e., the surgery is not performed at an accredited surgical facility, the anesthesia is not administered by a licensed anesthesiologist, etc.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley warns patients that “non-specialists” offering facelift has high “major” revision rate, while board certified plastic surgeons have very low complication rate, a “trend” which has been shown by several studies.
Facelift revision cost can be more expensive when it deals with major corrections—e.g., pleating along the jawline, overly tight mid face, “flattened” cheeks, and other types of facial distortion.
Occasionally, facelift revision could simply mean non-surgical touch-ups in the form of dermal fillers and Botox.
Standard fillers such as Restylane and Juvederm can address soft tissue shrinkage that causes hollowed eyes, deep tear trough, and gaunt cheeks. They typically cost between $600 and $800, depending on the injection sites.
The average cost of Botox, meanwhile, is $300-$500.
In very rare instances, the eyelashes after eyelid surgery become dormant although should the problem occur it generally resolves on its own after several months.
During a lower eyelid surgery, a fine incision is made very close to the lower lash line in an attempt to conceal the scar. However, the very same “line of thought” could injure the hair follicles, which may not grow back.
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Sometimes, the damaged lashes do grow back but because of the adjacent scar tissue they become misdirected and/or too sparse. While it may be tempting to use Latisse (a gel that helps the lashes grow thicker and longer), this should not be used on the lower eyelid.
Furthermore, eyelash transplant is inadvisable because the grafts tend to grow too long and too quick to the point that they could irritate the eyes, as suggested by Los Angeles plastic surgery experts.
Skilled plastic surgeons know the importance of precise scar placement during a lower eyelid surgery: There is a fine line between positioning it too close that the hair follicles become injured, or too far that it becomes visible.
Instead of using an exterior incision placed closed to the lower lash margin, patients with under eye-bags primarily caused by excess fat—with no or very little loose skin—the best approach is to place the scar inside the actual lower lid. Through this technique, the surgeon is able to excise a small piece of fat and/or transpose it so the lower lid surface would be almost the same as the upper cheek.
Whether the eyelid surgery involves the use of exterior or interior incision placement, the hair follicles might be damaged without meticulous surgical maneuvers. For this reason a prudent patient makes sure that she only deals with a board-certified plastic surgeon who performs the surgery on a regular basis, ideally over a hundred procedures every year.
Aside from having “extensive” experience, the “right” surgeon for the job should also have a good eye for detail. Fortunately, the before-and-after photos of his previous patients can shed light on his “artistic skills,” which play a critical role in plastic surgery.
The before-and-after photos should have no visible stigmata such as lid retraction, poor scarring, and obvious asymmetry.
Breast lift and implants revision is inherently a tricky combo procedure. First and foremost, patients seeking it have breast and skin tissue that is susceptible to the effects of gravity and stretching.
Nonetheless, breast lift and implants revision can still provide good results, provided that proper implant selection, strict patient selection, and correct surgical maneuvers are all present.
Before and After Photos of a Patient Who Have Had Breast Lift and Implants Revision
Depending on the patient’s goal and cosmetic concern, the revision surgery may involve replacing the implants with something smaller or bigger.
While large implants can give additional fullness in the upper breast pole, the added weight to the breast increases the stress on skin thus reversing the effects of breast lift. For this reason the underlying anatomies, particularly their limitations, must always be respected and recognized.
Tissue-based planning system is one way to lower the complication and revision rate in breast implant surgery, with or without simultaneous breast lift, according to a study published by journal Plastic and Reconstructive Surgery.
Tissue-based planning system involves careful evaluation of the underlying anatomies of the breast, particularly its soft tissue thickness, dimension, and skin quality, to identify the breast implant size range that will have no or very little detrimental impact on the long-term appearance of the breast.
Simply put, tissue-based planning system aims to prevent or at least minimize implant rippling and palpability and inadvertent shifting.
Aside from proper implant size selection, the breast lift technique will also have a large effect on the surgery’s longevity, as suggested by Los Angeles plastic surgery experts. Internal adjustment of the entire tissue with the use of sutures to support the new contour can lead to a better shape that can withstand the effects of aging for many years.
In any type of breast lift, the fascial layer beneath the skin is closed and sutured in several layers; this technique not only results in additional strength but also promotes better scars as the skin receives no or very little tension.
Despite reshaping the breast tissue, sometimes it remains weak and thus sagging will occur much sooner. For this reason some patients will need reconstructive tissue matrix or surgical mesh (e.g., Strattice), which is used beneath the skin to further reinforce the tissue.
The use of biological tissue matrix helps plastic surgeons address common challenges involved in breast lift and implants revision such as malposition, rippling, and capsular contracture.