To correct breast ptosis, plastic surgeons use breast lift which typically involves three separate incisions that form an anchor-shaped scar which will enable them to remove the extra skin and fats and manipulate the underlying tissues.  (See the incision pattern below.)

In some cases, this procedure is performed in conjunction with breast implants to further create volume especially in the medial and upper poles of the bust that will lead to a more prominent cleavage.

If breast implants are combined with breast lift, plastic surgeons would only use the areola incision instead of the extensive anchor lift; as a result, patients can also expect less scars.

As with any cosmetic surgery, breast lift involves risk of complications which can be reduced by following the pre-operative guidelines that typically include avoiding “blood-thinning” medications, smoking, alcohol, and herbal supplements.

According to several studies, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can inhibit blood clotting and healing which means that patients can experience excessive bleeding during and after their surgery.  For this reason, most plastic surgeons recommend to stop these medications at least two weeks prior to the procedure and during the recovery.

Certain herbal supplements such as those containing green tea, vitamin E, and gingko biloba have also been found to inhibit blood clotting.  Just to be on the safe side, patients should tell their plastic surgeons about all the medications and supplements they are taking.

For smokers, they will most likely be advised to stop the bad habit at least two to three weeks prior to the surgery and during the recovery.  According to several studies, skin necrosis or death of skin tissue is 1,500 times more likely to occur among smokers than non-smokers.

It is important to note that skin necrosis is associated with prolonged healing and unnecessary scarring.  And because of these risks, plastic surgeons conduct random blood testing prior to surgery to determine the presence of nicotine in the blood.

Meanwhile, preparing for breast lift also means planning for one’s recovery.  This will include assigning a companion for the first two days after the surgery, securing supplies needed during the recovery, and securing all the medications and special garments that will be used during the healing period.

However, patients should remember that they will most likely need a revision breast surgery at some point in their lives due to different reasons such as implant deflation, bottoming-out (implant migrating downward), asymmetrical appearance, and not being satisfied with the result.

Most plastic surgeons believe that the most common reason why women choose to have a revision breast surgery is that they are not satisfied with the size (either going too small or too large).  For this reason, it is important for patients to spend several months to think about the size they really want to achieve before their surgery.

For women who want to have larger breasts through a revision surgery, most plastic surgeons consider the overall body frame, amount of skin and tissue, and other factors which may limit the body from having a large-sized implant.

Going from small implants to bigger ones is usually easier compared to replacing large implants with a smaller version.  According to experts in LA plastic surgery, this procedure is usually possible as long as there is enough amount of skin and tissue to cover the implants and the body can accommodate larger breasts.

On the other hand, replacing implants with smaller ones requires a more extensive surgery since the skin and tissue have already been stretched.  For these reasons, LA plastic surgeons usually perform internal suturing (or capsulorrhaphy) to tighten the capsule that surrounds the implants and lift the skin and tissue.

In some cases, doctors in plastic surgery also recommend breast lift to be performed in conjunction with revision breast implant especially to patients whose breast skin and tissue become saggy due to weight loss, several pregnancies, aging, and natural changes of the body.

If breast lift is performed in conjunction with breast implant surgery, doctors usually use the areola technique since both procedures require the same incision site.

Meanwhile, these are the other reasons for revision breast surgery: implant deflation, bottoming out, ruptured shell, asymmetrical appearance, natural changes in the breasts, implant rotation (only happens to teardrop implants), and capsular contracture (a condition in which the capsule around the implants squeezes the materials resulting to a painful, distorted breast).

Instead of replacing the implants with a new one or different size, some patients prefer to permanently remove these biocompatible materials due to personal or medical reasons.

Most of the symptoms of capsular contracture begin several months after the breast surgery, although this may occur at any time.  But in most cases or about 75 percent of capsules appear within the first two years of breast augmentation surgery, with many of the reported incidents occurring on patients with silicone implants rather than those with saline version.

Perhaps the most widely accepted cause of this complication is a low-grade infection, although some doctors also associate this with the use of radiation therapy, severe breast trauma, seroma or collection of fluids underneath the skin, hematoma or broken blood vessels under the skin, use of inordinately large implants to patients with limited breast skin and tissue, and autoimmune disorders.

Meanwhile, plastic surgeons have found several ways to avoid capsular contracture.  One of these techniques include submuscular implant placement in which they put the synthetic materials under the chest muscle instead behind the tissue.  The theory is that the constant massage from the pectoral muscles will inhibit the growth of scar tissue around the shell.

Some specialists in LA plastic surgery also recommend taking antibiotics before and sometimes after breast augmentation which is said to prevent bacterial infection that may lead to capsular contracture, while others promote breast massage and compression exercises after the procedure which are believed to prevent the tissue from hardening and to encourage the implants to settle to their proper place.

In case the symptoms of capsular contracture have already occurred, most plastic surgeons believe that implant removal (including the scar tissue around it) is the only treatment that guarantees success.  Meanwhile, patients may ask for another set of implants or permanent removal, although the latter option may leave them with sagging breasts that usually require suturing methods to correct the stretched tissue.

However, some doctors in LA plastic surgery claim that there are non-surgical treatments for this complication, although the effectiveness of such approach is only based on anecdotal evidence.  Examples of these procedures include the use of sound waves to soften the breast tissue, certain anti-inflammatory medications, and oral vitamin E.

Jana, a former two-time world champ in the 2003 and 2007 400 meter hurdles, only had the implants for 14 months before, in her own words, “I’m  back to being as flat as a pancake.”

Dancers are another group of athletes that feel large breasts only get in their way.

Other celebrities have opted to go through explant surgery, the procedure to remove or replace breast implants.

For instance, former Spice girl, Victoria Beckham, had her large implants downsized during the summer of 2009. Victoria has a tiny frame and her implants just did not compliment her body.

O.C. Real Housewife Tamara Barney found she was having back pains due to her large implants so she had them replaced with a smaller set which also proved to be a pain in the back. At one point, Tamara was thinking she would lose the implants altogether.

New York City Real Housewife Jill Zarin reduced her implants from a 32 G to a 32D.

Some women having explant surgery, the procedure to remove implants, opt to have a breast lift (or mastopexy) at the same time.

According to the American Society of Plastic Surgeons (ASPS), the average cost of implant removal in the U.S. is $2435. With 20,967 breast augmentation patients having explant surgery in 2008, about $51,044,485 was spent.

 (2008 is the most recent year for which statistics have been compiled. 2009 statistics will be released in March, 2010.)

The three most common reasons for breast implant removal include:

• A change in size or shape
• Implant leak
• Capsular contracture, a type of internal scarring that hardens the implant and breast

Other famous women who had their breast implants removed or had a considerable reduction in implant size include:

• Britney Spears
• Demi Moore
• Jenny McCartney
• Courtney Love
• Jenna Jameson
• MTV’s Kacey Long
• Denise Richards

(Read our previous post about how Denise Richards first got uncomfortably large breast implants, and then received even larger implants – due to bad communication with the plastic surgeon — before going just right for her size.)

But among the possible risks that rear its troublesome head from time to time, a small percentage of these breast enhancement patients will report back to their surgeons, fearing that the implant is leaking or has broken.

All breast augmentation patients should be told about a possible replacement some time during their lifetimes during the first consult with the plastic surgeon, along with any other risks involved in undergoing a breast augmentation procedure.

One major manufacturer of implants published several studies revealing the deflation rates of saline implants. Approximately 3% of implants will deflate 5 years after undergoing the breast enhancement procedure. Overall, saline implants are estimated to have a lifespan of 10 to 12 years. Nonetheless, there is no expiration date or when a breast implant must be removed or exchanged.

For saline-filled breast implants, a leakage would not pose a health risk because this type of implant is filled with salt water, which is easily absorbed by the body.

According to the ASAPS, there is no one good medical test to show if a saline breast implant is leaking.

But signs that may indicate leaking include”

• a change in breast shape
• the breast deflating, much like air being released from a balloon.
• pain and/or tenderness

In some instances a silent rupture can occur and there are no signs at all.

For silicone implants, an MRI may be required. Each patient is unique; some women do not respond to silicone at all, while yet others do.

The technique for removing old or leaking breast implants is a surgical specialty known as explantation.

Your surgeon should be board-certified in plastic surgery and able to show you many before and after pictures of explantation.

Fortunately, some of the newer breast implants come with a warranty which may help with the cost of replacement.