Implant Replacement

Stretch marks can occur when the dermis layer of the skin, which lies beneath the epidermis (the outermost layer of skin), is stretched and torn, something that usually happens during rapid growth or rapid weight change. Considering that breast augmentation, in a sense, entails rapid growth of the breast area, it is not surprising that implants CAN result in skin stretch marks.

The skin on the breast is generally quite elastic and resilient, making it very uncommon for stretch marks to develop as a result of breast augmentation. Stretch marks can form when the tissue cannot expand quickly or sufficiently to accommodate the growth that occurs, and this is almost never the case with women’s breasts.

However, stretch marks can sometimes occur as a complication of breast augmentation, and there are several factors that can increase the risk. One of these factors — implant size — is entirely controllable. The other — genetic predispositions — is not.

At the most basic level, it can be said that the larger the implant, the greater the risk of stretch marks. If your skin is strong and elastic, you may be able to increase your breast size significantly with minimal risk. However, if you’re prone to stretch marks—such as having thin skin with low elasticity—you may opt for a more moderate augmentation. If you’re unsure whether you’re prone to stretch marks, don’t hesitate to ask your plastic surgeon—they can help you understand your skin’s condition and guide you toward the best choice.

Can breast implants cause stretch marks? Yes, but only very rarely. With the right plastic surgeon, who helps you determine what works with your body, you are unlikely to be at risk of getting them at all.

After a surgical incision, the body produces collagen to repair the “damage.” Collagen acts like cement, filling the space between two bricks. Always too much collagen is produced, which is why we also produce an enzyme called collagenase that “melts” away the excess collagen. This molding process lasts for months. Collagen is produced, and the surplus is removed to restore the skin’s original shape. If there is an excess of collagen left, a more prominent scar will form.

A perfect balance between collagen and collagenase leaves the slightest, barely noticeable scar. Often, however, we heal a little too well! After the skin has regenerated, the healing process continues—sometimes causing the scar to become larger than necessary. If we could stimulate our cells to produce extra collagenase, we would be able to dissolve this excess scar tissue.

Plastic surgeons and dermatologists have known for decades that there are ways to reduce the size of scars. However, until now, no method has been particularly comfortable. For example, it has been found that pressure bandages help increase the production of collagenase, and this has been used for burn treatment for over a century. Cortisone creams not only soothe irritated skin but also stimulate natural collagenase production. In extreme cases, doctors may use cortisone injections.

For decades, doctors have prescribed silicone sheets. Taping silicone film over a scar will reduce it. This was discovered in the early 1980s when a doctor attempted to apply even pressure to a scar using a silicone sheet. Scars treated with silicone appeared to diminish much more quickly. Vitamin E helps by working on the collagen fibers, making scars softer and more pliable.

Closing the skin after breast augmentation

The first step to achieving the best possible scar is to close the skin without tension. The skin may appear wrinkled initially, but it will smooth out over time.

After the skin is properly closed, what else can be done to minimize scarring?

What we do at Victoriakliniken is tape the breasts with silicone for 6 months after surgery. If you wish to continue treating the scar, vitamin E or a vitamin E-rich oil massaged into the skin can help. Massaging with oil by “folding macaroni” along the scar, upward and downward, often helps soften the scar and make it more flexible (this also works well for other scars, such as those from a cesarean section).

BIA-ALCL is a relatively new and very rare condition, but it is important for all patients with breast implants to be aware of it. It is believed to be caused by the texturing of breast implants, which in some cases creates a chronic inflammatory process inside the breast cavity.

“Bottoming out” typically occurs in slender patients with very little breast tissue and skin coverage, combined with large implants. It is more likely to happen if the implant is placed above the muscle and is less common with implants placed completely under the muscle. The type of implant does not matter in this context; bottoming out can occur with smooth, textured, saline-based, or silicone-based implants. However, there is an increased risk with smooth implants.

All breast surgeries can result in the breast and/or nipple becoming either overly sensitive or not sensitive enough. This change can vary in degree and may be temporary or permanent. It can affect sensation during breastfeeding or sexual response.

During the healing process, you may experience numbness or hypersensitivity—or sometimes both. This typically subsides over time. It is important to remember that it can take up to a year, sometimes two, for full sensation to return after a breast augmentation.

There are many factors that can affect the risk of “rippling.” The most important are the quality and thickness of the patient’s skin and tissue, the choice of implant type and size, and the technique used by the surgeon. While skin type is not something that can be altered, the risk of rippling can be minimized by choosing “denser” silicone implants (form-stable) that are not wider than the patient’s natural breasts, and by placing the implant under the muscle.

All implants can rotate. This is usually not visible but is more apparent with anatomical (teardrop-shaped) implants, as they are asymmetric. If round implants rotate, the shape of the breast is not affected. When an anatomical implant rotates, the shape of the breast becomes distorted. If it is a simple rotation, the implant can be repositioned during a revision surgery (and, if necessary, the pocket in which the implant rests can be adjusted), or it may be replaced with round implants.