What is a “Switch out” Procedure?
I am glad you asked that question. A switch out procedure is when a previous implant is removed and a new one is placed back. This is often seen when patients come to us having previously placed saline implants or older generation silicone implants. The old implants are carefully removed. The surrounding shell or capsule is then also removed. The tissue is sized and newer, better fitting or more appropriate implants are put in. Hence, the name “Switch Out.”
Tell me about the new silicone implants? Are they safe?
I am very glad you asked that question. This is a question that is asked so often.
Silicone implants or at the least the “gummy bear” implants have been available in the United States since 2006. In 2006, the Food and Drug Administration (FDA) after a 14-year moratorium, and after studying thousands of patients and surgeries, decided to again allow for the implantation of silicone based implants. Most importantly, the concern about rupture and/or extrusion of silicone was noted to be false. Lastly, the thought that the silicone gel would simply seep out was noted to be false. The FDA data found that there was no relationship between silicone implants and soft tissue diseases like systemic lupus or breast cancer. Both of the concerns that during the previous decade had prompted tens of thousands of females to get their implants removed, were noted to be invalid.
After all of that, the simple answer is YES. The new generation of implants from both Allergan and Mentor are as safe as possible and extremely sturdy. They also feel almost like regular breast tissue and so are often advocated for use in patients undergoing breast surgery, in cosmetic augmentation or in breast reconstruction.
What are the possible complications?
Like any surgery, there are risks and complications. With breast augmentation, the most common risks and complications are bleeding, infection, seroma formation, hematoma, perforation, malpositon and capsular contraction. Bleeding can happen if the local epinephrine solution has not had time to work. A seroma is a fluid collection that can develop in the space created by the surgery. To help prevent these two complications, care is taken to make sure that all the tissue areas are visualized properly. If there is any bleeding, it is quickly stopped. As for a seroma, it is not often seen in breast augmentation or in a “switch out.” The pocket for the insertion of the implant is often small and a seroma has not time to build.
Malposition is a common concern after breast augmentation procedure or a “switch out.” The best way to control that misadventure is to make sure that the pocket is minimized and fits the sizers or the final implant perfectly. The intent is to make sure that the implant and the pocket are a good match. Otherwise, the implant will seem too conical or abnormal in shape. Most importantly, if the pocket is too large, then the implant has the ability to move around and change shape. With meticulous technique, this is minimized.
Like malposition, capsular contraction is a well-known complication that affects all patients that undergo breast implantation. It is thought that capsular contraction is related to a microfilm type of infection/reaction on top of the implants themselves. This is not “rejection of the implant by the body” as some convey. It simply is a sub-clinical infection that over time causes the shell around a breast implant to harden and become problematic. To combat this, we use ample antibiotics before and after surgery. We also have patients actively engage in post-operative massage to minimize the hardening seen with capsular contraction.
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain after surgery. Most of the pain seen with a “Switch Out” is due to the bruising and the swelling involved. In regards to the breasts, the muscle will be sore and bruised. This of course will pass. To help this along, we give patients prescriptions for pain and anti-spasm medications. Most of the pain has been described to me as having a severe cramp. Again, to handle this, we offer patient prescriptions for pain medications and for anti-spasm medications. Most patients note that with such a combination of medications and regular post operative massage the spasms and the pain soon dissipates and the patients get on with their lives.
How long do I need to take off from work?
Great question. Most often I suggest to patients that they consider taking about 2 to 3 weeks from work. Let me elaborate. Once you’ve had a Switch Out, the areas involved become swollen and in many cases become extremely bruised. This area then slowly goes through healing. We have patients wear contour pressure garments to help with the swelling. This also helps with the postoperative pain as the swelling is controlled. We have patients start walking on post-operative day #1. They are usually walking comfortably by day#3-5. Most patients note that they are comfortable walking regularly by day#7. Additional time is taken off to help patients heal from all the bruising. However, in some cases the patients are comfortable to return to their work or activities by week#2. We advise against patients going back to their workout routine until weeks#6-8. The logic here is to prevent patients from doing too much so as to cause additional swelling. If and when additional swelling develops, the tissues and the body parts are more apt to become more asymmetric in contour. If the patient waits until week#6-8, the chance of having contour asymmetry is much less because the underlying tissues have had time to settle and the spaces where fluid can collect have closed off.
Please note that post-operative massage routines are given on a case by case basis. Most post operative massage is started by week 3 and continues for the entire year after surgery.
Can I combine this with another procedure?
Yes and no. Like any surgical procedure, there are limits to what can be done and what is safe. As for the Switch Out—yes–it can be combined with some other procedures. For example, I routinely will do this procedure along with a tummy tuck. In this way, the overall result is much more improved than simply doing a breast augmentation or a “Switch Out.” But remember that any procedure that may be too long or too arduous and place the patient at risk for significant bleeding or significant anesthetic exposure would have to be deferred and done in two stages. Please understand I say this without knowing exactly what you, the patient, may have in mind. I can only speak from my experience.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local Oklahoma City Plastic Surgeon.
Does insurance pay for this?
Unfortunately, no. Insurance does not pay for any cosmetic procedures. But we do offer other options such as Care Credit. Please ask us to go through financing options with you. We would be glad to help