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There has been a long history of attempts to augment breast volume with fillers since the 1900s. Development of new synthetic filler materials in the 1990s and early 2000s led to interest in such treatments. There is conclusive clinical data now to prove that filler injection for breast augmentation is unsafe, and such treatments have been discontinued in most parts of the world. However, there are still many individuals who have had previous breast filler injections who require surveillance or management of complications. Removal of breast fillers often removes hard and unnatural lumps and relieves infections.
In the past, liquid paraffin, silicone oil and silicone gels have been used to inject the breasts. These have been associated with high complication rates and are illegal procedures. In the 1990s and early 2000s, filler breast augmentation received renewed interest due to the introduction of new filler materials, including polyacrylamide gel (Amazing gel [奥美定] and Aqualift) and stabilized hyaluronic acid (Macrolane). The China Food and Drug Administration withdrew Amazing gel from clinical use in 2006 and Macrolane was withdrawn by its distributors in 2012.
Fillers that are not biocompatible elicit an inflammatory reaction after they are deposited. They present weeks to years later with skin redness (erythema) and/or hard nodules that may be seen or felt. In some cases, the nodules may migrate to the abdominal wall after many years. Infection presents as fever, redness, warmth and tenderness of the skin, and pus discharge. Breast fillers may cause abnormal calcifications on mammography and may interfere with breast cancer screening.
The breast contains milk glands whose physiological function is lactation. The gland tissue is open to the external environment through the nipple for lactation, and bacteria that naturally reside on the skin also reside within these glands (Staphylococcus sp). After injection, foreign body reaction forms around the filler deposits as a result of inflammation, which manifest as hard lumps. Occasionally, the resident breast bacteria may come into contact with these nodules and cause infection.
Individuals who present with hard nodules following previous breast filler injection may require assessment mammography or MRI scans, and possibly biopsy to exclude breast cancer. Such cases are managed together with partnering breast surgeons.
Individuals presenting with infection require urgent drainage. Those presenting with non-infected nodules may first undergo the assessment detailed above. The timing and type of surgery for the management of nodules are dependent on individual clinical and radiological findings.
In individuals who present with infection, it is usual to wait for 3 months or longer following resolution of the infection before performing breast augmentation. In cases where infection is absent, it is possible to perform filler removal and breast augmentation at the same operation or in staged operations, depending on the individual clinical characteristics and expectations.
Breast filler removal surgery may vary in extent and difficulty depending on the material that was previously injected, the volume and its distribution within the chest. The treatment recommended depends on whether there is any existing infection.
Urgent filler drainage is required in cases of infection. Early drainage prevents spread of infection and reduces overall antibiotic therapy duration. In most cases, this is performed as an ambulatory surgery case under a short general anesthesia. Inpatient hospital stay is sometimes required for severe cases of infection for intravenous antibiotic treatment.
The incisions are usually sited in inconspicuous locations for optimal aesthetic outcome following wound healing. Scars are usually located at the inframammary fold or within the areola. Complete drainage of infection using small incisions is possible in the hands of experienced plastic surgeons.
Surgery is performed under intravenous sedation or a short general anesthesia. A short incision is performed to drain the filler and the resultant cavity is thoroughly irrigated. The infected filler material is sent for bacterial characterization to guide antibiotic therapy. The wound may be left open following surgery for further wound irrigation and dressing changes in the outpatient clinic to accelerate recovery.
Most individuals experience significant reduction of pain and swelling following operative drainage. Small wounds that are clean may close spontaneously after about a week. Individuals who have longer wounds may benefit from simple wound suturing in the outpatient clinic 1 week after the drainage procedure.
Daily or alternate day wound flushing and dressing changes in the outpatient clinic may be required to ensure complete eradiation of infection and filler material. A compressive dressing may be used to collapse the inner cavity to accelerate wound healing. After the wound is healed, scar management will be instituted to optimize the postoperative outcome.
Filler removal and mastopexy may be performed in cases where the breast filler is not infected. Removal of filler alone results in reduction of breast volume and will lead to varying degrees of breast drooping. Mastopexy (breast lift surgery) is usually required as a complementary procedure to elevate the droopy breast and restore it to its youthful and natural position. Successful filler removal and mastopexy recreate a youthful and aesthetic breast form and removes the foreign material. This is usually performed as an ambulatory procedure under intravenous sedation or short general anaesthesia.
Individuals may consider concurrent breast filler removal and mastopexy if the filler is not infected.
The skin incision is planned based on the anticipated degree of skin excess following filler removal. There are a few common skin incisions used:
Some patients may require insertion of drainage tubes and these are usually removed in the outpatient clinic on the 1st or 2nd postoperative day. Mild bruising and swelling is expected after surgery, which will mostly resolve by the 7th postoperative day. Stitch removal, if required, is usually performed on the 10th postoperative day.
Showering is normally possible following the removal of drainage tubes. Individuals may require the wearing a postoperative support brassiere to reduce swelling and facilitate wound healing.
Re-augmentation may be safely performed in individuals who have had previous breast filler drainage. Re-augmentation restores the breast volume to the original desired size that was lost following filler removal. It is possible to achieve and restore natural-looking, beautiful breasts that add to your aesthetic appeal.
In cases where the breast filler is not infected, it is possible to perform filler removal and breast augmentation at the same operation or at a later time, depending on the individual’s desires and expectations. In cases where the breast filler was infected, it is usual to wait for 3 months or longer to permit resolution before performing breast augmentation. This may be done with either structural fat grafting or implant augmentation.
The options for re-augmentation include:
Dr Yeo is one of the select plastic surgeons in Singapore who is be able to offer the latest generation of nanotextured Motiva breast implants, as well as all other brands and types of implants.
Our clinic has an en suite operating facility that has MOH certification as an Ambulatory Surgical Center (ASC). This assures your maximal privacy and convenience while keeping facility and equipment costs contained.
Our operating room carries a full range of specialized equipment for breast augmentation, liposuction and structural fat grafting aimed at delivering optimal results.