Ten years after Bravo cameras documented Teresa Giudice's breast augmentation on Season 1 of The Real Housewives of New Jersey, the mom decided to have her implants switched out. Teresa recently opened up about her decision in 2018 to have a second procedure, saying, “I was very nervous to re-do my breasts, but I felt it was necessary for me to feel like my best self.” She also gave a ringing endorsement to Board Certified Plastic Surgeon, Aviva Preminger M.D., who performed the surgery: "She was amazing, and so professional. I absolutely loved her and could not be happier with the results.”
You may be wondering why Teresa's second procedure was necessary, but actually, replacing implants is a surprisingly normal practice. BravoTV.com chatted with Dr. Preminger, who specializes in cosmetic and reconstructive surgery of the face, breast, and body, to get the scoop.
What does "breast implant maintenance" mean?
Dr. Aviva Preminger: Breast implants are man-made devices. Like any other device, the devices themselves will not last forever. I usually tell my patients that getting breast implants is a bit like buying a car: They will enjoy them, but at some point they may require a tune-up. In addition to the lifetime of the devices themselves, women’s bodies do not remain the same over a lifetime, particularly after pregnancy, breastfeeding, changes in weight, and menopause. Because breast tissue responds to hormonal changes, breasts often shrink after breastfeeding and weight loss, and other women experience a sudden size increase at the onset of menopause. Some lifting and tightening may be necessary to help support the implants and keep the breasts looking youthful.
Women often also desire to increase or decrease the size of their implants at different points in life. Many get so comfortable with the fullness of their implants that they want a little more volume. Some patients who had larger implants placed in their youth decide that they want to downsize. Some women also have asymmetries (differences in the appearance of their two breasts). This may have been an issue from the beginning or may have developed with time. I generally tell my patients that their breasts are “sisters not twins.” If the differences are noticeable and bothersome, I will do my best to improve the appearance.
How often should women get their implants checked?
I recommend that my breast implant patients follow up with me once a year. I usually recommend that all of my patients over age 40 get annual mammogram screening, particularly if they have any family history of breast cancer. If I suspect a rupture on an exam, I will order an MRI or ultrasound imaging test.
How often should they be replaced?
While I have seen implants hold up for longer than 10 years, the average implant will last approximately 10 years. The longer the implant has been in place, the greater the likelihood of rupture. When a saline implant ruptures it is usually easily detectable as it appears deflated, but silicone implant ruptures are often harder to detect (“silent”) and may require and ultrasound or MRI to diagnose. That said, if the implants are intact and aesthetically pleasing, there is no reason to rush to remove them. There has been a lot in the news recently about ALCL, a rare lymphoma thought to be associated with textured devices. Many patients who have these devices in place are deciding to have them replaced with smooth devices.
Is a maintenance procedure different from putting implants in for the first time?
Maintenance or revision procedures are always more complicated than first time procedures. Each case is different, and the changes that need to be made are sometimes subtle and require a higher level of skill and experience. There is sometimes scarring around the implants, and the implants may not be sitting in the correct position. Secondary breast surgeries are some of my favorite procedures, because they are all about the art of plastic surgery. I love problem solving, and it is so satisfying when I can achieve the correction the patient is looking for.
What is the recovery like for a revision procedure?
I find breast surgery to be one of the less painful procedures that we, as plastic surgeons, perform, and the recovery after the second procedure is often much easier than the first, because the patient knows what to expect and the tissue is already used to having an implant in place. Also, I can often use or revise the same incisions/scars that were made the first time.
How much does a maintenance procedure cost?
This really depends on what needs to be done and how complicated the correction is. It can range from $9,000 to $15,000, depending on the individual patient circumstances. A simple size increase or exchange from a textured or shaped device to a round, smooth device is relatively uncomplicated and therefore less costly. Some of these cases require the use of cadaver tissue or placement of an absorbable mesh to create an internal bra for support. Patients may also require a lift at the same time, particularly if their breast volume has changed due to pregnancy, breastfeeding, or weight fluctuation. These cases can get more expensive. Price also varies by market. For example, New York City is usually more expensive than somewhere more rural. While price is always a factor, if the case is complicated, I tell patients not to be penny wise and dollar foolish, and to choose an experienced surgeon who can solve their problem.
Anything to add to the subject?
Breast augmentation is one of the most common procedures that I perform in my practice. Let’s be honest, “maintenance” is something we as women are very familiar with! I don’t think that knowing that implants are not lifetime devices should discourage patients from having the procedure done. Rather, I think it’s important that surgeons be honest and upfront with their patients that implants will require maintenance at some point. That way, patients are educated and prepared and know to follow up for regular examinations.
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