Breast Implant Revision

As discussed on our breast augmentation page, maintenance involving implants after breast enhancement is very common. When a woman chooses to improve the appearance of her breasts with implants, she is also assuming a lifelong endeavor to sustain the quality of her enhanced breast profile.

If you take 100 women who have received a breast augmentation and follow them for thirty or forty years, you will find that the majority of these women will have had one or more additional surgeries on their breasts. Therefore, it is highly likely that breast augmentation patients will need implant revision surgery during their lifetime.

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What Is Breast Implant Revision?

Breast implant revision—also referred to as breast revision, revision breast surgery, and breast redo surgery—is a procedure performed to correct issues with a woman’s present breast implants and/or breast appearance following a previous augmentation. This can be due to breast implant scar contraction, hardening, rupture, or deflation of the implant; breast changes from pregnancy; a desire to exchange implants from a saline breast implant to a silicone breast implant (or silicone to saline); and/or a variety of other reasons. The goal is to improve the breast better than it was before.

Revision breast surgery often takes more skill, precision, and artistic ability than the primary breast augmentation surgery. Each case requires careful study of a patient’s needs and a personalized treatment plan in order to achieve the best outcome. Board-certified plastic surgeon Miguel Delgado, MD has extensive experience and expertise with breast implant revision, and he can guide you through the various decisions that will customize your new look.

What Are Some Common Reasons for Breast Implant Revision?

There are many reasons or conditions to have implant revision surgery. The most common ones are the following:

• Capsular Contraction – When the breast implant is inserted into the body, the body’s response is to recognize the breast implant as foreign material. In response, it forms a scar capsule that encases the implant and walls off the breast implant from the body. In some instances, an inflammatory process occurs which causes the scar tissue to thicken and constrict around the implant, making it unnaturally hard. Though theories exist, it is not known exactly what triggers this response, or why it happens to some people and not to others. The current theory is that a low-grade infection causes inflammation around the breast implant and starts the formation of scar tissue.
• Deflation or Rupture of the Breast Implant – Breast implants are human-made products that can deflate or rupture, causing spillage of the internal material.

Saline breast implants are filled with saltwater, and leakage is of no contamination problem. The loss of the water is analogous to a flat tire. Sometimes, there is a partial leak due to an incompetent valve and the implant can reseal itself.

Silicone breast implants are filled with a silicone gel of varying consistencies and cohesiveness. The most popular today is the “gummy bear” implant. The gummy bear implant has a firmer gel consistency, unlike a fluid with the consistency of syrup or honey—but a gummy bear candy! The advantage of this implant is, with a rupture, the firmer gel does not migrate out of the capsule like a more fluid gel.

The rupture occurs due to the following:

• Fatigue and break-down of the outer capsule over time
• Capsule contracture or scar tissue that compresses the implant so firmly that it ruptures
• Trauma—like a car accident with the seat-belt strap compressing the implant
• Needle insertion during a biopsy
• Silicone implant ruptures were caused by damage by surgical instruments during the initial implant surgery
• Defective implant
• Skin Laxity and Resulting Changes in Breast Shape – One of the most common reasons for revision breast surgery is due to skin laxity. The loose skin will cause the breast mound to drop slowly, and the breast tissue can slide off the ideal position to the implant. The result is a malpositioned breast implant, which only gets worse with time.

One of the more common reasons which cause skin laxity is pregnancy. The breast engorgement from breastfeeding stretches the skin to the point of rupturing the dermis, creating stretch marks. In some women, the skin can bounce back very well after the first pregnancy, especially in younger mothers. As more children are birthed, the less the skin can maintain its integrity, and it begins to sag.

In women who do not have breast implants, the breast volume can be significantly reduced with skin laxity after having children. The breast shape and size can be improved by a variety of techniques depending on the patient’s desires.

• Changes Caused by Pregnancy and Breastfeeding – Pregnancy affects the breasts in a variety of ways. Each pregnancy does not affect each woman the same way due to factors of age when having the child, the number of pregnancies, and the genetic coding of your body. In general, pregnancy will stretch out the skin, which causes the breasts to sag and to lose volume.
• Infection or Bleeding in the Early Postoperative Period – While uncommon, infection or bleeding may occur in 1–2% of patients nationwide in the early recovery period. Even though these complications are uncommon in breast revision surgery, it can set back recovery. In today’s environment, the risk of infection is high on every surgeon’s list. Dr. Delgado adds further layers of protection, including body cleansing with Chlorhexidine (which is done the first and second days before surgery), as well as a double antibiotic prep done on the operating room table. In addition, there is a 14-point plan put out by the American Society of Plastic Surgeons that he uses. These are the points:

1. IV antibiotics 15 minutes before surgery
2. Do not make the incision in the areola
3. Nipple shields (which is an adhesive barrier against bacteria)
4. Atraumatic dissection
5. Avoid bleeding
6. Avoid dissection into the breast tissue
7. Use the duel plane pocket
8. Antibiotic irrigation in the dissection pocket
9. Minimize touching the breast implant
10. Minimize the implant touching the skin (Dr. Delgado uses the Keller Funnel)
11. Changing the surgical gloves before inserting the implant
12. Do not use drains
13. Layered suture closure
14. Use antibiotic prophylaxis to cover subsequent surgical or dental procedures

Dr. Delgado follows all of these guidelines, which helps significantly minimize bacterial infection, capsular contracture, and bleeding.

• Desire to Be Larger or Smaller
• Implant Switching from Normal Saline to Silicone (or Vice Versa)
• Breast Asymmetry or Implant Malposition
• Implant Rippling
• Desire to No Longer Have Breast Implants
• “Breast Implant Illness”
• Symmastia
• Double Bubble Deformity

What Are My Breast Implant Revision Options?

There are various surgical options for breast revision, and the most appropriate technique will depend on the specific needs and goals of the patient. Below, we have highlighted the typical approach to breast implant revision based on several common reasons for seeking surgery.

• Breast Capsular Contracture – Patients with breast implant capsular contracture usually have the scar tissue and implant removed and the implant replaced. The replacement of the implants may be with the same size, larger, or smaller breast implants. The en-bloc implant removal is the best approach for this situation.
• Breast Implant Rupture or Deflation – A damaged implant needs to be removed. If it is a silicone implant, the silicon gel needs to be meticulously cleaned out. If it is deflation of a saline implant, there is no issue but to remove the empty silicone shell. In this situation, the implant is most commonly replaced, but another option not replacing the implant. If the decision is to not replace the implants, then a breast lift may be an option if the breasts have moderate to severe laxity.
• Desire to Be Larger or Smaller, or to Exchange Implants – This is not an uncommon scenario. This is a very simple procedure as long as there are no other complicating factors. The procedure is just as simple if one wants implant exchange from normal saline to silicone and vice versa.
• Breast Asymmetry or Malposition – This is a situation when the breast has an altered shape due to a change in the position of the implant. It could be one or both implants which require correction. This usually requires an alteration in the breast capsule to hold the breast in the proper position. Acellular Dermal Matrix (ADM) is sometimes used as an internal bra to hold the breast position. The correction of double bubble or symmastia fall into this category.
• Breast Implant Rippling or Wrinkles Around the Edges – This is a very common problem with normal saline breast implants. It is a product issue and not a complication of surgery. The problem is compounded in patients who have thin breast tissue, the implants being placed on top of the muscle, and if the implants are under-inflated. The easiest and most common solution is replacement with silicone implants.
• Desire to No Longer Have Implants – This is seen not uncommonly when a woman reaches an age where the implants are becoming a burden, such as now too large and heavy for her body, interfering with activities, or an issue has occurred and taking them out is the best option. In addition, Dr. Delgado is seeing more patients who complain of “breast implant illness” symptoms and want the implants removed.

How Do I Prepare for Breast Revision Surgery?

A personal consultation is the first step for every patient considering breast revision surgery.

Dr. Delgado will ask you to discuss your concerns about your appearance. He will go over your breast surgery history in great detail to understand the previous procedures. During this meeting, he will discuss your current conditions and what goals you wish to achieve. A physical examination will be done and your medical history reviewed to determine if surgery is the best option for you. If you are a good candidate, Dr. Delgado will explain:

• The best surgical options for your goals
• If a breast lift is advisable with the implant
• Locations of the incisions
• The pros and cons of saline versus silicone implants
• How to correct the double bubble, breast capsular contracture, etc.

Dr. Delgado will want operative reports, if possible, and the breast implant cards you were given at the time of your breast surgery. Blood tests done within six months of your surgery date are required to assure Dr. Delgado and the anesthesiologist that surgery is a safe option for you. These include a CBC (Complete Blood Count) and possibly other tests, depending on your medical history. If you are 40 years old or older, a current mammogram is required, and if you are 50 years old or older, an EKG (Electrocardiogram) is required.

You will be given a preoperative instruction booklet that will explain your medications and any preparations that you need to make at home. This booklet supplies you with a list of aspirin and aspirin-containing compounds, including anti-inflammatory products, all of which must not be taken within the period of two weeks before and two weeks after surgery. This precaution is taken to avoid excessive bleeding during and after surgery. Tylenol may be safely taken during this time; however, do not exceed 1 gram over 4 hours or 4 grams per day from all sources, since this can cause liver damage. You will also be given a list of vitamins and homeopathic medications that you can opt to take prior to and after surgery to minimize bruising.

What Is Recovery from Breast Implant Revision Surgery Like?

The first few hours after breast implant revision will be spent in the recovery room at Marin Cosmetic Surgery Center. When you are fully alert, you will be able to go home with the assistance of a friend or family member. For the next week, it is important to sleep with your head and back elevated to reduce swelling in the area. Two days after surgery, you may take off the dressing and take a shower. If drains are placed, a shower should not be taken until 24 hours after the drains are removed. Drains are usually removed after three days. Revision breast surgery is usually more uncomfortable than primary breast augmentation, especially if the breast capsule is removed or the muscle is manipulated. Pain medications are taken for a few days to manage comfort. Sometimes patients will opt to have an Exparel long-acting pain injection, which can last up to four days.

The recovery period is generally seven to ten days. Once the bruising and tenderness are gone, you will likely be able to return to your normal activities. Most patients can drive a car and return to work or social activities after a week. Strenuous exercise should be avoided for four to six weeks following surgery, as it can cause uncomfortable swelling to occur.

Will I Have New Scars from Breast Implant Revision?

As with any surgery, incisions or scars are a part of the breast revision process. Dr. Delgado is very concerned about incisions and most often uses the incisions from the previous surgery. During this process, the previous scars can often undergo a scar revision. New incisions may be required if a breast lift is added, and Dr. Delgado provides a scar management program to improve the long-term outcome of these incisions.

Are There Potential Risks & Complications with Breast Implant Revision?

The risks and complications of revision breast surgery are the same as breast augmentation; except if a breast lift is done, more scar management is required. Each year, thousands of women have secondary breast implant surgery. It does not guarantee that you will never need another revision procedure in the future. As with all surgery, the risks of bleeding, infection, and anesthesia exist. Additional complications specific to breast revision include deflation or rupture of the implant. In addition, capsular contraction can still occur, and there may be a slightly higher chance of it reoccurring in those patients who have had previous breast capsular contracture. Breast redo surgery can be extremely complicated. The surgery is usually dealing with a very complicated issue and compromises must be considered. Dr. Delgado will go to great lengths to explain the possibilities and perform at the highest level.

What Kind of Results Can I Expect from Breast Revision Surgery?

The results of breast revision surgery are different for each and every patient. Dr. Delgado is very specific with a targeted surgical plan based on your unique needs. He is very realistic as to what can be achieved and will explain the most challenging aspects of your surgery. The pros and cons are discussed regarding each detail of this complex surgery.

As a breast revision specialist, Dr. Delgado has a very high rate of patient satisfaction and sees overwhelmingly happy patients on a daily basis.

What Is the Cost of Breast Implant Revision Surgery?

The specific concern(s) treated and surgical technique utilized for breast implant revision will determine the cost.

If the correction is capsular contracture caused by scarring, the cost of breast implant revision is generally about $8,000–$10,000 to remove the scar tissue and replace the implants. Some women may need a breast lift in addition, and then the cost may be as much as $10,000–$12,000; but if it is for removal only, then approximately $2,500.

If the breast implant is ruptured or deflated within the warranty period, the implants are at no cost and $1,200–$2,500 will be awarded to offset the expense of revisional surgery. Your out-of-pocket expense will be reduced significantly.

An additional cost for breast implant revision may be the use of Acellular Dermal Matrix for reconstructing the implant pocket. This is very expensive ($3,000 per sheet) and is only advised when necessary.`

En bloc breast implant removal is also more expensive than simple implant removal. The en bloc procedure takes much more time because the scar capsule needs to be carefully removed from the chest wall.

Additional Breast Revision FAQs

How long do I need to wait after my initial procedure before undergoing breast implant revision?

When breast implant revision surgery can be performed really depends on the problem. As a general statement, six months is usually a good time frame. The scar tissue has softened and the final outcome of surgery will be seen. This could be longer in some cases, like infection.

What surgery is needed for a breast redo?

Depending on what the complication is, if it is scar tissue around the implant known as capsular contraction, the scar tissue will be removed surgically and the implant must be replaced. If the implants have ruptured or deflated, then the implants must be exchanged. If the breast tissue becomes loose from pregnancy, the patient may need a breast lift or a larger size implant. These are some of the more common scenarios.

Can the breast implants just be removed?

You can always remove the implants. However, your breasts may look aesthetically unacceptable and deflated. A breast lift may rebuild the breasts to a very nice shape and volume, but only if there is enough breast tissue.

If I have a problem after breast implant surgery, do I need to have a revision?

When breast augmentation surgery is performed, a revision will be required in nearly 100% of patients over a lifetime. Many patients live with breast issues and have breast revisions when they can afford the surgery or when the issue becomes too uncomfortable or aesthetically unpleasing.

The exception is a rupture of a silicone implant and deflation of a saline breast implant. The silicone breast implant releases silicone slowly. Even though the present-day silicone breast implants have “conforming gel,” which is more like the consistency of firm Jell-O, it should be removed as soon as possible to prevent the spread outside the breast capsule and into the breast and surrounding tissue.

Is there a manufacturer warranty for failed implants?

Yes. Mentor Implants, which are the type that Dr. Delgado uses, has lifetime replacement for failed implants and a ten-year warranty for compensation toward replacement surgery. Also, the patient can purchase an extended warranty for $100, which increases the amount of compensation towards surgery. Allergan also produces a great breast implant product with a wide variety of sizes and shapes as well as Mentor, with their own warranty.

Should I go back to my original surgeon?

Possibly—the surgeon’s experience required for revision breast surgery is critically important. Be aware that revision surgery is much more complex and necessitates more skill than the original surgery. If your surgeon is a board-certified plastic surgeon certified by the American Board of Plastic Surgery, this is a good start. If your surgeon is confident in the correction required and you are comfortable and confident in his or her skills, then “go for it.”

Dr. Delgado has performed hundreds of breast enhancement surgeries, with about 40% being revision cases. He is very confident in his artistic eye and surgical skills.

Is it possible that a second breast revision surgery may be needed?

Yes, very possible. If a woman has breast augmentation surgery in her early 20s and lives to be 80 or 90 years old, if you do the math, you can see it is very possible.

How painful is breast implant revision?

Breast redo surgery is more complex than the initial surgery; therefore, it may be more uncomfortable, especially if scar tissue needs to be removed and/or a breast lift is required.

How long will I need to take off work and exercise?

If your work does not require any heavy lifting, it is often possible to return by the end of the second week. Usually one can drive after a week if no longer taking pain medication. You will need to wait to resume exercise for about five to six weeks.