Revision breast surgery

Our skill and experience acquired in complex breast reconstruction is applied to all types of corrections after previous surgeries.

  • variety of techniques can improve the appearance of the breasts after failed aesthetic or reconstructive procedure
  • big, small or ruptured implants can be replaced safely
  • capsular contracture, implant bottoming out and rotation, synmastia, rippling, unsightly scars and double bubble deformity can be corrected
  • after implant-based breast reconstruction, they can be replaced with your own tissue

What is revision breast surgery?

Revision breast surgery refers to various procedures performed to reshape or improve the appearance of the breasts that have been previously operated upon. Less than ideal aesthetic outcome may result from flawed surgical plan or execution. It can be implant-related or simply a consequence of natural changes in the breast tissue such as those following the childbirth.
Most commonly revision include replacement of breast implants, reshaping of the breasts that have previously been lifted or reduced, or correction of unsightly or misplaced scars. Revision surgery can be significantly more complicated than the original surgery. It sometimes requires additional expertise from the surgeon with experience in breast reconstruction.

Who is a candidate for breast revision surgery?

The following conditions may be considered for breast revision surgery:

  • Loss of volume after augmentation with implants
  • MRI suggesting implant rupture or shell leak
  • Desire to change breast size after augmentation with implants
  • Capsular contracture (tightening of the scar tissue around the implant)
  • Implant malposition or rotation
  • Synmastia
  • Double-bubble deformity
  • Breast shape or size changes caused by skin stretch or weight loss/gain

Is implant ruptured?

Implants filled with saline (rarely used in Europe) can leak and deflate. On the other hand, rupture of implants filled with silicone gel may go unnoticed as the cohesive gels stay put under the breasts. Change in firmness and shape of the augmented breast can be very subtle. MRI (magnetic resonance imaging) is the most sensitive imaging method to confirm the suspicion of implant rupture. Most implants used in recent years come with an implant warranty issued by the manufacturer. In (unlikely) case of implant rupture the manufacturer should cover the implant replacement costs. Ruptured implants may be removed and replaced with new devices of your choice. This can usually be done without additional scars.

Are implants to small?

Before primary breast augmentation, it is essential that the patient is able to express her wishes regarding breast shape and size. The plastic surgeon will thoroughly evaluate the breasts, chest size and skin quality and help you choose the implant. If you are unsatisfied with the final size at any stage following the augmentation, the implants can be safely replaced with bigger pair. However, it is necessary to understand that larger the implants will exert more stress on the tissues. This can lead to higher incidence of size-related problems and less natural look and feel of the breast.

Are implants to big?

As with changing to a larger implant size, some patients choose to reduce their implant size after their primary surgery. The choice of an implant should be based on patient’s desires and wishes following a thorough evaluation of breast shape, dimension and tissue characteristics. If you want to reduce the size of your implants significantly, the implant tissue pocket might have to be restricted with suture placement. The breast envelope might need to be tightened and lifted with breast lift (mastopexy).

Can implants be removed?

Yes. Women want their implants removed because of implant related complications or for other reasons (increased age, personal preference or weight gain). Removal of breast implants is a simple procedure, but the contour of the breast may be relatively flat or deflated after removal of an implant. A breast lift may therefore be recommended to reshape the breast tissue and create the most aesthetically pleasing contour.

What is capsular contracture and how it is treated?

When any foreign material is inserted, the body makes a protective coating around it. In case of breast implants, this is usually a thin membrane that remains undetectable externally. However, if the reaction to the implant is greater and the membrane becomes thicker, it is referred to as a capsule. The capsule around the implant can become thickened and contracted. The newer generations of implants have features to reduce this risk. Capsular contracture presents to some extent in around 5 % of patients. It usually starts at about a year after surgery although it may take many years to become noticeable. This can lead to changes in breast firmness or if it develops fully to breast distortion and pain or discomfort. Once a capsular contracture has become symptomatic it will most likely require surgery to correct. Surgical treatment can involve either removing the entire capsule (capsulectomy) or opening the capsule by making cuts in it (open capsulotomy). The implants are usually changed for a new pair and sometimes placed to a new position – under the pectoral muscle, as subglandular placement is associated with higher risk of capsular contraction. The implants with polyurethane coating are associated with lower risk of capsular formation and are hence sometimes advised as replacement.

What is bottoming out and how it is treated?

“Bottoming out” is an unfavorable breast shape with implants descending lower on the chest wall than desired. It leads to a fuller lower pole, empty upper breast and high position of the nipples. Treatment revolves around properly diagnosing the problem. If it appears shortly after breast surgery it is likely due to over-dissection of the implant pocket. In later stages it can usually be attributed to the combination of heavy implant and weak supporting tissues. It can be treated with remodeling the pocket in which implant was placed with internal sutures (capsulorrhaphy). Sometimes the procedure has to be combined with breast lift for optimal and durable results.

What is implant rotation and how it is treated?

Sometimes the implant does not attach itself to the surrounding tissues and can rotate in the pocket. If round implant rotates it does not change the shape of the breast as it is symmetrical. However, when anatomic (tear drop) shaped implants turn in the pocket it will distort the breast to some extent. This can be treated with changing the anatomical implants with round or polyurethane-covered implants, as the later have been associated with reduced risk of rotation.

What is synmastia and how it is treated?

Synmastia occurs when the pockets in which implants were placed communicate with each other across the midline. This is not a common complication, but can occur to various levels in women with chest wall concavity as well as with the use of larger and wider implants. Usually it can be repaired with internal suturing of the pocket with or without the use of acellular dermal matrix which may help to strengthen the repair.

What is double-bubble deformity and how it is treated?

A breast with constricted lower pole has short distance between the nipple and the natural crease under the breast. When augmenting such a breast with a large implant a tight lower pole of the breast may fail to accommodate the implant and the new inframammary crease will form lower on the chest wall. If the old crease retains the memory and does not stretch there will be a visible tethering on the lower pole of augmented breast giving the appearance of a breast sitting on the implant – “double bubble”. Another scenario occurs when natural breast tissue sags over and below the high ridding implant. This sagging also called “snoopy” deformity may worsen with advancing age or following pregnancy. The treatment required depends on the cause. Treatment may include breast lift, repositioning of the implant, and creation of new inframammary fold.

What is rippling and how it is treated?

Being able to feel the implant is quite common, particularly in the lower and outer aspect of the breast. If the breast tissue covering the implant is too thin, you may see the creases on the implant through the skin (rippling). In the upper part of the breast, these are referred to as traction ripples and are classically seen if implants are placed over the muscle. Treatment is focused on trying to provide a thicker coverage. This can be attained by fat transfer (lipofilling) or lining the pocket with acellular dermal matrix. Moving the implants placed bellow the gland to a pocket bellow the great pectoral muscle will improve the rippling in the upper in medial areas.

How long will the results of breast revision surgery last?

Breast shape after revision breast surgery will remain relatively stable unless you gain or lose a significant amount of weight or become pregnant. However, it must be emphasized that gravity and aging will alter the size and shape of every woman’s breasts.

Can scars after breast surgery be corrected?

The quality of the scar is mostly genetically determined. Stretched, unsightly or misplaced scars resulting from prior breast surgery may be improved by revision. Revision of unsightly scars can be done as part of breast revision or may be the primary goal of surgery. To learn more about scar treatment and prevention, please follow the link.

Is conversion to autologous reconstruction after reconstruction with implant possible?

Some women who have implant-related complications or are not satisfied with implant reconstructions may want to have conversion to autologous reconstruction with their own tissue. Microsurgical free flap breast reconstructions have numerous benefits, described in further detail in our section on breast reconstruction. If you are a good candidate for autologous reconstruction, the conversion is possible.

How can I prepare for revision breast surgery?

Every information on your previous surgeries will be helpful in the preoperative planning of breast revision surgery. We will give you a realistic idea of what breast revision can and cannot achieve so that you can make the most informed decision. If you have recently undergone breast surgery and are looking for a correction, usually a period of more 3 months should pass before having a revision surgery.

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