{"id":45,"date":"2021-12-01T20:47:29","date_gmt":"2021-12-01T20:47:29","guid":{"rendered":"https:\/\/new.drdanamd.com\/?post_type=procedures&p=45"},"modified":"2026-06-01T04:12:04","modified_gmt":"2026-06-01T09:12:04","slug":"breast-augmentation-revision","status":"publish","type":"procedures","link":"https:\/\/www.drdanamd.com\/procedures\/breast\/breast-augmentation-revision\/","title":{"rendered":"Breast Augmentation Revision"},"content":{"rendered":"

If you’re considering breast augmentation revision surgery do to unsatisfactory surgical results, implant rupture, or breast augmentation surgery complications you are not alone.\u00a0 The truth is that most women decide to have multiple breast augmentation surgeries in their lifetimes for many different reasons. Many patients have come to our practice feeling hopeless, but I assure you there are options that meet and often even exceed their expectations. Ultimately, having a female plastic surgeon who understands your desired results, connects with you emotionally, and makes you feel safe can have a tremendous impact.<\/p>\n

Breast implant revision surgery commonly involves removal or replacement of existing implants, and sometimes includes surgery on the breast or the scar tissue layer surrounding the implant, which is called the capsule. Most patients are vaguely aware that their implant may need to be replaced at some point, but many are confused about when or why repeat surgery is really needed.<\/p>\n

First, I want to distinguish between patients who \u201cwant\u201d revision surgery and those who \u201cneed\u201d it. Those who \u201cwant\u201d repeat surgery are not experiencing any complications and simply desire a different look, such as a bigger size or adding a breast lift after having kids.<\/p>\n

Those who \u201cneed\u201d surgery have a complication related to what the surgeon did, something done wrong during recovery (not following restrictions), or just because of bad luck (some complications happen no matter how careful the surgeon and patient are).<\/p>\n

Watch our video<\/a>
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What is a normal breast capsule<\/p>\n

Before I write about what can go wrong and how to fix it, I\u2019d like to explain the details of a \u201cperfect\u201d breast implant surgery result. Ideally, the breast implant should add volume to the breasts without the edges of the implant going too far beyond the \u201cfootprint\u201d of the breast on the chest. The footprint refers to the outline your breast takes up on your chest from where it starts under your collar bone to the fold underneath. The textbooks state that 45% of the implant volume should be above the nipple and 55% should be below, but some people have different preferences that vary from 30-60% of the fullness above the nipple. Finally, the implants should remain soft and slightly mobile on the chest, but maintain a stable position during movement.<\/p>\n

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Breast Augmentation Revision Before & After<\/span>
\nIndividual results from procedures cannot be guaranteed, and may vary between patients.<\/p>\n

Things that go wrong during surgery or recovery<\/h3>\n

Choosing the wrong implant \u2013 Most patients can get a great result with a wide variety of implants, but there are certain situations in which the choice of implant has a big impact on the chances of developing a complication. For example, 500mL saline implants, filled just to capacity, placed above the muscle in a thin skinned woman will put her at much higher risk of capsular contracture, rupture, and rippling compared to 350mL silicone implants placed under the muscle. Understanding how the breast, chest, and body measurements suggest specific implant types and sizes is called Bio-dimensional planning, and it is important if you want the lowest chance of short and long term complications.<\/p>\n

Incorrectly placing the implant – As discussed above, the \u201cideal\u201d breast has certain proportions of volume above and below the nipple, and essentially, the nipple should be in the middle of the breast. If the implant pocket is made too high, too low, too far in or out, or in the wrong position relative to the nipple, then the final result will not look good, and there may be asymmetry from side to side. Implants can also displace due to over-activity in the recovery period, non-compliance with garments, and factors outside of the surgeon\u2019s or patient\u2019s control, like poor elasticity of the tissue or a complication like bleeding or fluid collection.<\/p>\n

Just as implants can be placed in the wrong position relative to the nipple, there can be problems with how implants are positioned relative to the muscle. Patients with thin tissue should have their implant placed under the muscle to minimize visibility of the implant edges. If there is any sag to the breast, implants are placed partially under the muscle and partially behind the breast tissue (called dual plane) to allow sagging breasts to be filled out by the implants. If the surgeon releases too much muscle, the natural division between the breasts can be lost (\u201csymmastia\u201d), the fold can become disrupted (\u201cbottoming out\u201d), or you might be able to see muscle contractions across the breast during chest movement (\u201canimation deformity\u201d). Sometimes these complications happen because of factors outside the surgeon\u2019s control, but sometimes the surgeon\u2019s planning or technique are factors.<\/p>\n

Implant related complications<\/h3>\n

Capsular contracture \u2013 Normally, within 6-8 weeks after surgery, implants develop a thin layer of scar tissue called a capsule around themselves. This is a normal reaction to a foreign object being in the body. In some people, one or both capsules thicken and tighten over time. This can cause the breast to become uncomfortable and can even cause the implant to seem to move higher on the chest. At times, the breast will contract with it, masking the amount of sagging to the breast. In other cases, the breast tissue will sag off the higher implant making the breasts look droopier than they actually are. In the worst cases, the shape of the breast can be completely distorted. Up to 25% of women with implants will get mild cases of capsular contracture that will not be noticeable to others and sometimes even themsleves, but about 5-10% of patients will decide to have repeat surgery for noticeable capsular contracture.<\/p>\n

We know that capsular contracture is due to a heightened response by the immune system, so some people are more prone to it than others, although this can\u2019t be predicted before surgery. Because the process is similar to the body\u2019s response to any kind of inflammation, any blood or fluid around the implant after surgery can increase the chances of capsular contracture. That is why it is important for surgeons to be meticulous about controlling bleeding during surgery and for patients to follow all post op instructions carefully. The main culprit behind capsular contracture seems to be a low grade bacterial presence around the implant. Antibiotic irrigation and IV antibiotics during surgery are helpful in preventing contamination, but bacteria can get near your breast implants even after surgery any time they circulate in your bloodstream, such as during a dental procedure or during a bad infection elsewhere on the body.<\/p>\n

For mild or early cases of capsular contracture, there are some early studies that suggest that the asthma medication Singulair can be effective at stopping the progression and occasionally reversing capsular contracture. For my patients, I have found that about 30-40% of them feel like the medication helps soften the breast or improve implant position.<\/p>\n

However, for significant cases, surgery is needed. Due to the concern for continue bacterial contamination, the best approach includes complete removal of all the existing capsule of scar tissue. This can make for a long surgery, but if capsule is left in place and just scored to make more room for the implant, the chances of recurrence are quite high, and it usually happens within a year after surgery. After the capsule is removed, the pocket is washed multiple times with antibiotic solution, and a new implant is placed. For the best chances to avoid future capsular contracture, acellular dermal matrix (or a tissue sling) is added to cover the implant and help act as a mechanical tissue barrier to the reformation of abnormally thick implant capsule. This approach is supported by data showing lower capsular contraction during breast reconstruction surgery as well as by surgeons performing cosmetic revisions.<\/p>\n

Finally, the form stable implants have the lowest rates of capsular contracture, and implants under the muscle have lower rates of capsular contracture, so discussion will be undertaken about the best choice for revision.<\/p>\n

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Breast Augmentation Poor Results with Revision, Before & After<\/span>
\nIndividual results from procedures cannot be guaranteed, and may vary between patients.<\/p>\n

Rupture<\/h3>\n

Rupture rates are about 1% per implant per year for silicone gel implants. Implants over 500mL and saline implants (especially when \u201cunderfilled\u201d, meaning not filled to maximum capacity), have higher rupture rates. Form stable implants (also called Gummy Bear, 410, or CPG implants) have lower rupture rates.<\/p>\n

When saline implants rupture, all entire implant empties within 12-24 hours, although slow leaks are possible. The fluid is absorbed by the bloodstream like IV fluid, and the solid shell remains in the scar tissue capsule that surrounded the implant. If the implant is not replaced within a few weeks, the capsule will begin to shrink down and possibly even adhere to itself internally if left long enough. This can make replacement surgery slightly longer and potentially more complicated.<\/p>\n

When a silicone implant ruptures, most commonly the gel stays within the capsule and the breast neither looks nor feels any different. Over many years, the capsule can react by forming calcium deposits or developing capsular contracture, but this does not always happen. Rarely, after a few years, the gel can work its way through the capsule to contact the breast tissue. In general, a new capsule will form and separate the gel from the breast, but it is possible for the gel to be incorporated into the breast tissue, making complete removal very difficult.<\/p>\n

Grafts and Mesh<\/h3>\n

Many women who are seeking breast augmentation or breast lift want as much upper pole fullness as possible. For some women, the use of an internal bra (also known as a graft or sling) can help maintain the position of a breast implant or the breast tissue after surgery.<\/p>\n

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What are Dermal Slings?\u00a0<\/b><\/h3>\n

When grafts or slings were first used in breast surgery, the most common type was a dermal allograft. This was skin from a cadaver that was processed to remove all living cells. Human and animal versions were created, and common ones were Alloderm (human), Strattice (pig), and Surgimend (cow). These products added support to surgery and coverage of implants when muscle was not available, but they had complications. Patients had a higher number of seromas (fluid collections around the implant), and some women developed an immune reaction called “red breast”.<\/p>\n

Surgeons also used these grafts to reinforce weak abdominal muscles or to help in hernia repair. These were an alternative to non-dissolving or permanent mesh grafts (the kind you see the lawyers advertising about lawsuits on TV).<\/p>\n

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What are bioabsorbable Mesh slings?<\/b><\/h3>\n

Newer grafts\/slings are now made of the same material as absorbable\u00a0sutures. They dissolve and are incorporated into the body over 12-18 months. Examples are Galaflex and Durasorb. The complication rates are lower than the dermal slings since these grafts are thinner and finely meshed to decrease the chances of fluid collections and non-absorption of the graft.<\/p>\n

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Who benefits from using mesh?<\/b><\/h3>\n

Using mesh in patients after massive weight loss or with significant stretch marks can prevent the tissue from stretching after surgery by up to 20%. This can also help maintain the position of a breast implant.<\/p>\n

Mesh can be helpful in breast implant revision surgery. If the pocket needs to be changed from above the muscle to below, the sling can help cover the bottom half of the implant and prevent it from moving into the old pocket. Grafts can also help correct inferior or lateral malposition, which means the implants sit too low or fall to the sides. Grafts can be critical for correcting symmastia (aka uniboob). The only limit of the grafts is that they are sutured to the body, and in some cases the graft can stretch away from the body and not function properly.<\/p>\n

Mesh can also be helpful in cases of capsular contracture. After the thickened capsule is removed, the graft can help stabilize the position of the implant until the new capsule forms. Also, some studies show decreased rates of capsular contracture recurrence when grafts are used.<\/p>\n

Does everyone need a sling?<\/a><\/b><\/h3>\n

Many patients have strong enough tissue that a sling is not necessary. Given the cost ($1000-2500) I tend to offer grafts to the patients who might benefit from it the most.<\/p>\n

Fat Grafting with Breast Reduction<\/h3>\n

Any patients choosing breast reduction are not only looking for relief from physical discomfort, but also hoping to achieve a more youthful, balanced breast shape. In select patients, breast reduction can be combined with fat transfer or internal grafting techniques to further enhance contour, structure, and long-term support.<\/p>\n

Fat transfer<\/a> uses a patient\u2019s own fat \u2014 commonly harvested through liposuction from areas such as the abdomen or flanks \u2014 to add subtle fullness and improve contour in specific areas of the breast, particularly the upper pole or cleavage area. This technique can help create softer, more natural transitions and enhance overall breast shape without the use of implants.<\/p>\n

For patients with thinner tissue quality, significant skin laxity, or heavier breast tissue, internal support grafting may also be recommended. Often referred to as an \u201cinternal bra,\u201d grafting materials can provide additional structural support to help maintain breast shape, improve implant or tissue positioning when applicable, and support longer-lasting results after surgery.<\/p>\n

Every breast reduction procedure is highly customized, and during your consultation to determine whether fat transfer or grafting techniques may help optimize your final outcome.<\/p>\n

Male Breast Reduction or Gynecomastia<\/h3>\n

Male breast surgery, including male breast reduction, chest liposculpting, and pectoral implants is becoming more popular than ever. Male breast reduction surgeries offer one of the highest patient satisfaction rates we see. The freedom to feel great with your shirt off increasingly makes Gynecomastia Surgery one of the fastest growing procedure rates for patients undergoing cosmetic surgery in Florida. In fact, gynecomastia is often the main reason men seek out these procedures.<\/p>\n

Gynecomastia refers to male breast enlargement caused by excess breast tissue. This excess breast tissue can range from a small amount of firm tissue, which may cause discomfort around the nipple to larger amounts that create a female like breast appearance. Excess fat and skin and an enlarged areola can also contribute to an undesirable appearance. It\u2019s important to know that gynecomastia can affect men of all ages.<\/p>\n

The Guide To Male Breast Reduction\u00a0<\/a><\/p>\n

Can Breast Tissue Grow Back?<\/a><\/p>\n

Contact Us to Learn More<\/a><\/div>\n

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More questions to consider when deciding to have breast Revision surgery<\/h3>\n