For a range of reasons, women will sometimes either want or need to have breast implants from a previous breast augmentation replaced with newer implants. Additional work may also be done to improve breast appearance, or correct problems that developed over time as a complication of surgery. This is called breast implant revision.
Breast implant revision can be useful for women whose original implants were placed for either cosmetic or reconstructive reasons. For some women, having a breast lift or breast reduction at the same time as implant revision surgery might be the best option for rejuvenating the appearance of the breasts.
Breast implant revision is a specialized plastic surgery technique that must be customized for each woman’s situation. When breast implant revision surgery is requested, a good plastic surgeon will listen to your vision for your body and discuss which new implants and a combination of surgical techniques will give a result that suits your needs.
Dr. Ginger Xu uses her technical education and understanding of aesthetics to make sure each woman’s appearance will ultimately align with her own unique sense of self. Dr. Xu is a Board-certified plastic surgeon with specialty training in aesthetic plastic surgery at Harvard and is now based in the San Francisco Bay area.
Breast implant revisions can involve:
- Replacing the original breast implant with a new version of an implant
- Replacing the original breast implant with a different sized or shaped implant (either larger or smaller, and either more or less projected)
- Replacing the original breast implant with an implant filled with a different material (eg. replacing a saline-filled implant with a silicone gel-filled implant or vice versa)
- Reshaping the breast to enable repositioning of the new implant
- Changing the overall appearance of the breasts – for more significant changes in size or appearance, this can involve breast lifts or reductions at the same time as an implant revision
- Correcting asymmetry of the breasts, areola shape, or nipple position
- Releasing and removing scar tissue that can distort the breast shape and also be a cause of pain or tightness
Breast implant revision is a perfectly valid choice women can make for either cosmetic or reconstructive reasons.
With time, the breasts and skin naturally change and the look and feel of breast implants can also change. Some women choose to have implant revision to improve the aesthetics of their breasts. Breast implants are also inserted for reconstruction after cancer or other medical conditions and so revision after breast reconstruction is also a possibility.
As time passes, some women feel the appearance of their breasts no longer matches their goals for their bodies. Women can choose implant revision for a range of cosmetic reasons including:
- Changing the size of their breasts
- Changing the shape and projection of their breasts using a different style of breast implant
- Wanting to change the feel of the breasts – silicone implants can have a more natural feel compared with saline implants
- Being dissatisfied with the results of a previous breast augmentation procedure with another surgeon
- Wanting to improve age-related changes – sagging breasts and skin can cause implants to move downwards on the chest
- Downsizing the breasts after weight gain – women find their breasts become larger than they anticipated and would like to adjust the appearance of their breasts
- Improving changes to the breasts after weight loss
Dr. Xu can help you to choose the technique or combination of techniques (eg. a breast lift or reduction at the same time as the implant revision) that will give an appearance as close as possible to your vision for your body.
Women should consult a plastic surgeon if they feel any tightness or pain related to breast implants, if their breasts start to appear distorted or deformed over time, or if they experience any problems at all related to breast implants. Breast implant revision will address problems associated with an implant or previous implant surgery including:
- Implant rupture or leak – including “silent rupture” which occurs with silicone implants
- Sudden deflation of the breasts – loss of fullness especially in the upper part of the breasts which occurs with saline implant rupture
- Capsular contracture – excess scar tissue forms around the breast implant which contracts and hardens with time causing tightness, discomfort, pain, breast deformity, and often presents as a hard, painful implant
- Implant malposition – one or both implants are in the wrong position and make the breasts appear distorted
- “Bottoming out” – the implant moves downwards while the nipples remain high
- “Double bubble” – a crease is seen across the lower part of the breast
- “Waterfall deformity” – the implant sits high on the chest while the natural breast tissue descends with time and appears to be hanging or falling off of the implant
- Rippling – visible folds and wrinkling of the implant surface that are seen through the skin
- Symmastia – rarely, the two pockets of tissue holding the breast implants merge to create one pocket and give the appearance of a single breast in the middle of the chest
It is very important for women to be properly counseled regarding implant size before surgery. Women often have breast implants placed that are too large for their bodies. This may initially look pleasing but over time, there can be long term consequences that are irreversible and difficult to correct.
A very large implant in a patient with a small chest will sometimes cause the skin to stretch too much and result in permanent stretch marks. It can also cause undesired areola enlargement. The pressure of the implant against the chest wall can also cause chest wall deformity and indentation of the rib cage, with a scooped-in appearance that is only seen if the implant is removed. The pressure from the implant can even result in a loss or atrophy of natural breast tissue. As a result, if the woman ever requires implant removal in the future, she may not be able to return to a normal appearance.
Dr. Xu is passionate about preventing these types of problems in women seeking breast augmentation or breast revision surgery. It is of paramount importance to her that all issues like this are reviewed and discussed, so each woman can make the best decision for her body.
Breast revision surgery is a complex procedure best performed by a surgeon with excellent skills. The technique or combination of techniques needed will depend on the reason for the revision.
Implant replacement involves removing old breast implants and replacing them with newer ones of your choice. This can result in cosmetic improvements or it can correct problems from previous surgeries. Dr. Xu will discuss any changes you would like in the size and shape of your breasts and the options available with newer models of implants. For women who have experienced a rupture or leakage, implant replacement can also maintain your breast size and shape.
Capsulectomy refers to the removal of internal scar tissue (breast capsule) that has formed around the implant. This is usually the solution to improving breast shapes that appear contracted and distorted due to the capsule. This can also relieve the source of implant hardening, tightness, deformity, and pain.
Acellular dermal matrix or surgical scaffold can help to support the breast to hold a new implant in position. The surgeon typically places this material on top of the implant but under the breast tissue to provide support. These are sterile medical products and help surgeons to decrease the risk of a number of problems such as:
- Capsular contracture – can protect the implant from being surrounded by scar tissue
- Rippling – gives added thickness over the implant in addition to the tissues over the breast
- Implant malposition – can support the implant and prevent it from Dr.ifting out of position
Breast Skin Reshaping involves removing or re-shaping breast skin to improve the appearance and contours of the breasts. This can be a critical step in helping you to achieve your goals for your breasts. Examples are breast lift, breast reduction or nipple and areola surgery which might be performed in addition to implant revision surgery. This can help improve breast shape as well as symmetry.
All of these potential procedures must be customized to each woman’s individual body type and needs, and are best performed by a board-certified plastic surgeon like Dr. Xu who has specialty training in aesthetic surgery and experience in complex breast techniques.
Even before you arrive for your consultation, it is very important for you to think about your goals and be ready to discuss this. Dr. Xu will then perform a careful assessment and explain how your previous implant surgery, age, breast size, breast shape, and skin affect the choice of the new implant, the surgical techniques required, and the results you can achieve.
Dr. Xu understands how women’s preferences for their bodies can change with time. She will design a customized surgical plan and guide you on selecting new implants for the look you want.
Before you agree to a surgical approach, you should have a realistic understanding of:
- Which implant will be used
- How your breasts will look after surgery
- Where your nipples will be positioned
- The limitations of the surgery
- Any short- and long-term effects such as scarring
- Any possible complications
- The potential need for more breast surgery
The surgery will involve:
- General anesthesia
- Incisions – see below for the potential types of incisions
- Removal of the old implant
- Reshaping of breast tissue to create a pocket to hold the new implant
- Replacement of implants – this might involve a surgical support scaffold (see above)
- Sutures to close the incisions and Dressings to protect the area
You may have new scars, or Dr. Xu may be able to use your existing scars. The degree of new scarring depends on:
- The original surgery and scarring pattern
- Which surgery or combination of surgeries is needed for the breast revision
- Whether a new incision allows the surgeon to have better access to place a new implant or reshape the breast
- Around the nipple (periareolar) – where the areola border can help to hide the scar
- The crease under the breast (inframammary fold) – this gives the easiest access for placing implants, allows placement of larger silicone implants, and the scars are almost invisible
- A combination of two incisions – one around the nipple and one extending vertically from the areola to the crease under the breast
- A combination of three incisions (Wise pattern) – one around the nipple, one extending vertically from the areola to the crease under the breast and one extending horizontally along the breast crease
Breast implants are medical devices and manufacturers and surgeons are constantly working to provide better results for people wanting their first breast augmentation or breast augmentation revision.
There have been dramatic improvements in the past few decades, and even in recent years, as newer generations of silicone are being developed and released on to the market. This has resulted in improved outcomes and improved device longevity. The gel is also more cohesive and less likely to migrate in scenarios of implant rupture or leak. Newer implants also have improved elasticity, shell strength, and a variety of other characteristics that make them feel more natural and life-like.
Even with the latest advancements to implant technology, it is important to understand that breast implants are not guaranteed to last a lifetime. While newer generations of implants are more robust than older models, future surgery may still be needed to replace an implant if a rupture or leaking develops. After the placement of breast implants, it is a good idea to have regular breast exams to check the condition of your implants.
Saline implant rupture would result in obvious deflation and a change in the size of the affected breast. But silicone breast implant rupture is often “silent” and undetectable by the woman or even by a physical exam. In this scenario, an MRI is a useful tool that can detect silent rupture. Currently, the Food and Drug Administration (FDA) recommends MRI screening for silent rupture three years after receiving a silicone implant and every two years afterward.
Breast implant manufacturers in the US have warranties. For the latest details, ask your surgeon or search the manufacturer’s website:
- Allergan® Natrelle® ConfidencePlus® Warranty Program and Natrelle® ConfidencePlus® Premier Breast Implant Warranty
- Mentor® – Saline-filled Breast Implants Warranty and MemoryGel® Breast Implants Warranty
- Sientra® – Platinum20TM Limited Warranty and Lifetime Product Replacement Program
This a personal choice for each woman to make and Dr. Xu will help guide and support your decision. Modern silicone gel-filled implants are safer than ever before, and give a more natural shape and feel than saline-filled implants. It is important to remember that saline-filled implants are not silicone-free – they also have a silicone shell.
Women might have had a saline implant originally inserted because they:
- Were between 18 and 21 years of age when they had their implants
- Had their implants placed during the moratorium on silicone implants in the 1990s
- Wanted to be able to detect implant rupture or deflation right away
- Chose a saline implant for other reasons
A saline-filled implant is a viable option but, especially in thinner women, saline implants:
- Are more likely to result in rippling
- Make implant deflation appear more obvious
- Can have a less natural look and feel than silicone implants
Yes, you can absolutely choose to change your implant size. In fact, breast implant revision surgery is a great opportunity for women to make these types of changes. Choosing the size of your new implants is one of the most important decisions you can make for breast revision surgery. Dr. Xu will help guide your decision, but ultimately supports women to make their own choices about their own bodies.
The condition of your skin and breasts before surgery will play a role in what implant size will give you optimal breast aesthetics. For example, if your skin is loose and stretched, a larger implant may help lift your breasts while a smaller implant might leave your breasts looking deflated. On the other hand, an implant too large for you may result in unsightly stretch marks and thinning of your natural breast tissue. If you prefer a smaller implant but have skin excess, Dr. Xu might then recommend a breast lift or other procedure to give you aesthetically pleasing results.
Dr. Xu will review these types of nuances with you at the time of consultation. She will also recommend a balanced surgical plan that helps achieve your goals in a safe way.
What If I Just Want My Implants Removed? Do I Always Need to Have My Implants Replaced in Breast Implant Revision Surgery?
Breast implant removal is always an option. If that is your preference, it is important to understand that your breast skin will usually have stretched to accommodate your original implant. Once the implant is removed, your breasts will appear deflated. The level of deflation will depend on the size of the original implant, how much your skin stretched in response to the implant, and how well the skin is able to shrink back after the implant is removed. In addition, very large implants may have also placed pressure against your chest causing some rib cage indentation as well as loss or atrophy of natural breast tissue. Some women are very unhappy with their appearance after implant removal alone, and this can be a source of depression.
As with all breast surgery, the options available should be customized for your needs and anatomy. During a consultation for breast implant removal, Dr. Xu will discuss the potential of a breast lift. This can help restore a more shapely and youthful appearance to the breast which may otherwise sag due to skin excess. In some cases, a smaller implant will help camouflage emptiness and deflation in the upper breast after the removal of a larger implant.
In addition to breast revision surgery, some women will take this opportunity to enhance other areas of their bodies. This can be achieved with additional body contouring around the chest and torso, or perhaps even rejuvenation of the face. Liposuction is the most commonly requested addition to breast surgery. If this is of interest to you, Dr. Xu can examine your entire body with an artistic eye and let you know if liposuction or other procedures can enhance your results.
Areas that can be shaped and contoured with liposuction and other rejuvenating procedures during breast implant revision surgery include the:
- Outer regions of the breast – liposuction of “bra side rolls” as well as “axillary fullness” near the armpits improves the contour of the whole breast and chest area
- Back – liposuction of fat from back rolls
- Abdomen – liposuction in this area can be done alone or as part of a tummy tuck or mommy makeover
- Face and neck – modern facelifts and neck lift techniques give natural-looking results for people who would like to rejuvenate their faces – liposuction can be done to the neck as well
Dr. Xu understands the responsibility of transforming a woman’s appearance to better reflect her identity and build self-esteem. Her top priority is understanding your vision and desires.
Once Dr. Xu has examined your body, implants, breasts, and chest, she will use her artistic sense and technical expertise to recommend an approach to your surgery that will best suit your goals.
During a consultation, Dr. Xu will explain:
- The different types of breast implant available
- Which implants will best meet your needs
- Whether you would benefit from other procedures such as a breast lift or reduction
- Why your exact breast size after surgery cannot be guaranteed
- What types of incisions will be needed
- How much new scarring you can expect
- How other surgeries (eg. tummy tuck, mommy makeover) can fulfill your vision for your body, if that is your preference
- Any potential need for further breast surgery
- Potential complications or side effects – nipple sensation and ability to breastfeed may be affected
- What to do during the recovery period
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least 6 weeks prior to surgery.
You may need to get a blood test or undergo additional workup depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
- Making sure you get enough sleep and rest
- Eating a healthy diet with adequate protein and nutrition
- Exercising or engaging in physical activity to strengthen your body
- Maintaining a positive state of mind
- Prioritizing your well-being and reducing stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
After your breast implant revision surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:
- The surgical approach used for your breast revision surgery
- Whether you have had other surgeries completed at the same time (eg. tummy tuck)
- Your age
- Your health before the surgery
Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
Recovery typically takes approximately two weeks. During this time, you should avoid lifting any heavy weights. Once bruising and tenderness have gone, you can return to normal activities. Most women can return to work after a week, but strenuous exercise should be avoided for four to six weeks. Ask Dr. Xu when you can return to the full range of activities.
If you have had a combination of surgeries, Dr. Xu can advise you of any additional recovery needs.