Breast Implant Revision

Breast revision surgery is a procedure performed to correct or improve the results of a previous breast augmentation. This surgery may be necessary to address complications, such as capsular contracture, implant rupture, implant malposition, or asymmetry, or to achieve new aesthetic goals, such as changing the implants' size, type,or shape. Breast revision can also be performed to address natural changes in the body over time, like sagging or changes in breast tissue due to aging, weight fluctuations, pregnancy, or breastfeeding. The procedure can involve implant replacement, implant repositioning, or additional procedures like a breast lift to create the desired outcome.

Breast implant removal is a surgical procedure in which one or both breast implants are removed from the body. This can be done for a variety of reasons, such as addressing complications (like capsular contracture, implant rupture, or infection), health concerns (such as Breast Implant Illness), or personal preference. Some patients opt for implant removal because they no longer wish to have implants or desire a more natural breast appearance. Breast implant removal can be performed on its own or combined with additional procedures, such as a breast lift to improve the shape and contour of the breasts after the implants are taken out. The surgery typically involves using the same incisions from the original augmentation to minimize scarring.

Capsular contracture:  Although rates have steadily declined over the years, capsular contracture remains one of the most common functional problems with implants.  Capsular contracture is a progressive abnormal thickening of the scar tissue around the implant (the capsule).  Capsular contracture causes the implant to feel more firm, develop a more rounded breast shape, and may cause pain.  As with any breast pain, breast cancer should be excluded first.  The pain from a contracture can begin as intermittent feeling of tightness in the breast especially with certain arm movements, and can progress to chronic discomfort.   Although contracture occurs more frequently with implants above the muscle, any breast implant can develop it.  It can develop in one breast or both, with saline or silicone gel implants, and either smooth or textured surface implants.  The most frustrating issue with contracture is that a contracture can reoccur even after surgery to correct it. Dr. Albright will formulate an individualized surgical plan for you to help lower this risk and get your softer, more natural breast back.

‍Implant Rupture:  Although there are many different types of breast implants, all implants are man-made and will not last forever.  A common rule of thumb is that the annual risk of implant rupture is about 1% per year per implant.  Patients may have had blunt force trauma to the implant, or no trauma at all.  For saline implant rupture, patients may experience a gradual reduction in volume or present with a more sudden decrease in breast size.  For silicone implants, particularly the newer generation of cohesive gel implants, patients (and surgeons!) may not be able to identify a ruptured implant as it may not look or feel different.  For this reason an MRI may be necessary to help identify a ruptured silicone implant (although this too is not 100% accurate!).  With a ruptured implant, you have surgical options depending on your preferences and desires.  Whether it is to remove the implants without replacement or a more advanced Breast Implant surgery, Dr. Albright will help you make an informed decision.

Waterfall Deformity is seen in the seated or standing position where the implant stays high up on the chest, and the breast tissue starts “sliding off the mound” as it is pulled downward by gravity.  This is also called the ‘snoopy deformity’, as the hanging breast tissue resembles snoopy’s face in profile.  Typically this involves an implant that is completely under the muscle, whereby the muscle has continued to support the implant high up on the chest while the native breast has begun to droop. It tends to occur in women who are prone to droopy breasts (multiple pregnancies with breastfeeding, and large native breasts).  Often, some form of breast lift surgery will be needed to fix this issue.

‍Implant Displacement can occur due to gravity pulling on the implant (all implants), or by active displacement due to muscle contraction (below muscle implants).  There are a variety of breast deformities that are due to implant displacement.  The stretch deformity is most characteristic of implants placed above the muscle or partially under the muscle, and have  inadequate soft tissue support.  With stretch deformity, the implant migrates downward and begins to stretch the skin of the lower pole of the breast, and the nipple may remain high. This is different than a Double Bubble deformity, where the implant has actually moved downward and below the native lower breast fold (IMF).   This creates a step-off from native breast tissue to a lowered bottom edge of the implant, and typically occurs with partial submuscular implants in which the muscle has forced the implant past this natural barrier.  Finally, another commonly encountered issue is implants that have moved toward the armpits.  Not only does this bother patients as their arms can bump into the displaced implant during exercise, but also the patient will develop a breast implant "gap" between the breast mounds.

‍Visible rippling or implant folds can be particularly distressing to patients and are typically a result of implant characteristics, implant pocket, and patient soft tissue coverage. Whether saline-filled or silicone breast implants, every implant currently in the US has rippling of the shell but they differ in how pronounced the rippling is.  The other critical factor is how well this inherent rippling is disguised or camouflaged by the patient’s own soft tissue (how thick is the skin, fat, breast and/or muscle). Thinner patients are at a higher risk for being able to see the ripples and feel the implant edges or folds. Fat transfer to the breast is one possible solution to correct (camouflage) implant rippling.

Patients’ fear of revision breast implant surgery is not completely unfounded, as there is an inherently higher complication rate with revision breast surgery when compared to the first augmentation procedure. There are many reasons for this.  But broadly, the tissues themselves have changed due to: scar tissue from previous surgery, the weight of the implant on the soft tissue, and from the natural aging of the breast. As the skin around the implant begins to sag, longer incisions are often needed which increases risk of wound healing problems, operative time and creates less well-hidden scars.  Patients may also be less medically healthy than they were when they had the implants placed. To minimize your risks for complications, it is important to find a surgeons who will take these factors into account when formulating an individualized surgical plan, such as Dr. Albright, a board-certified plastic surgeons in San Antonio.

Patients often wonder why their personal health insurance will not cover the cost of their revision surgery especially if they are experiencing a functional problem like capsular contracture. Whereas in the past insurers may have been less restrictive and covered claims made for complications from cosmetic surgery, nowadays insurers almost always deny these claims.  Even if the surgery is performed and a claim is submitted, once it is rejected by your insurer, you will be on the hook for the full insurance rate charges from the surgeons, anesthesiologist and surgical facility; typically a much higher bill than full cosmetic rates. For this reason, Dr. Albright will not submit insurance claims for cosmetic surgery.

All current implant manufacturers in the US provide a basic limited warranty for implant rupture by providing replacement implants at no cost. However the cost of the implants themselves is a relatively small part of overall surgery cost.  Manufacturers in the past, offered an additional warranty that patients had to pay extra money for at the time of the implant placement. Typically, within ten years, if the implant were to fail, the manufacturer would write a check to offset some of the out-of-pocket expenses from revision surgery.  However, even this is not typically enough to cover all expenses.  Today, implant warranties offer more inclusive coverage, but still fall short of covering expenses. Dr. Albright, one of the best breast implant surgeons in Texas, and his staff will help assist you with taking advantage of any available implant warranty you may have.

One of the most frequently cited issues for patients seeking revision of their cosmetic breast surgery is cost. There is no denying that it is expensive.  Implant warranties are variable and rarely contribute enough to cover surgery expenses. Health insurance plans will not cover complications from cosmetic surgery.  Therefore patients usually will have to pay for the care out-of-pocket. The costs for breast implant surgery are higher than initial augmentation surgery because the surgery is more complex and time-consuming.  There may be more supply costs for new implants, surgical mesh and postoperative garments. Surgeons, anesthesia, and facility fees are usually based on the complexity of the procedure and operation time.  There are also additional miscellaneous fees such as cosmetic insurance and financing fees which may be different than previous arrangements. All together, revision surgery can be expensive.  Dr. Albright is a breast implant specialist, and he is sensitive to this issue and offers financing plans, as well as competitive pricing to get you the best results possible.

After breast implant removal, your breasts may appear saggy or deflated, especially if your implants were large, you’ve had them for a long time, or your skin has stretched due to the implants. Factors such as skin elasticity, the size of the implants, and natural aging can all affect how your breasts look after implant removal. In some cases, the breasts may look smaller or have loose skin after the implants are removed. To address this, many patients choose to combine implant removal with a breast lift (mastopexy), which can tighten the breast tissue, remove excess skin, and elevate the breasts to a more youthful position. This combination procedure can help restore a more natural and firm breast shape after implants are removed. Your surgeon will assess your situation and recommend the best approach to achieve your desired results.

After breast implant removal, it typically takes several weeks to a few months for your breasts to fully settle and achieve their final appearance. Initially, you may experience swelling, and your breasts may look different than expected right after surgery. Over the first 4 to 6 weeks, swelling will gradually subside, and the breasts will begin to settle into a more natural position.

However, the settling process can take up to 3 to 6 months, especially if a significant amount of skin or tissue was stretched due to larger implants. During this time, your body adjusts to the absence of the implants, and the breast tissue naturally contracts and reshapes. If you had a breast lift along with the removal, the healing and settling process may take longer as the tissues heal and adjust.

Your surgeon will provide guidance on what to expect during recovery and may recommend wearing compression garments or a supportive bra to help with healing and skin retraction during the initial recovery phase.

After breast implant removal, you can generally begin to resume light activities within 1 to 2 weeks, but full recovery will take longer. Depending on their feelings, most patients can return to non-strenuous work or daily activities after the first week. However, avoiding heavy lifting, strenuous exercise, and activities that engage the chest muscles for at least 4to 6 weeks is important. These restrictions help ensure proper healing and prevent complications.

By six weeks, most patients can fully resume regular physical activities, including exercise. Still, getting clearance from your surgeon before returning to intense workouts or heavy lifting is crucial. Your surgeon will provide personalized recommendations based on your recovery progress to help you safely return to your routine.

It’s generally recommended that you wait at least 6 months to 1 year after your initial breast augmentation before considering a breast implant revision. This waiting period allows enough time for the implants to settle fully, the swelling to subside, and the final results to become visible. Many post-surgical changes, such as minor asymmetry or uneven positioning, may improve independently during this time.

However, if you are experiencing complications such as implant rupture, capsular contracture, or significant discomfort, revision surgery may need to be performed sooner. It's essential to consult with your surgeon, who will evaluate your situation and determine the best timing for revision surgery based on your healing and the nature of your concerns.

After breast implant revision surgery, it's essential to follow your surgeon's recommendations on when to resume physical activities to ensure proper healing. Generally, you should stop all strenuous physical activities, including exercise, heavy lifting, and movements that engage the chest muscles, for at least 4 to 6 weeks after surgery. You’ll need to focus on rest and allow your body to heal during this time.

For the first 1 to 2 weeks, limiting activity to light walking is advisable to promote circulation, but avoid any movement that could strain the chest area. After six weeks, most patients can gradually resume their regular exercise routine, including more intense activities, but it’s important to get clearance from your surgeon before doing so. Complete healing, including the settling of implants and reduction of swelling, can take up to 3 to 6 months, but your surgeon will provide personalized guidance based on your recovery progress.

Breast implant revision may be considered when there are concerns about the implants, their position, the surrounding scar capsule, breast tissue, or the overall appearance of the breasts. Reasons for considering revision can include changes in breast shape or symmetry, firmness or discomfort, suspected implant rupture or deflation, implant movement or malposition, visible or palpable rippling, or changes that develop over time.

Revision may also be considered when there is no implant complication but a patient wants to change implant size or type, improve breast shape, or have the implants removed.

A consultation can help determine whether the concern involves the implant, capsule, implant pocket, breast tissue, or a combination of these factors and which treatment options may be appropriate.

Breast implants are not considered lifetime devices, but they do not automatically need to be replaced simply because they have reached 10 years. Some patients may have their implants for longer without requiring revision, while others may need additional surgery sooner because of an implant-related concern, changes in breast tissue or implant position, or a change in personal preferences.

The need for breast implant revision should be based on factors such as symptoms, implant condition, examination findings, appropriate imaging when indicated, changes in the breasts over time, and the patient’s goals rather than implant age alone.

Regular follow-up and appropriate implant monitoring can help identify changes that may require further evaluation.

Silicone implant rupture may not always cause noticeable symptoms, which is why imaging can play an important role in monitoring silicone breast implants.

The FDA currently recommends that patients with silicone gel-filled breast implants have their first ultrasound or MRI to screen for rupture approximately 5–6 years after implant placement and then every 2–3 years afterward. If symptoms develop or ultrasound findings are uncertain, MRI may be recommended.

These recommendations may change over time, and individual monitoring needs can vary. Dr. Albright can discuss appropriate follow-up based on your implant type, implant history, symptoms, and other individual factors.

Recovery after breast implant revision varies depending on the procedures included in the surgical plan. A straightforward implant exchange may involve a different recovery than a more complex revision that includes capsule surgery, implant pocket reconstruction, internal support, fat grafting, or a breast lift.

Swelling, bruising, tightness, and temporary changes in breast shape can occur during the early stages of healing. Activity restrictions and the timing of returning to exercise or other activities depend on the extent of surgery and individual healing.

Because revision procedures can differ substantially from one patient to another, Dr. Albright provides postoperative instructions based on the specific procedures performed and monitors healing during follow-up appointments.

Yes. Breast implant revision does not always require replacing an existing implant with a new one. Some patients choose to have their breast implants removed without replacement because of implant-related concerns, changes in personal preferences, or a desire to return to their natural breast volume.

How the breasts look after implant removal depends on factors such as implant size, how long the implants have been in place, the amount of natural breast tissue, skin elasticity, previous surgeries, and changes that have occurred over time.

For some patients, implant removal alone may be appropriate. Others may consider a breast lift, fat grafting, or another procedure to address breast shape or tissue changes after implant removal. The appropriate approach depends on the patient’s anatomy and goals.