Breast Implant Revision

Breast augmentation is one of the most common plastic surgery procedures in the world. Last year alone, over 250,000 women received breast implants. A large percentage of these women will undergo another breast operation in their lifetime, whether it be to exchange the implants, adjust the size, remove scar tissue, or improve the appearance.

These corrective breast procedures are called “revision breast surgery”.

Revision breast surgery is used to correct a variety of problems. Some relate to implant location, such as bottoming out or symmastia. Others are due to a patient’s anatomy, pregnancy, or weight change. Revision may also be required to treat complications such as a hematoma, infection, or capsular contracture.

The most common breast revision procedures include:

  • Implant exchange – removing existing implants and replacing them with new ones. It is commonly performed for women who want to change their implant size, replace old implants, or reduce implant visibility or rippling. In many instances, this will involve changing implant position from on top of the muscle (sub-glandular) to beneath the muscle (sub-pectoral) or vice versa. It is also done to change from saline breast implants to silicone gel breast implants.
  • Pocket Revision — a general term for modifying the space where the implant is located using surgical dissection or repair sutures. Used to improve shape, gain cleavage, release muscle, or allow size change.
  • Capsulectomy/ Capsulotomy – removing scar tissue (capsulectomy) or making incisions in the scar tissue (capsulotomy) that surrounds the implant to produce a softer, more natural appearance and feel.
  • Capsulorraphy – Tacking sutures are placed within the breast capsule to reconstruct the implant pocket or space. used to reposition breast implants that are either too far apart (“laterally displaced”), too close (“symmastia”) or too low (“bottomed out”).
  • Acellular Dermal Matrix (ADM) - sheets of material made from processed skin (usually from pig or cadaver) that is sewn in to add support or coverage over breast implants. May be useful in severe cases but it is very expensive. Brand names include Strattice, Alloderm, and Allomax.

Dr. Ciaravino -- Breast Revision Specialist

Most plastic surgeons can put in breast implants. In fact, some doctors who are not even board-certified plastic surgeons are doing so. The basic procedure is not that difficult.

However, what is difficult is recognizing the subtle details of a patient’s anatomy and tissue characteristics, analyzing her breast measurements, selecting the correct breast implant, and performing the operation to perfection with minimal trauma and no complications. Such expertise can only be acquired through proper training and years of experience.

Even in the best surgical hands, some things are beyond our control. Over time, skin may stretch, scar tissue develops, or gravity and childbirth can take its toll. As a result, many women with breast implants will eventually need a revision.

Revision breast surgery is a highly specialized field. Few plastic surgeons are very experienced with these challenging cases. As one of the nation’s leading breast implant surgeons, Dr. Ciaravino has extensive experience with both primary breast augmentations and complicated revision cases.