Breast Revision Procedures

Implant exchange

This procedure involves 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 require a “site change”—changing the 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

This is a general term for modifying the space where the implant is located using surgical dissection or repair sutures. It is used to improve shape, gain cleavage, release muscle, or allow size change.


This involves removing scar tissue (“capsule”) that surrounds the implant to produce a softer, more natural appearance and feel.


Making incisions in the scar tissue capsule to allow for the release of the contracture and softening of the implant. This is usually not as effective as a capsulectomy which actually removes the hardened breast capsule.


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”).

Bottoming out repair

Dr. Ciaravino’s surgical technique usually involves reconstructing the inframammary crease (lower breast fold) using permanent sutures. Several strong sutures are placed in the lower breast capsule using a technique known as “capsulorraphy”. Sometimes, suture will even be placed directly into the ribs for additional support. The breast implants are moved upward and toward the center to improve cleavage, position, and shape.

Symmastia Repair

The goal here is to revise the pocket to prevent the breast implant from crossing the midline. Dr. Ciaravino often uses a capsulorraphy technique with permanent sutures placed into the capsule layer along the inner breast contour. In some instances, these sutures are placed directly into the bone. The breast pocket is also opened toward the outside to allow the implant to move laterally. Selection of the new breast implant size and shape is based the patient’s anatomy and dimensions. Frequently, this involves using a slightly smaller or narrower implant. In patients with sub-glandular breast implants, converting to a sub-pectoral position (under the muscle) may correct the symmastia. Extreme cases may require more involved reconstructive techniques such as the use of acellular dermal matrix (Strattice). Post-operative taping and compression garments are commonly used.

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.