Revision Breast Augmentation – Understand Your Options

Reviewed by Walter Erhardt, MD

Is bigger better?

Make up your mind before your breast augmentation because the No. 1 reason that women opt for revision breast surgery is that they wish they went bigger. Other reasons for revision breast augmentation may include implant deflation, capsular contracture, the "double bubble" breast augmentation complication, breast changes following pregnancy or massive weight loss, and poor implant placement. Some women may wish to change from saline implants to silicone implants, or vice versa. Other women may choose to remove their implants because they want their natural breasts back.

The bottom line is that revision breast augmentation is performed when a woman is not happy with some aspect of the look and/or feel of her new breasts. This repeat surgery can be more complicated than primary breast augmentation, will likely cost more and may entail a more involved recovery.

Revision Breast Augmentation: Getting Started

The process begins with a consultation with a board-certified plastic surgeon who specializes in breast augmentation and revision breast augmentation. Some women return to the surgeon who performed their original breast augmentation for a revision, while others seek out a new surgeon. This decision depends largely on the nature of the cosmetic concern as well as how much time has passed since the first surgery. For example, you may have been pleased with your breast augmentation but your breasts have changed due to pregnancy. Or, perhaps you did not like your original surgeon's work, or maybe he or she is no longer practicing in a convenient location. If you are going to a different surgeon, take your records. Your new surgeon will need to know what type and size of breast implants you currently have to best plan your revision breast augmentation.

During your initial consultation with the surgeon, you must discuss your concerns regarding the look and feel of your breasts, as well as your expectations. Be as specific as possible about what you want to change. Tell your surgeon what, if anything, went wrong with your initial breast augmentation surgery. In many cases, nothing went wrong with the surgery per se. Instead, your body and breasts changed over time and what was once ideal is no longer acceptable.

Your plastic surgeon will examine your breasts, and may take "before" breast augmentation photos during this visit. He or she will analyze the size and shape of your breasts, their skin quality and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). Based on the results of this examination, your surgeon will develop and explain a surgical plan of action. He may discuss implant types and size, the location of the new incisions and whether your new breast implants will be placed on top of or underneath the pectoral muscle. Most revision breast augmentation surgeries involve under-the-breast (inframammary) or around-the-nipple (periareolar) incisions.

Your Revision Breast Augmentation Surgery

When it comes to some revision surgeries — such as revision rhinoplasty — surgeons recommend waiting at least one year until all swelling has subsided. However, the timeframe for revision breast augmentation varies based on the nature of the problem or cosmetic concern. In some cases, the surgeon may go back immediately to fix a cosmetic issue such as implant deflation or pronounced asymmetry. Women who wish they had gone bigger should wait a minimum of three to six months for revision breast augmentation.

Capsular contracture, the most common implant-related complication of breast augmentation surgery, is caused when scar tissue forms around the implant, resulting in breast stiffness. This complication tends to occur within the first few months of breast implant surgery. It can be fixed after 10 to 12 weeks if conservative measures such as massage or medication don't do the trick.

Other revision surgeries may include overfilling the implants to reduce rippling, changing your implants to a new shape — such as high-profile, smooth or anatomical implants — or changing the implant surface from smooth to textured (or vice versa). There also are a growing number of experimental options that may one day be used for revision breast augmentation surgery. This includes cohesive gel or gummy bear breast implants, and the possibility of injecting fat from other areas of your body into your breasts to increase size without an implant.

There is no one-size-fits-all breast revision surgery. Your surgery may be similar to your primary breast augmentation or it may differ entirely. The surgical plan depends on your cosmetic concerns, your anatomy and your expectations. Some surgeries may be more straightforward than others, such as switching from a saline to a silicone breast implant (or vice versa), but keeping the same implant placement. Others may be more complicated, such as a revision surgery that corrects capsular contracture and moves the implant placement from sub-glandular (under the breast tissue, but above the muscles) to sub-pectoral (under chest muscles). Some women may also require a breast lift to raise and firm their breasts as part of their revision breast augmentation. The nature of the surgery also affects the breast augmentation cost and recovery process.

Breast augmentation is usually performed in an office surgical suite or an outpatient surgical center using local anesthesia (you remain conscious). Breast surgery can also be performed in a hospital under general anesthesia (you are unconscious). Revision breast augmentation can take anywhere from one to four hours to perform, whereas primary breast augmentation takes one to three hours.

Understanding the Risks of Revision Breast Augmentation

The risks of revision breast augmentation depend on the type of surgery that is performed. Some risks may include infection, anesthesia problems, bleeding and the need for a third procedure. Ask your surgeon about the specific risks of your revision breast augmentation surgery.

Revision Breast Augmentation Recovery

Your breast augmentation revision recovery may be similar to the recovery you experienced after your initial breast augmentation surgery, or it may be more significant. It depends on the extent of the repeat surgery. Ask your surgeon what you can expect this time around.

You may feel pain and stiffness after the surgery, as your breast will be bruised and swollen. Prescription painkillers can help. Your surgeon may recommend wearing a surgical bra for several days. In addition, there may be reduced nipple sensitivity, but feeling should return as your breasts heal.

Heavy lifting or straining — and sometimes driving — should be avoided after surgery because such activities can cause the breasts to swell. You can typically return to work within a week and to full activity within a few weeks. There may be permanent scarring.