Breast implants are not considered lifetime devices, and a follow-up procedure becomes necessary for many patients after their initial breast augmentation. This secondary operation is known as breast implant revision surgery, a common and highly customized procedure. Revision surgery addresses complications that have developed over time or a patient’s desire for a change in appearance. Implants typically have an average lifespan of ten to fifteen years before replacement is often considered.
Defining Implant Revision Surgery
Breast implant revision surgery is any procedure performed after an initial breast augmentation to correct, refine, or improve the results. This makes it distinct from a primary augmentation, which is the first-time placement of implants. Revision is typically more complex than a simple implant replacement, often involving changes to the surrounding breast tissue. The procedure may involve changing the size, shape, or filler material of the implants, adjusting their position, or correcting issues with the scar capsule or implant pocket.
The procedure is highly individualized, depending on the specific problem being treated and the patient’s current anatomy. It can range from a relatively straightforward exchange of old implants for new ones to an extensive operation that reconstructs the breast pocket. The complexity of the operation reflects the need to work within an already altered anatomical space.
Primary Reasons for Seeking Revision
Patients seek revision surgery for two main categories of reasons: medical necessity and aesthetic or lifestyle changes. The most frequent medical indication is capsular contracture, a condition where the natural scar tissue capsule that forms around the implant thickens and tightens. This can cause the breast to feel firm, painful, and visibly distorted.
Capsular contracture is categorized using the Baker Grades, which describe the severity of the condition. Grade I indicates a soft, natural-looking breast, while Grade II is slightly firm but still appears normal. Surgical correction is recommended for Grade III (a firm, abnormal-looking breast) and Grade IV (a hard, painful, and severely distorted breast). Implant rupture or deflation, occurring when the implant shell is compromised, is also a common medical necessity. Saline implant deflation is usually immediately noticeable, while a silicone implant rupture may require imaging like an MRI for diagnosis.
Additional medical reasons include implant malposition, where the implant has shifted from its original placement, leading to asymmetry. This can manifest as the implant sitting too low (bottoming out) or shifting sideways. Aesthetic and lifestyle motivations are also frequent drivers for revision. A patient may be dissatisfied with the original size or shape, or they may wish to switch from saline to silicone implants or vice versa. Changes in the body due to weight fluctuation, pregnancy, or the natural aging process can also lead to sagging or volume loss, prompting revision to restore a youthful breast contour.
Surgical Approaches to Revision
The chosen surgical approach is dictated by the underlying reason for the revision. For capsular contracture, the surgeon performs a capsulectomy, which involves surgically removing the thickened scar capsule surrounding the implant. A total capsulectomy removes the entire capsule, while a partial capsulectomy removes only a section.
If the implant has migrated or is malpositioned, the surgeon performs a pocket adjustment, reconstructing the space where the implant sits. This might include tightening the pocket with internal sutures or changing the implant’s plane, such as moving it from a subglandular (over the muscle) to a submuscular (under the muscle) position. If the patient changes the size, the implant pocket may need to be surgically enlarged or reduced to accommodate the new device.
Many revision procedures also incorporate a breast lift, or mastopexy, especially if the patient has experienced significant breast sagging (ptosis) due to aging or weight loss. A mastopexy is necessary to tighten the skin envelope and reposition the nipple and areola to a more aesthetically pleasing height. In some circumstances, a patient may choose to have the implants removed entirely (explant), which is often combined with a lift to manage the resulting excess skin.
The Recovery and Post-Operative Period
The recovery period following breast implant revision surgery is highly variable, depending on the complexity of the procedure performed. Patients can typically expect the first week to be the most challenging in terms of discomfort, swelling, and bruising. Prescription pain medication is used to manage the initial soreness, which tends to peak within the first 48 hours after surgery.
Physical activity is significantly restricted during the initial recovery phase, and patients are advised to avoid lifting anything heavy or raising their arms above shoulder level for several weeks. Most patients are able to return to light, desk-based work within one week, but full resumption of vigorous exercise usually requires four to six weeks. A compression garment or surgical bra is worn continuously to support the breasts, reduce swelling, and help the new implants settle into position.
While most of the swelling subsides within the first few months, it can take six months to a full year for the implants to completely settle and for the final results to become fully apparent. Follow-up appointments are scheduled frequently to monitor healing, check incisions, and ensure the implants are settling correctly.