Information about the procedure
Exchanging, removing or repositioning breast implants after a complication, an unsatisfactory result or a change in what you want.
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What it involves
Revision surgery is technically more complex than primary augmentation, because it involves tissues that have already been operated on, and because the task is often not simply to replace the implant but to correct a specific problem.
The reasons vary — capsular contracture, displacement, rupture, a wish for a different size or shape, sagging of the breast around the implant, or a decision to have the implants removed for good.
Planning begins with understanding exactly what is wrong. Replacing the implant without addressing the underlying problem leads to the same outcome over time.
Types and approaches
Implant exchange
The old implant is removed and a new one is placed — if desired, of a different size, shape or position. This is often combined with correction of the pocket.
Capsulectomy
Removal of the thickened capsule around the implant in capsular contracture. The extent depends on the severity — from partial to complete removal.
Removal without replacement
The implants are removed for good. The breast returns to its own volume, which after years with an implant usually looks smaller and saggier than before. This is often combined with a mastopexy (breast lift) or fat grafting (lipofilling).
Changing the pocket position
Moving the implant from beneath the gland to beneath the muscle, or vice versa, in cases of displacement, visible implant edges or deformity.
Who it is suitable for
Suitable for
- Capsular contracture with hardening, change in shape or pain
- Implant rupture, confirmed or suspected
- Displacement, asymmetry or symmastia (merging of the implant pockets)
- Visible implant edges or rippling
- Wish to change size after a number of years
- Sagging of the breast around the implant
- Decision to have the implants removed
Not suitable, or postponed, in cases of
- Active infection — this is treated first
- Unrealistic expectation that a revision will give the same result as a primary operation
- Unstable weight or a planned pregnancy
- Smoking with no willingness to stop
Preparation
- Imaging — breast ultrasound, or MRI if rupture is suspected
- Records of your current implants, if available — model, volume, date of surgery
- Pre-operative tests and a consultation with a cardiologist or an anaesthetist
- A clearly defined goal: exchange, correction or removal
How it is performed
The operation is performed under general anaesthesia. Its duration varies considerably with the task: from about one hour for a straightforward replacement to three hours or more for a complete capsulectomy and pocket reconstruction.
Where possible, the same incision is used so that no new scars are added.
The hospital stay is usually one night, and longer after more extensive procedures.
Recovery
- The first 48 hoursSimilar to primary augmentation. After a capsulectomy, discomfort is greater and drains are often placed.
- The first weekSupport bra worn day and night. Arm movements are restricted.
- 2–4 weeksReturn to office work usually after 10–14 days; longer after more extensive surgery.
- 1–3 monthsThe final shape develops. The tissues soften more slowly than after primary surgery.
- 6–12 monthsThe final result.
Pain and discomfort
After a straightforward exchange, discomfort is similar to or less than after the primary operation. After a capsulectomy, it is greater and lasts longer, because the surgery is deeper and tissue is removed. Pain relief is given on a fixed schedule.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Recurrent capsular contracture
- Haematoma — more common than after primary surgery
- Infection, which with implants may require their removal
- Compromised blood supply to the skin in a breast that has had several operations
- Asymmetry that cannot be fully corrected
- Unsatisfactory shape after removal without replacement
- Change in sensation
Results and longevity
The result of a revision is rarely as predictable as that of a primary operation. The tissues have changed and respond differently.
When implants are removed without replacement, it is important to have realistic expectations: the breast will not look as it did before the first operation.
Each further operation in the same area makes the tissues thinner and harder to work with. This is why decisions should not be made in haste.