Breast Implant Revision or Breast augmentation revision

Breast augmentation is one of the most widely sought procedures in San Diego, and most patients love their results. But poor surgeon skill, a complication, or other unexpected issues can occur, leading you to seek a breast implant exchange or other revisionary procedure. If your previous breast augmentation results are in need of a touch-up, La Jolla plastic surgeon Dr. Katerina Gallus is here to help you get it right this time.

What is breast augmentation revision?

Breast augmentation revision surgery is a procedure performed for one or more reasons, including: 

• To remove and replace old, damaged, or leaking breast implants
• To remove scar tissue or to refine the aesthetic results of your initial augmentation surgery, i.e. by adjusting the implant pocket for more aesthetically pleasing results.
• To resize or upgrade your implants, such as if you currently have saline implants but wish to exchange them for more natural-feeling silicone gel implants.

How long do breast implants last?

Breast implants are not meant to last a lifetime—most manufacturers estimate that breast implants have an average lifespan of 10 to 15 years. So, what happens when your breast implants reach the end of their useful life? This is where revision breast augmentation surgery comes in.

Patients who are good candidates for breast implant revision

Revision breast implant surgery may be the right choice for you if you have an identifiable, correctable abnormality in breast look or feel with your current implants, or you are ready to upgrade your implant type or size. In general, the answer should be “yes” to one of these questions:

• Have you had prior breast enhancement surgery and now need some refining or lifting? 
• Are you interested in switching out your older implants with newer generation implants?
• Do you want to change the size of your implants—or just want to have them removed? 
• Did you have a complication after previous breast surgery, such as implant rupture, capsular contracture, malposition, bottoming out, or breast animation deformity?

In sum, revising your augmentation is a uniquely individual decision—but whether your concern is correcting poor results, reversing the effects of aging & gravity, or changing size, revision can yield dramatic, durable results that will keep you looking good for years to come.

It’s also important to have realistic ideas and expectations of what can be accomplished. Talk to your surgeon in detail about their planned approach and expected results, reviewing photos of patients with similar concerns and anatomy. 

Lastly, you need to be a good candidate to undergo surgery, including general anesthesia. You can safely undergo surgery if you are…

• At a healthy and a stable weight
• Not taking blood thinner medications
• Not using nicotine products

Because of the wide range of surgical options and multi-modal approaches often required,  breast augmentation revision is one of the most complex areas in the field of cosmetic plastic surgery, and choosing a surgeon who is both understanding and exceptionally skilled is critical. Dr. Katerina Gallus is a breast revision surgery expert with over 20 years of experience in cosmetic and reconstructive surgery, and she partners with you—learning about your goals and history, and educating you on all of the available options that can achieve a stellar result that gives you confidence and peace of mind.

Video transcript

Let’s talk about who’s a good candidate for breast implant revision. Women who seek revision for their implants often have either a deflated (if it’s a saline implant) or a ruptured (if it’s a silicone implant). Sometimes, they’re looking to change the size of their implant, either to go larger or smaller. Sometimes, they’re addressing a malposition, which is when the implant is either too lateral, too high, or too low. Any of these things can cause significant asymmetry that might be addressed with a second surgery.

Some women have capsular contraction, which is when the capsule that normally forms around your implant gets thickened and hard, distorting the appearance of your breast implants. It can even cause pain if the capsular contracture becomes significant enough. In this case, you might need the implant removed, as well as a capsule and a new implant placed.

There are many reasons why women might need implant revision surgery. Please reach out to Restore SD Plastic Surgery to find out if you’re a candidate. We look forward to seeing you. – Dr. Katerina Gallus

Will my health insurance cover surgery?

Most insurance providers do not cover elective cosmetic surgery. If you are experiencing a complication that makes revision surgery medically necessary, talk with your insurance company to find out if they may cover it.

While insurance is unlikely to offer coverage for most cosmetic breast surgeries, the breast implant manufacturer may cover the cost of the new breast implant in the case of a breast implant rupture while the device is still under warranty. (You will clearly know if you have a saline implant issue as they deflate after rupture, while rupture of silicone implants can be detected during your routine scans with MRI or ultrasound). Most manufacturers also offer 10 years of warranty coverage for revision after capsular contracture.

The consultation for breast revision San Diego

When you arrive at Restore SD Plastic Surgery to discuss breast implant revision surgery, you will meet face to face with Dr. Katerina Gallus. Our goal is to help you feel comfortable every step of the way—here’s what you can expect:

• Ahead of your consult, we email you our digital forms where you can fill out your intake information, including your complete medical history, at home where you have your information handy. We will request a recent mammogram if you are over 40 or have a family history of breast cancer. Dr. Gallus will review your medical history and any medications you take beforehand.
• When you arrive, Dr. Gallus sits down to talk with you face to face. This is an open conversation, allowing you to share any symptoms or concerns you have and get Dr. Gallus’ expert input. She takes the time to listen to you, and partners with you to develop a surgical plan that prioritizes your safety and beautiful results.
• Dr. Gallus performs a physical exam with another clinical staff member present to ensure your comfort. You will discuss all options available to you and together decide on the right procedure specifics for your body.
• We take digital images of your breasts using our Vectra 3D system. This state-of-the-art camera and software renders possible outcomes and helps us to discuss what your breasts may look like after surgery, as well as the aesthetic you could get with additional procedures like a breast lift.
• If, after completing your initial appointment, you’re not yet ready to book a surgical date, you are welcome to return for a second consultation to ensure you feel fully informed and empowered in your decision. This is normal, and we encourage it for patients who are not ready to commit just yet! (Our office is a zero-pressure environment.)

Finally, after working out the procedure(s) that could meet your goals, you’ll meet with our stellar patient care coordinator to go over a comprehensive personal fee quote that covers the pricing of all options you discussed with Dr. Gallus.

What to expect in your consultation »

Procedure options for revision

The options for breast implant surgery are constantly evolving, so you will have many choices for replacing old implants with new ones—including special techniques Dr. Gallus can use to enhance a certain aspect of your results, or avoid problems like breast animation deformity. Here are some you might discuss in your consult:

Implant exchange

The simplest breast revision involves swapping out old implants for new ones. Breast implants are not designed to be forever devices, and they will eventually fail. Sometimes implants are too big and heavy, which can stretch the skin and lead to various complications; other times they may be a bit too small, and you want to upsize. Sometimes there are no technical problems, but a patient is ready to upgrade to newer generation lightweight silicone gel breast implants to improve the feel of their breasts. Whatever your reasons are, implant exchange is an opportunity to change the size, projection, and material of your breast implants and achieve the updated look and feel you desire.

Capsulectomy

If you have an implant rupture, you will have the option to exchange your implants—with or without removal of the “capsule” of surrounding scar tissue, a procedure called a capsulectomy. Dr. Gallus will discuss whether she recommends a partial, total, or en bloc capsulectomy in the treatment plan based on the details of your implants and your anatomy.

Acellular dermal matrix or absorbable mesh to support implant & pocket

In the last decade, the introduction of acellular dermal matrix and naturally absorbable mesh products have revolutionized our available surgical techniques. These amazing products allow surgeons to enlarge, decrease, modify, and soften the implant pocket or pockets to achieve an improved breast appearance. This may be especially helpful if you are experiencing certain cosmetic issues related to the pocket such as sagging, rippling, bottoming out, symmastia, or asymmetry. Be aware, however, that these products do carry an increased cost and this procedure is often more expensive than an initial breast augmentation or lift due to the complexity of the surgery as well as the expense of the materials used.

Fat grafting

Fat grafting, or fat transfer, removes fat from the thighs, hips, flanks, waist, or sides of the chest and carefully and precisely adds it to the breasts. This is a wonderful addition: Using the SAFELipo™ technique to maximize results and safety, Dr. Gallus sculpts the breasts into the shape you want and addresses small volume asymmetries very nicely, using harvested fat from your own body. (You also get the bonus of a little liposuction shaping at the fat harvest site!) Fat transfer to the breasts may also be used as an add-on to treat to prevent breast implant rippling (about 4% of those who undergo revision surgery aim to correct visible implant rippling).

Breast lift

A breast lift, or mastopexy, corrects breast ptosis (sagging) by reshaping tissues, removing any excess skin, and raising nipples higher on the breast mound. If you are downsizing implants, having a full breast implant removal surgery, or if your breasts have begun to sag due to aging, then a lift is more likely to be necessary to achieve pleasing results.

Reconstructive approach

Occasionally a patient comes to us with a problem so complex that the best treatment calls for a reconstructive approach. Whether it involves a complete mastectomy, use of tissue expanders, or just patience, hand-holding, and listening, Dr. Gallus and the Restore SD team are here for you. Time and patience are often important factors in successfully correcting significant cosmetic breast issues: frequently, a staged treatment plan (with multiple procedures spaced 4-6 months apart) is necessary for a significantly improved appearance.

Capsular contracture

Capsular contracture is a common condition that affects women with breast implants at a rate of approximately 10%. Implants are a foreign object, and your body’s natural response is to create a scar tissue capsule that surrounds the implant. Over time, however, the capsule can begin to tighten irregularly and can affect the way the implant looks and feels on your chest. Treatment for capsular contracture involves removing the implant and the scar tissue capsule, then placing a new implant and letting your body begin the healing process again. Certain surgical choices Dr. Gallus makes, such as using the Keller Funnel during placement of implants, as well as prescribing medication after surgery, can help decrease your chance of developing capsular contracture after revision.

I’m done—I just want my implants out!

If you’ve decided that you simply want to permanently remove your implants—a.k.a. an explant—you are not alone! Many women will reach a point where they are happy to leave implants behind and downsize to a smaller breast size. The surgery that best accomplishes this will differ from person to person. Some women have enough residual breast tissue that simply removing the implants and scar capsule is all they need. Other women have experienced the effects of gravity and may have some natural drooping of the breast skin that occurs over time, requiring a lift. 

The breast implant removal surgery in this case may involve removing the implant and the scar capsule, as well as performing some form of breast lift. Dr. Gallus will talk with you about the safest way to achieve your desired look, and usually will give you options. In certain circumstances, everything can be done in a single, consolidated procedure, while other circumstances may dictate that the safest approach requires two separate surgeries spaced apart by 4-6 months.

Combining procedures

Your breast revision San Diego does not have to be performed as a stand-alone procedure! In many cases, Dr. Gallus can combine this procedure with tummy tuck (abdominoplasty), liposuction, or certain facial rejuvenation procedures, like facelift. (Procedure combinations like this are often referred to as a “mommy makeover,” but they’re not just for moms!) Dr. Gallus will work with you to develop an effective plan that is totally optimized—for your results, recovery, and safety.

The surgery

Breast implant revision surgery is performed in the outpatient setting in our onsite, accredited ambulatory surgery center. There are many complex variables that affect what happens during your surgery: If possible, we will use your previous breast surgery incisions to avoid creating new scars on your skin. The surgery can take from 1-3 hours depending on the severity of the case. Dr. Gallus will tailor the approach to your individual circumstances and goals. Once your surgery is over, you will be placed in a post-operative compression bra.

Will I need drains?

Maybe—if liposuction or the use of an acellular dermal matrix is part of your breast revision procedure, then drains are more likely to be used. Advances in techniques over the last few years now allow many patients to enjoy a drain-free recovery. However, each surgery is unique, and Dr. Gallus wants the best and safest outcome for you. We try our very best to do this surgery without drains, but we also don’t hesitate to use them if it is the best and safest course of action to optimize your healing, safety, and results.

The recovery & results

After surgery is completed, you will be able to go home with a responsible adult. Ideally, this loved one or friend will be able to stay with you during the first few days of recovery. Some postoperative surgical pain is expected, and you will be prescribed pain medication to help ensure a comfortable recovery. Initially, the area around the nipple and most of the breast skin is numb, but sensation gradually returns over the next few months. 

Depending on your profession and the details of your procedure (i.e. if a lift was included), you should expect to take 1-2 weeks off from work. Normal daily activities like showering, eating, and light activity such as walking can be resumed within 24 hours after surgery. Some postoperative swelling is normal and generally resolves within the first 4 weeks after surgery. (As swelling subsides, your final results will take shape.)

Patients also cannot drive while taking narcotic pain medication and should plan to have a friend or family member drive them to and from appointments during the early recovery period. 

You will not be able to lift anything heavier than 10 lbs. or perform strenuous activities for 2 weeks following surgery and should refrain from intense physical activity for 4 weeks. 

During the recovery period, you will have follow-up appointments with Dr. Gallus and will be guided as to when you can return to each of your usual activities. Most complications occur from getting too active too early (which can lead to issues like seroma), so select a surgical date that allows an appropriate amount of time to heal and gradually return to your routine. 

Video transcript

“What is the recovery like for breast implant revision if you already have implants in place and you need them exchanged? The recovery can often be longer than the original surgery. This can be due to a multitude of factors. Often, if you’re having your implants revised, you’re doing a size change, adding a lift, or a fat transfer, or internal mesh. Sometimes, you’re removing a ruptured implant or a capsule or addressing a malposition. All of these things can lead to increased complexity of the surgery, which can also increase the time it takes to perform the procedure and how long you will need to recover.

It’s very important that you schedule appropriate time for recovery after breast implant revision surgery. Most women need to refrain from increasing their heart rate or blood pressure for 2 weeks after surgery. It is four to 6 weeks before you can do any kind of pushing, pulling, or chest exercises after breast implant revision surgery.

If you want to know more about whether breast implant exchange or revision surgery is right for you, please seek us out for a consultation at Restore SD Plastic Surgery.”–Dr. Katerina Gallus

How we help to minimize postoperative scarring

There’s no such thing as a scarless surgery, but we take every opportunity to help minimize scars and promote a gorgeous healing process! And where possible, your revision or removal will be performed using the same incision locations used in your original procedure. 

Dr. Gallus and our team will educate you about scar management and help you optimize this part of your recovery: A surgical scar will take 9-12 months to fully mature, and your scar will go through changes during the healing process. At your one month post-op appointment, we’ll send you home with a tube of scar gel (included in your surgical package) and advise you to avoid the sun, wear sunscreen, and practice scar massage. To further refine your results, we also offer a series of fractionated laser treatments—the same laser used in our medical spa for facial anti-aging—to minimize scars’ appearance. 

References »

Denney BD, Cohn AB, Bosworth JW, Kumbla PA. Revision Breast Augmentation. Semin Plast Surg. 2021 May;35(2):98-109. doi: 10.1055/s-0041-1727272. Epub 2021 Jun 8. PMID: 34121945; PMCID: PMC8186996.

Spear SL, Low M, Ducic I. Revision augmentation mastopexy: indications, operations, and outcomes. Annals of Plastic Surgery. 2003 Dec;51(6):540-6. doi: 10.1097/01.sap.0000096450.04443.be.

Navanjun S. Grewal, Jack Fisher, Why Do Patients Seek Revisionary Breast Surgery?, Aesthetic Surgery Journal, Volume 33, Issue 2, February 2013, Pages 237–244, https://doi.org/10.1177/1090820X12472693

Clough R, Darragh L, Maclennan L, O’Donoghue JM. Revision Surgery to Improve Cosmesis with Immediate Implant-Based Breast Reconstruction. JPRAS Open. 2021 May 21;29:106-112. doi: 10.1016/j.jpra.2021.04.006.

Forster NA, Künzi W, Giovanoli P. The reoperation cascade after breast augmentation with implants: what the patient needs to know. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2013 Mar;66(3):313-22. doi: 10.1016/j.bjps.2012.09.033. 

Your Safety = Beautiful Results

Breast Implant Revision at Restore SD

At Restore SD Plastic Surgery, patient safety comes first. Board-certified plastic surgeon and former Navy plastic surgeon Dr. Katerina Gallus operates in a private, on-site Quad A-accredited surgery center, with state-of-the-art equipment and LED surgical lighting. She proudly works with a board-certified anesthesiologist and holds privileges at Scripps Memorial Hospital La Jolla.

Here’s how we keep you safe »

Let’s do this!

San Diego Female plastic surgeon Dr. Katerina Gallus and our team are here to make your vision a reality. By partnering with you to learn about your goals and priorities, Dr. Gallus develops the ideal plan to help you feel comfortable and confident in your body through cosmetic surgery. We also discuss pricing, personalization, and much more in your consultation. Schedule your consultation today—to get started, shoot us a quick message to request your consultation or give us a call at 858-224-2281. We look forward to helping you feel your personal best!

Areas served:

• La Jolla
• San Diego
• Rancho Santa Fe
• Del Mar
• Carlsbad
• Carmel Valley

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Breast surgery blog posts from Dr. Gallus

• Podcast – Bri Breaks it Down: Breast Implants, 2 BBLs, & Botched Filler in Mexico
• Saline vs. Silicone Implants—What’s the Difference?
• Do I Need a Breast Lift with My Augmentation?