Surgeon’s notes — Breast revision
Breast revision.
Revision begins with a person who has already been through surgery once. The first thing owed to them is an honest account of what a second operation can do.
Who comes to me for revision
Many of the people I see for breast revision had their first operation somewhere else, and some arrive uneasy about trusting a surgeon again. That is understandable. My part is to listen to what went wrong, or simply what changed, examine carefully, read the earlier operative records when they are available, and then tell you plainly what I think can be improved and what cannot.
The reasons vary widely. The most common is capsular contracture, where the scar tissue around an implant tightens and hardens. Others include an implant that has settled too high, too low, or too far to the side; rippling; an implant that has bottomed out; rupture or deflation; an implant that moves when the chest muscle contracts; asymmetry; or breasts that have changed with pregnancy, weight loss, or time. Some patients simply want a different size, and some want their implants out altogether.
The tools of a revision
Most revisions are built from a few techniques used in combination. For contracture, a capsulectomy removes the hardened capsule, either in one piece or completely, so that a new implant sits in a healthy pocket. An implant exchange lets us change size, profile, or type, including a move between saline and silicone, and replaces an implant that has failed. Even when an implant is intact, I usually recommend a new one during revision; there are cases where the existing device can stay, and I will say when that applies.
When the problem is position, I adjust the pocket itself, with internal sutures, fat grafting, a change of plane, or an acellular dermal matrix such as Strattice for extra support in more complex cases. For those who want their implants removed, explant surgery can be done with or without a lift, and I talk through what the breasts are likely to look like afterward so the decision is made with open eyes. The different routes through breast implant revision in Newport Beach are described in more detail at Allure MD.
Timing and expectations
Tissue needs time to heal and implants need time to settle, so I generally suggest waiting at least six to twelve months after the original surgery before revising it. A rupture, a severe contracture, or an infection can change that, and those situations are assessed on their own terms.
Revision is more involved than a first operation. We are working with scar tissue and with anatomy that has already been altered, and that brings limits that a primary augmentation does not have. Many people can be meaningfully helped, but I am careful never to promise more than the tissue can deliver. Revision surgery is done under general anesthesia and usually takes two to four hours.
Recovery
Recovery resembles a primary augmentation, adjusted for how much was done. The first few days are for rest with the upper body raised, and drains may be placed and then removed at the first visit, around day five to seven, once output falls. A supportive surgical bra is worn throughout the early weeks. Most people return to desk work and daily routines at three to four weeks while avoiding heavy lifting, and over the next few months the implants settle and the scars soften. The final result is usually judged at six to twelve months.
What I want from a revision consultation is the same as any other: a clear plan, reasons for each part of it, and no pressure. You should leave knowing exactly what I would do and why.
Capsulectomy · Implant exchange · Pocket adjustment · Explant