What is this consultation about?
Most women who come for a revision surgery consultation are not looking for a change: they are looking for an explanation. Something hardened, shifted, deflated or simply stopped looking like what had been agreed upon, and no one has clearly explained why.
Revision surgery starts there. Before proposing anything, we need to understand what was done the first time, which materials were used, where the implant was placed, and which part of the problem relates to the implant, the tissue or time. These are three different causes, and they are corrected differently.
Common reasons for a second operation
Capsular contracture. The capsule the body forms around an implant thickens and contracts; the breast hardens, rises, changes shape and sometimes hurts. It is the most common late complication of implant surgery.
Implant malposition. Dropping below the breast fold, shifting sideways when lying down, or implants sitting too close to the midline.
Rippling. Visible or palpable folds, almost always due to insufficient tissue coverage for the chosen implant.
Implant rupture. Often causes no symptoms and is detected through imaging.
A size that no longer suits you. Implants chosen fifteen years ago may no longer fit your life today.
Breast tissue that has descended over a stable implant. Here, the implant is not the problem — the skin is. Replacing the implant alone is not the right solution.
Implant removal. A legitimate and increasingly common decision, mentioned separately because it deserves its own conversation.
How long should you wait before another operation?
Except in an emergency, revision surgery is not decided based on a recent result. After breast augmentation, the result is considered final at one year; before then, much of what causes concern is still settling. Operating on inflamed tissue means operating with incomplete information.
When there is an established complication — contracture, rupture or malposition that will not correct itself — the problem determines the waiting time, not the calendar.
What changes compared with the first surgery
Three things — and they should be discussed before surgery:
The tissue has already been operated on. There is scar tissue and an implant capsule, and the tissue covering the implant may have thinned. What can be achieved depends on the tissue that remains, not just the result you would like.
Additional support is almost always needed. Simply exchanging one implant for another is rarely enough: if the pocket failed once, it will fail again unless it is repaired. For implants above 275 cc, I consider structural support, stability and reinforcement essential. In revision surgery, my threshold for adding that support is even lower.
The risk of recurrence is real. Capsular contracture recurs more often after revision than after primary surgery. That difference should be discussed before signing anything, not afterward.
What I do not do, and why
I do not use textured or anatomical implants. I do not perform revision surgery through axillary or periareolar incisions. In revision surgery, these decisions matter even more than in the first operation, because each approach affects what another surgeon can do later.
I also do not try to fit into one operation what requires more than one. My surgical time limit is six to seven hours: when correction requires capsulectomy, repositioning, reinforcement and a lift, I prefer two well-performed operations to one prolonged surgery that leaves no one satisfied.
What to Expect
Assessment with imaging when rupture or established capsular contracture is suspected.
3D simulation and sizing garments to help choose implant volume, just as for a first breast augmentation.
Operating time depends on the correction needed. We establish this during your consultation, not beforehand.
The final result is assessed at one year. Scars take longer to mature.
An honest conversation
Not every revision surgery improves the result. Sometimes the best recommendation is not to operate again; in other cases, removing implants rather than replacing them is the right approach. If that applies to you, you will hear it at the consultation.
References
- Wan D, Rohrich RJ. Revisiting the Management of Capsular Contracture in Breast Augmentation: A Systematic Review. Plast Reconstr Surg. 2016;137(3):826-841.
- Haas E, Christodoulou N, Secanho M, Kokosis G, Malgor RD, Winocour J, Yu JW, Mathes DW, Kaoutzanis C. Capsular Contracture After Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J Open Forum. 2025;7:ojaf003.
- Zhai P, Wu Y, Yang D, Ma W, Zhai Y, Xie H. A systematic review and meta-analysis of capsular contracture rate after breast augmentation with textured and smooth breast prostheses. Gland Surg. 2022;11(1):166-174.
- Larsen A, Rasmussen LE, Rasmussen LF, Weltz TK, Hemmingsen MN, Poulsen SS, Jacobsen JCB, Vester-Glowinski P, Herly M. Histological Analyses of Capsular Contracture and Associated Risk Factors: A Systematic Review. Aesthetic Plast Surg. 2021;45(6):2714-2728.
- Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg. 2015;42(5):532-543.