Breast implant revision — fewer options than the first operation, and more to decide

Breast implant revision means replacing an implant already in place, working on the capsule around it, or removing it.

Why people come back.

• capsular contracture — the capsule around the implant has thickened and tightened. One of the commonest reasons.
• rupture or leakage — sometimes found without any symptoms.
• position change — dropping, drifting outward, or coming together in the middle.
• wanting to reset shape and size
• not wanting an implant any more — the reasons vary, and this is a legitimate reason too.

There are broadly four options.

Replacement — a new implant in the same pocket. Sometimes in a different plane.

Working on the capsule — cutting the tightened capsule to release it (capsulotomy), or taking the capsule out (capsulectomy). How much is taken changes the size of the operation a great deal.

Removal only — the implant comes out and nothing goes in.

Removal with something else instead — moving your own fat, or, depending on how much things have dropped, a lift of the kind used in breast reduction.

This page has one thing to say. A revision is not a repeat of the first operation. There is a capsule, the tissue has already been stretched once, and there are already scars. Even with the same surgeon and the same technique, the range of outcomes is wider than it was the first time.

Check exactly what is meant by 'en bloc'. It refers to taking the capsule out whole, in one piece with the implant. It is a technique needed for particular reasons, not one needed for every removal. As the extent taken widens, operating time, bleeding, drains, and the risk of injury towards the ribs and lung all rise with it. Ask what the reason for choosing it is.

Taking an implant out changes the shape. It does not return you to before. The skin and the tissue beneath have been stretched, so sagging and a feeling of emptiness can remain. Many people say they were not told this beforehand.

Complications are reported more often in revision than in first-time surgery. Infection, collected blood, wounds opening, changed sensation, and contracture coming back are all included.

Find the details of the implant you already have. Manufacturer, type, surface, date placed. A lymphoma has been reported in association with certain surfaces, so this information changes the reasoning.

If one side suddenly enlarges or hurts, if you run a fever, or if the armpit swells, report it without delay.

Whether to keep an implant or remove it is where medical judgement and your own decision overlap. This site does not recommend either.

Bring everything you have. The record of the first operation, the implant card or product sticker, older photographs, any scans done since. In a revision, past information is the operative plan.

Put your goal into one sentence. 'Smaller', 'softer', 'I don't want one any more', 'just fix the shape' are four different operations.

Ask what it will look like after removal. How much sagging to expect, whether a lift would be done at the same time, and if so where the scar would sit.

Not doing it all at once is an option. Taking the implant out first and deciding the rest a few months later, once the tissue has settled, is a route people take.

If rupture is suspected, ask which scan will be used. Ultrasound and MRI see different things.

Not smoking matters especially here. A site that has been operated on once does not have the same blood supply it had the first time.

This is not 'undoing' but 'deciding again'. Taking the implant out also creates a new state. That is why this page marks reversibility as partial.

The range of outcomes is wider than the first time. With the same plan, the state of the capsule, how much tissue is left and where the scars are all change the result. Setting expectations from photographs is harder.

Some people come back more than once. A revision after a revision is not rare. It is better to start knowing that.

Time affects the decision. A reason that is hard to postpone, like rupture or infection, is not the same as thinking about shape. Work out which one you are in first.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.