Breast Implant Revision Guide: Top Questions & Answers
Breast implant surgery uses silicone or saline implants to add volume to existing breast tissue. While the procedure is frequently performed and typically very safe, there are still potential risks that may require additional surgery.
Breast implant revision surgery can address a variety of concerns following the initial procedure, including implant malfunction, capsular contracture, and dissatisfaction with breast size, among others. “There are patients who develop complications because the implants have deflated or ruptured, or [because the patient] did not follow strict post-op instructions,” says Beverly Hills plastic surgeon Dr. Sheila Nazarian. “There are cases, too, when patients have breast procedures with doctors who are not highly experienced and trained.”
If you’re considering breast implant revision, you probably have a lot of questions. We’ve drawn on the expertise of our doctors and the RealSelf community to give you answers to those most commonly asked.
In This Overview:What Is Breast Implant Revision?
Is It Right for Me?
What Are the Different Options?
How Much Does It Cost?
Will Insurance Cover It?
How Do I Choose a Surgeon?
How Do I Choose the Right Size?
What Happens During the Procedure?
What Can I Expect During Recovery?
What Results Can I Expect?
What Are the Possible Side Effects?
Is there an increased risk of lymphoma?
What Else Do I Need to Know?
What Is Breast Implant Revision?
Breast implant revision typically involves replacing silicone or saline implants in order to alter the size, change the type, or correct complications that occurred following initial breast augmentation. The intended result is restored breast contour and a youthful appearance. Back to top
Is Breast Implant Revision Right for Me?
Even if your breast implants were placed properly the first time, changes to the breasts and implants can still occur over time. Revision is typically performed on those who have experienced implant rupture, implant rippling, capsular contracture, asymmetrical results, or sagging due to aging, pregnancy, or weight fluctuations. It’s also commonly performed on women who are dissatisfied with the look and feel of their current implants and wish to replace them with a different size or style.
As with any cosmetic surgery, you need to be in good overall health to be considered for breast implant revision. If you have a heart or lung condition, or a neurological disorder, you may not be a good candidate. If you smoke, your doctor will likely advise you to stop smoking for at least six weeks before and after surgery, as nicotine impairs the healing process. Meet with a board-certified plastic surgeon, who can help you determine if implant revision is right for you. Back to top
What Are the Different Options for Breast Implant Revision?
As with your initial breast implant surgery, you’ll have a number of sizes and styles to choose from for breast implant revision. These typically fall into two main categories, based on the implant’s filling.
- Saline implants are filled with sterile salt water. In the event of a leak, the implant deflates and the body absorbs and naturally removes the saline. There are two types of saline implants: single lumen (traditional) and the newer double lumen. The double lumen have internal shells that are designed to make the implant feel more like silicone and maintain their shape better with less chance of capsular contracture.
- Silicone implants are filled with an elastic gel prior to surgery. They may require a longer incision. In the event of a leak, the body does not absorb the silicone, so you may need regular check-ups and MRIs every few years to monitor the status of the implants.
- You may also hear about cohesive gel breast implants. These implants use a silicone gel that’s thicker than traditional silicone filling and has more of a tendency to maintain its shape. These are also known as “form-stable” or “gummy bear” implants.
There are other choices to make, such as rounded or shaped and textured versus smooth. Discuss the goals of your revision clearly with your plastic surgeon so he or she can help you determine which style is right for you.
Implants can also be placed above or below the pectoral muscle, through a number of incision locations. The RealSelf Glossary of Breast Augmentation Terminology provides more information on these options. Back to top
How Much Does Breast Implant Revision Surgery Cost?
Breast implant revisions may start as low as $3,500 and go as high as $15,000. Many factors affect this range, including the experience of the surgeon, type of implants, length and difficulty of the procedure, the location of your doctor, and additional fees associated with anesthesia, surgical facility, prescription medication, and post-op appointments.
If you decide to return to the surgeon who performed your initial augmentation, you may be able to get a discounted rate. “Every plastic surgeon has their own revision policy,” says Salt Lake City plastic surgeon Dr. York Jay Yates. “Many plastic surgeons will charge little to nothing for revisions related to complications. Most will charge you something for implant size exchange, [but] many will give you a patient loyalty discount. If you are only changing the size of your implants, this can be a very simple, straightforward operation done at a lesser cost than your initial surgery.” Back to top
Will Insurance Cover Breast Implant Revision?
Breast augmentation and revision are typically considered elective cosmetic procedures and not medically necessarily treatments. For this reason, implant revision surgery is not likely to be covered by insurance. In most cases, the only breast surgeries that are covered are those performed as part of reconstruction after breast cancer.
Discuss your options with your plastic surgeon and insurance provider. If coverage is not available and you can’t pay out of pocket, payment plans may be available through a financing company. Back to top
How Do I Choose a Surgeon for Breast Implant Revision?
As with any elective procedure, the most important factor in choosing a doctor is experience. If the surgeon who performed your initial augmentation is trained, experienced, and certified, many RealSelf doctors advise returning to them for your revision, as they’re likely to have the best knowledge of your medical background and individual needs. “[Just because] a complication occurs, doesn’t necessarily mean that someone did something wrong,” explains Denver plastic surgeon Dr. Paul Zwiebel. “Unfortunately, complications can occur even in the hands of the best surgeons, staff, and facilities.”
If you don’t feel comfortable returning to your original doctor, we recommend having at least three consultations with board-certified plastic surgeons before making a new choice. During these consultations, expect to have your breasts examined for size, shape, breast tissue, skin quality, and placement of the nipples and areolas. Be prepared to discuss your current implants, the complications or dissatisfaction you’re experiencing, your desired results, and past and present health conditions or medications.
While any doctor can legally offer breast implant revision, you want to look for a doctor who performs the procedure frequently and has proven safe results. “There are a lot of doctors who are cosmetic surgeons or board-certified in fields other than plastic surgery,” says Dr. Franco. “They do not have the same training as a plastic surgeon.”
Check the American Board of Plastic Surgery website [to verify certification].Ask About the Operating Facility
“It is critical to ask about the surgery center where your procedure will be performed,” explains Dr. Law. “You need to know about accreditation, sterile processing procedures, and who will be with you in the surgery.”
You can check accreditation with the American Association for Accreditation of Ambulatory Surgery Facilities [AAAASF] or another nationally recognized body.Look at Before and After Photos
Ask how many breast implant revisions the doctor has performed and how frequently they do them. Then “insist on seeing before and after photos,” says Dr. Law. “A plastic surgeon with experience and expertise should have dozens of images of breast augmentation from three different angles, all with the same lighting, distance from the camera, and cropping … Seek out a surgeon who has the same aesthetic sensibility that you have.” Also look at before and after photos posted online by other patients to be certain you’re seeing real results.
How Do I Choose the Right Size for Breast Implant Revision?
If you’re unhappy with the size of your implants following your initial augmentation, you can swap them out for larger or smaller implants. Keep in mind that breast implants are measured in cubic centimeters (ccs), and the same number of ccs will look different on each individual.
“The right size of breast implants is based on a few things,” says Dr. Nazarian:
Dr. Nazarian also recommends doing the rice implant sizer test at home. “What I have my patients do is to get some ziplock bags and some rice. Start measuring out based on your consultation and the choices I’ve given you during our first meeting. Then go get the bra you’re hoping to fit into later and put the rice bag in. Walk around in that bra with the rice bags for a day: See the weight of it, the size of it, how you look in your clothes with it. Then you can adjust — go a little lower, a little bit higher. When you come back in, you’ll know what size is right for you.”
Discuss your expectations and desired results with your plastic surgeon, so he or she can help you decide which implant size is best. Back to top
What Happens During a Breast Implant Revision Procedure?
While what happens during your breast implant revision depends on the issue that’s being addressed, your surgeon will most likely use the same incisions as your original procedure. If you’re changing the size or repositioning your implants, your surgeon will manipulate the space inside the breast to accommodate the new implant. (He or she may also need to use other tissues or acellular dermal matrix to add additional support to the breast pocket.) If you’re suffering from capsular contracture, your doctor will remove the hardened capsules before inserting a new implant. If it’s necessary to lift the position of the nipple, you’re going to need additional incisions. Depending on the amount of lift that’s needed, this incision can range from just the top portion of the areola to the entire way around with a vertical incision extending down to the crease. In the event that you need a significant amount of sagging skin removed, there may also be a horizontal incision along the breast crease.
Breast implant revisions typically take between one and three hours, depending on the severity of the case, the implants used, the doctor’s technique, and whether or not a breast lift is being performed at the same time. This is typically done under general anesthesia (meaning you go to sleep), but some surgeons may choose to use local anesthesia (only the treated area is numbed). Once your surgery is over, you’ll be taken to a recovery area for a short period of observation. Unless your doctor thinks otherwise, you should be able to go home in your dressing and surgical bra that same day. Back to top
What Can I Expect During Breast Implant Revision Recovery?
While recovery varies from person to person, most RealSelf doctors agree that recovery after breast implant revision is much easier than your initial procedure. “Revisionary breast surgery is generally associated with very minimal recovery time and discomfort compared to first time breast augmentation,” says San Diego plastic surgeon Dr. Tom Pousti. “This is because the submuscular pocket has already been stretched.”
Expect to feel somewhat sore and tired for the first 24 to 72 hours after surgery. During this time, you should refrain from raising your arms above your head or lifting anything over 10 pounds. Light activities like walking are often recommend to encourage blood flow and decrease swelling. “Swelling and bruising will subside during the first week after surgery and will be controlled by pain medication,” explains Newport Beach plastic surgeon Dr. Jed Horowitz. “The initial surgical tapes will be removed a few weeks after surgery during a post-operative visit. Patients typically return to work a few days after surgery (only a light workload during the first two weeks). Showers are permitted on the third day post-op, once drains are removed.”
It’s critical to follow all the instructions given to you by your surgeon. These will include information on taking care of your drains, wearing compression garments, taking pain medication, and avoiding certain activities. Your surgeon will explain the types of symptoms you can expect. If you think you’re experiencing something abnormal, call your plastic surgeon’s office right away. Back to top
What Results Can I Expect From Breast Implant Revision?
Once swelling has subsided and the new implants have “dropped” into position, you can expect a full and symmetrical chest with long-lasting results. The majority of your swelling should go down within three months, and may continue to improve for up to a year.
While there’s a common misconception that implants need to be replaced every 10 to 15 years, Toronto plastic surgeon Dr. Frank Lista says this isn’t necessarily true. “If you have no problems with your implants, then nothing needs to be done with them.” That said, it’s important to monitor the state of your implants on a regular basis. Those with saline implants can check their status on their own simply by looking in the mirror. Leakage will be obvious as a ruptured implant will deflate and the saline absorbed by the body. Women with silicone implants are recommended to have an MRI three years after initial placement, and then every two years thereafter to ensure they’re functioning correctly.
To get an idea of the kind of results you can expect, here are three of our most viewed breast implant revision before and after photos. Back to top
Photo courtesy of Baltimore plastic surgeon Dr. Michael Cohen
Photo courtesy of Boca Raton plastic surgeon Dr. Hilton Becker
What Are the Possible Side Effects of Breast Implant Revision?
When it’s performed by an experienced plastic surgeon, breast implant revision surgery has a very high success rate. However, as with any surgery, it’s not completely risk-free. Potential side effects include infection, bleeding, hematoma, scarring, capsular contracture, implant rupture, adverse reaction to anesthesia, and unsatisfactory results that may require yet another surgery. Minimize these risks by following your surgeon’s post-op instructions closely. Back to top
Is there an increased risk of lymphoma?
In March 2017, the FDA released a report highlighting the possible association between breast implants and the development of a rare type of non-Hodgkin's lymphoma called anaplastic large cell lymphoma.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of lymphoma that can develop following breast implants,. The FDA said the condition occurs more frequently with textured surface implants compared to smooth surface implants.
"All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants," read the FDA statement. "Most cases of breast implant-associated ALCL are treated by removal of the implant and the capsule surrounding the implant and some cases have been treated by chemotherapy and radiation."
If you have breast implants, the FDA says there is "no need to change your routine medical care and follow-up." The report says to continue to follow your doctor's instructions on how to monitor your breast implants, including routine mammography screening and periodic MRIs to detect ruptures in silicone gel implants.
If you are considering breast implants, the FDA suggests you discuss the benefits and risks of textured implants compared to smooth implants with your doctor.
Additional information about BIA-ALCL can be found on the FDA's breast implants website.
What Else Do I Need to Know?
What Happens If I Get Pregnant After Breast Implant Revision?
There’s no way to keep your breasts from changing during pregnancy. While these changes won’t damage the implants themselves, they may contribute to additional loose skin. Should this occur, a breast lift may be able to restore your results.
Breast implants should not interfere with your ability to breastfeed, but tell your doctor if you plan to get pregnant in the future. “To lower the risks of interfering with breastfeeding, the general recommendation is to avoid the periareolar incision because of the risk for interfering with nipple sensation and to place the implant under the muscle,” says Denver plastic surgeon Dr. Gregory Buford.
What Will My Scarring Be Like?
Implant revision scars typically heal very well and can often be inconspicuous, however this comes in stages. “Every wound gets harder and more reddish or purplish for about three to four months,” says Dr. Nazarian:
During this time, Dr. Nazarian recommends keeping your scars out of the sun, as UV light can cause them to heal darker than they would otherwise. She also suggests using silicone sheeting or creams to further minimize the appearance.
Dr. Nazarian warns patients against certain products that are commonly considered to have healing benefits. “Things like vitamin E, which everyone thinks is so amazing, can actually be harmful to a scar. Vitamin E weakens collagen cross-linking and can actually lead to a flat, but wider scar.”
Discuss your options for scar management with your plastic surgeon.
When Can I Have Sex After Breast Implant Revision?
“Most surgeons will tell you to wait two weeks,” explains Beverly Hills plastic surgeon Dr. Luis Macias. “We don’t want your blood pressure rising too much, as that can lead to a blood collection around the implant called a hematoma. After two weeks, you should approach it carefully and avoid movements that can cause you or your partner to dislodge the placement of the implant for about six weeks.”
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This guide has been medically reviewed for accuracy by Beverly Hills plastic surgeon Dr. Sheila Nazarian. Dr. Nazarian is certified by the American Board of Plastic Surgery and trained in cosmetic, plastic, and reconstructive surgery. She completed undergrad at Columbia University and holds a medical degree from Yeshiva University. She spent her plastic surgery residency at USC, where she continues to serve as an assistant professor. Learn more on her RealSelf profile.
Disclaimer: This content is for educational and informational purposes only. It is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare professional. Your reliance on any information or content provided in the guide is solely at your own risk. You should always seek the advice of your physician or healthcare professional for any questions you have about your own medical condition. RealSelf does not endorse or recommend any specific content, procedure, product, opinion, healthcare professional or any other material or information in this guide or anywhere on this website.
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