Revision Breast Augmentation: Could It Be in Your Future?

When a woman has breast augmentation surgery, the idea of possible future revision surgery probably doesn't enter her mind. In the interests of being well informed and prepared for the unexpected, it should.

Revision breast augmentation is a surgical option available to women who are not happy with the look or feel of their new breasts. For many of them, size is the issue — usually too small, but sometimes too big — or they decide to change the type of breast implant or have them removed altogether and return to their natural breasts. Other women are unhappy over time with normal changes to their breasts following pregnancy or a large weight loss. And let's not forget that breast implants aren't intended to last forever; most implant warranties are for 10 years, so secondary surgery to replace them at some point is practically a given.

There are valid medical reasons why women seek revision breast augmentation. The most common include suspected or known implant rupture, pain, capsular contracture, an implant pushing through the skin (displaced implant), and medical reasons like seroma (collection of fluid below the skin), hematoma (blood clots) and infection. A Food and Drug Administration (FDA) study of more than 900 women with breast implants found that one-third of them had at least one such complication. Some of these complications may require breast implant replacement.

So before you undergo breast augmentation surgery, it's important to understand that complications can and do occur, and they may make revision surgery necessary. Keep in mind that repeat breast surgery is often more complicated and costly than primary surgery, and may require a longer recovery period.

The Revision Breast Augmentation Process: What to Expect

Like all cosmetic plastic surgeries, the revision breast augmentation process begins with a consultation with a board-certified plastic surgeon specializing in breast augmentation and revision breast augmentation. This could be the same surgeon who performed your original breast augmentation (some offer to revise their work for free within a certain time frame) or a new surgeon. Your decision depends on a number of factors, including whether or not you were pleased with your initial surgical experience, how much time has passed since then and the nature of your concerns with your breasts.

If you stay with your original surgeon, he or she should have your medical records on file. If you go to a different surgeon, take your records to the consultation so the surgeon can review them.

During your consultation, be as open and specific as possible about your issues with your breasts and your expectations. If there were problems with your initial surgery, share them with the surgeon. If your concerns stem from other factors (e.g., natural aging or a change of heart), be honest about that, too.

The plastic surgeon will examine your breasts, analyzing their shape and size, placement of the nipples and areolas, and skin quality. He or she may also take some "before" photos for reference. Based on all these factors, the surgeon will develop a plan and go over it with you, discussing the finer points of implant types, sizes and their placement, where and how the incisions will be hidden, and what your realistic expectations should be.

Your Revision Breast Augmentation Surgery

Each breast revision surgery is as unique as the procedure that came before it and the woman involved. The surgical plan reflects your anatomy, cosmetic concerns and expectations. The surgery itself may be as straightforward as replacing an implant, or switching from one type, shape or texture of implant to another. Changing an implant placement from subglandular (under the breast tissue) to subpectoral (under the chest muscles) is more complicated. Some women opt to combine their revision breast augmentation with a breast lift. All these factors affect the cost of the surgery as well as the length of the recovery period.

The timing of revision breast augmentation varies depending on the circumstances. A surgeon may go back in immediately following the initial surgery to address a cosmetic issue like pronounced asymmetry, or when an implant ruptures. Women who wish to go larger or smaller are usually advised to wait a minimum of three to six months for revision breast augmentation to allow for healing and to get a better idea of their true new size.

Revision breast augmentation is usually performed in an office surgical suite or an outpatient surgical center under local anesthesia. If necessary, it can be performed in a hospital under general anesthesia. The length of surgery ranges from one to four hours, slightly longer than a breast augmentation procedure.

Risks of Revision Breast Augmentation Surgery

Like all surgery, revision breast augmentation has its risks. The following potential complications should be discussed with your surgeon, who may add others:

• Reaction to anesthesia
• Blood/serum accumulation (hematoma/seroma)
• Infection
• Bleeding
• Permanent scarring
• Changes in nipple or breast sensation (usually temporary)
• Capsular contracture (scar tissue)
• Implant rupture
• Poor healing
• Possible need for future revision surgery

Recovery from Revision Breast Augmentation Surgery

To ensure a healthy recovery, keep all follow-up appointments with your surgeon. He or she will evaluate your progress during these visits. Raise any questions or concerns you have with your recovery.

Your recovery from revision breast augmentation surgery may be similar to the recovery you experienced after breast augmentation, but be prepared if it turns out to be more difficult. Your surgeon should be able to give you a good idea of what to expect prior to surgery based on the techniques involved.

Pain and stiffness after surgery is normal, as are bruised and swollen breasts and reduced nipple sensitivity. Your surgeon can prescribe prescription painkillers and ice packs to help ease your discomfort. A surgical bra can be worn postsurgically for several days to provide additional support as you heal.

Avoid heavy lifting and straining during recovery, as both can cause your breasts to swell. Most patients are cleared to return to sedentary work within a week; normal activities are usually off limits for a few weeks.

Revision Breast Augmentation Cost

Revision breast augmentation may be more costly than the primary surgery. It also may be relatively inexpensive if your surgeon offers to correct or revise his or her work free of charge. This decision is based on the nature of the complication and your surgeon's policy. Some do not take a surgeon's fee, but you may be responsible for other costs, including (but not necessarily limited to) the operating room fee and anesthesia costs. Your breast implants may also be covered under a warranty, which could offset the cost as well. Make sure you are clear about the cost of your revision breast augmentation before you book your surgery.