Breast Augmentation Revision: Implant Removal vs. Implant Replacement

Breast implants, like pacemakers and other implantable medical devices, are manufactured to be highly safe and durable, enabling most patients to enjoy their enhanced breasts for decades. There are, however, instances where patients become unhappy with the current look or feel of their previously augmented breasts. In these cases, an implant removal or implant revision procedure can be performed to re-enhance the breasts. The most appropriate treatment option (i.e. implant revision or implant removal) may vary depending on the individual characteristics and patient’s desired end result.

Here are the most common reasons patients seek to either remove or revise their breast implants (along with common techniques):

Change Breast Size

Some former breast augmentation patients simply wish to further change the size their breasts. Some women decide to go with a smaller sized implant after realizing that their original implant is too large and no longer fits with their lifestyle. In other instances, the patient may wish to go larger in order to greater accentuate their chest.

For patients who prefer smaller breasts, the surgeon can use the original incision sites to remove the implant and reduce the size of the implant pocket as needed. The reverse is true for patients who want to go larger: the surgeon will surgically enlarge the pocket and insert a larger sized implant. In either case a breast lift (mastopexy) procedure can simultaneously be done for enhanced breast symmetry.

Capsular Contracture

Capsular contracture (the formation of a hardened capsule around the implant) is a complication of breast augmentation. While the exact cause of capsular contracture is unknown, it is generally thought to be the body’s response to the presence of certain bacteria in the implant pocket. Implant revision surgery is the most effective way to treat capsular contracture. During this procedure the affected implants are removed and capsule scar tissue is surgically excised (capsulectomy). A fresh implant is usually placed during such a procedure.

Implant rippling

Some patients may begin to notice the development of rippling, where the edges of the breast implant become visible and/or able to be felt. To correct rippling most surgeons will suggest a revision procedure that uses a silicone implant placed under the muscle (sub-muscular placement). Often the incision sites used for the initial augmentation procedure can be re-used. However, the surgeon may need to create a different breast pocket that is below thicker muscle and breast tissue to better conceal the implant.

Implant repositioning

There are instances where the implant becomes malpositioned. Sometimes the breast tissues thin out over time leading to decreased support for the implant. This can cause the implant to shift or move in an undesirable way, negatively affecting the symmetry and appearance of the breasts. The implant pocket may need to be surgically reconstructed to better support the current implant. Other times your surgeon may recommend reducing the size of the implant and reconstructing a new smaller pocket.

Symmetry Issues

As the body naturally ages or experiences significant changes from weight gain or loss the breasts may take on an asymmetrical appearance. Such symmetry changes are not confined to past breast augmentation patients. All women may develop unwanted symmetry differences of their breasts. If this occurs implant replacement may be necessary to reinstate an even appearance. The use of different sized implants or a surgical restructuring of implant pockets may be performed to even out the chest.

Cameron Craven MD, FACS is board certified by the American Board of Plastic Surgery. Dr. Craven specializes in the full spectrum of cosmetic surgery including breast augmentation, liposuction and body contouring, facial rejuvenation, laser surgery, eyelid surgery, and rhinoplasty, as well as reconstructive surgery for skin cancers.