Breast Implant Revision

Breast implant revision is a broad term that covers any further surgery on a patient who has previously had breast implants. It includes everything from a simple implant exchange through to complex capsular work, pocket reshaping, and combined procedures that address changes in the breast tissue alongside changes to the implants. The right approach depends on why revision is being considered, what’s been done previously, and what the patient is hoping to achieve.

We see patients who had their original surgery elsewhere as well as those returning for follow-up surgery on their original implants. In either case, the assessment process is similar, and we put time into understanding what’s happened in the past and what’s needed now before making any recommendation about further surgery.

Patients come to us looking at revision for many different reasons. Some are clinical problems with the implants themselves. Others are changes in the breast tissue around the implants. Others again are decisions to change implant size or type. Common reasons include:

The procedures grouped under the heading of revision surgery vary substantially in scope, and the right combination for any individual patient depends on what's needed.

Revision surgery requires more careful pre-operative assessment than primary augmentation, because we’re operating on tissue that has been operated on before and we need to understand what’s happened previously. We’ll ask about the history of your previous surgery, including the type of implants, the surgical approach used, the placement chosen, and any complications that have emerged since.

Imaging may be requested to support the assessment, including ultrasound, MRI or mammography depending on the situation and the questions we need to answer. Implant rupture, particularly of silicone gel implants, is sometimes silent and is best picked up on imaging rather than on examination. If you have records from your previous surgery, including the implant card showing the implant make, model and size, please bring them. This information makes a real difference to planning and reduces the chance of unexpected findings during surgery.

Revision surgery is performed under general anaesthesia in an accredited hospital. Operating time depends on the complexity of the revision and ranges from approximately one hour for a simple implant exchange to several hours for combined revisions and total or en bloc capsulectomies. Most patients stay in hospital for one or two nights, with the second night more likely after larger or more complex revisions.

Drains are commonly used in revision surgery and are typically removed before discharge or at the first follow-up appointment, depending on the volume of fluid produced.

Recovery from revision surgery varies depending on what’s been done. A simple implant exchange has a recovery profile that’s broadly similar to recovery from the original augmentation. Larger revisions, particularly total capsulectomy, have a longer recovery and a greater risk of bleeding because the dissection is more extensive and the surfaces involved are larger.

A surgical bra is worn continuously for several weeks. Lifting, vigorous exercise and overhead activity are off the list for around six weeks. Most patients return to desk work after one to two weeks, with longer for more complex revisions or for patients in physical roles.

Revision surgery generally has higher complication rates than primary surgery, because the tissues have been operated on previously and the planes are no longer pristine. The recognised risks include:

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545