Breast revision surgery: fixing problems after breast surgery

What is breast revision surgery?

Breast revision surgery is any operation that corrects or improves the result of previous breast surgery – augmentation, a lift, a lift with implants, reduction or reconstruction. Some problems appear soon after surgery, others years later as tissues stretch and age. Revision is generally more complex than the first operation, so an accurate diagnosis of the problem and an experienced surgeon are essential. Hardening of the breast is covered separately on our capsular contracture page.

Double bubble

A "double bubble" is a visible step or groove across the lower breast, so that the breast looks as if it has two curves. It happens when the implant sits below the original breast fold, and the fold remains as a visible line (most common in tuberous breasts or when the fold was lowered), or when the breast tissue sags over an implant that stays high. Correction may involve releasing the old fold, reinforcing a new fold, changing the pocket, choosing a different implant or adding fat transfer.

Bottoming out and implant malposition

• Bottoming out: the implant slips too low, below the fold, so the nipple seems to point upwards and the distance from the nipple to the fold increases. It is associated with large, heavy implants, thin tissues and excessive lowering of the fold.
• Lateral displacement: the implants fall to the sides when lying down, creating a wide gap between the breasts.
• High-riding implants: implants that stay too high, often due to capsular contracture or tight muscle.

Correction usually involves tightening the pocket with internal stitches (capsulorrhaphy), creating a new pocket (for example, a "neo-subpectoral" pocket), sometimes with a supportive mesh or tissue matrix, and often a smaller or different implant. Our implant replacement page explains the exchange procedure.

Symmastia

Symmastia – sometimes called "uniboob" or breadloafing – is when the implants meet in the middle, lifting the skin off the breastbone so there is no visible separation between the breasts. It may be caused by over-dissection of the pocket towards the centre, overly wide implants, or a natural predisposition. Correction involves closing the inner part of the pocket with layered stitches, sometimes with a new pocket and smaller implants, followed by a period of special compression to hold the cleavage in place.

Rippling and visible implant edges

Rippling is visible or palpable wrinkling of the implant, usually at the sides or cleavage area. It is more common with thin tissues, implants placed over the muscle, saline implants and underfilled implants. Treatment options include moving the implant under the muscle, changing to a cohesive silicone implant, choosing a smaller implant, adding fat transfer to thicken the coverage, or using a tissue matrix.

Asymmetry and sagging after surgery

Some asymmetry is normal before and after surgery, but a significant difference may require revision: unequal implant position, different nipple heights after a lift, unequal reduction, or one breast that has changed due to contracture. Over time, the breast tissue may also sag over the implant ("waterfall deformity"), requiring a lift with implants or a change of implant. Our page on breast asymmetry explains more.

Scars that are wide, raised or pulled can also be revised, usually after at least a year, when they have fully matured.

When to have revision surgery

Except in urgent cases such as infection or implant exposure, revision is usually best done at least six to twelve months after the previous operation, when swelling has resolved and tissues have softened. Before revision, your surgeon will want to know the implant type and size (bring your implant card), the operation report and any imaging. An ultrasound or MRI may be needed to check the implants. Clear communication about what bothers you – shape, size, position, feel or symmetry – is key to a good plan.

Recovery after revision

Recovery depends on the procedure: pocket corrections and implant exchange usually require one night in hospital, a supportive bra for six weeks or more, and a return to desk work after one to two weeks. Strenuous exercise and heavy lifting should be avoided for at least six weeks, because the internal repairs need time to heal. Revision surgery has a somewhat higher risk of complications than first-time surgery, and a further procedure is occasionally needed. Our recovery guide and safety page cover the general principles.

How New City Clinic can help

Send photos from several angles, your implant card and your operation report via WhatsApp for a free online assessment. Plastic surgeon Dr. Fatih Kılıç will explain what has happened and how it can be corrected. Read more on newcityclinic.com about breast implant revision and breast lift with implants. Revision operations take place in accredited hospitals in Istanbul, and your coordinator arranges your stay and follow-up.