Breast Surgical Revision: Facts Patients Ask About Now
Andrew Smith, MD, FACS, Plastic and Reconstructive Surgery
Late-year calendars fill up with consultations, as summer movement, weight shifts, and one more pregnancy reveal small changes that feel bigger in a T-shirt. At the same time, long-term maintenance questions surface: Is this tightness normal? Why is the implant drifting? How long should I wait before changing anything? A clear, fact-forward look at breast revision helps you decide what to do next—and when.
Dr. Andrew Smith, MD, FACS, treats revision as its own discipline. The work happens in his accredited, on-site surgical suite in Irvine with the same team from consult through follow-ups. The goal is practical: relief, better support, and a shape that fits your frame now.
Primary surgery starts on tissue that hasn’t been altered by prior incisions or capsules. Revision must account for scar behavior, an implant pocket that may have stretched or tightened, and the blood supply that has adapted over time. Planning inside those constraints—rather than pushing past them—reduces complications and produces results that hold up. In practice, that means careful dissection, measured pocket work, and a willingness to stage when safety or circulation call for it.
Two themes show up again and again: capsular contracture and pocket problems. FDA post-approval data lists capsular contracture among the most frequent reasons for reoperation after augmentation and revision-augmentation, often outpacing size change and other issues.
Capsular contracture is the tightening of the normal scar capsule around an implant. The breast can ride high, feel firm, or drift toward the armpit, sometimes with soreness. Pocket problems are different: the implant sits too low, too far out to the side, too close to the center, or simply unstable. Both issues are fixable; the plan depends on what your tissue can safely support.
Pocket repair starts with boundaries. Surgeons may tighten lax areas (capsulorrhaphy), release bands that are pulling an implant off-center, or create a new pocket in healthier tissue when the old space can’t hold position. Changing the implant plane (over-to-under muscle or vice versa) is common when the capsule or soft-tissue coverage works better in a different layer. For thin or fatigued support, internal reinforcement—biologic or synthetic “mesh”—can distribute load across the lower breast so the position holds in daily life. Peer-reviewed reports and reviews describe these methods and the scenarios where reinforcement improves stability; they also note that added material means added decisions about risk, cost, and follow-up.
Dr. Smith’s take: pick the simplest move that solves the problem and protects the small vessels that keep skin and the nipple–areola complex healthy. Position on the table is easy; the position that lasts is the metric that matters.
Treatment usually means releasing or removing the tight portions of the capsule, rebuilding the pocket, and often exchanging the implant. A plane change is common when the prior environment contributed to the problem. Recurrence can happen. Recent studies confirm contracture remains a leading cause for revision and may recur on shorter intervals for some patients; technique, pocket control, and follow-through help lower risk, but can’t erase it. Evidence also suggests the implant surface alone isn’t a reliable solution in a revision setting.
This is a planning conversation as much as a technical one: what improves comfort and shape, and what steps keep a second recurrence less likely.
Time, weight change, and prior surgery can leave coverage thin. Edges show. Rippling reads near the neckline. Here, strategy shifts from “tighten more” to “share the load.” Internal reinforcement—biologic or synthetic—acts like a hidden sling for the lower pole. Meta-analyses and comparative series report acceptable safety profiles and similar contracture rates between biologic and synthetic options when used in selected patients, with trade-offs that should be discussed in advance.
Dr. Smith’s approach: match implant size and profile to the support you actually have today; use reinforcement when it meaningfully improves stability, not as a default.
Revision stresses blood supply more than primary surgery, especially after multiple operations or large lifts. Good plans reuse prior scars when possible, avoid unnecessary undermining, and stage when a single session would push circulation too far. Intraoperative checks guide decisions before closure. This quiet part of the operation determines how well the rest of the plan holds up.
Patience saves revisions. Most patients are better served waiting six to twelve months after the last breast operation. That window allows swelling to resolve, scars to soften, and the capsule to stabilize—essential data for accurate planning and safer surgery. Many reputable sources and specialty practices advise this range; the exact interval depends on the indication and your healing arc.
If a rupture or infection demands earlier action, the timeline changes. Otherwise, time clarifies which details truly bother you and which fade.
History and exam lead. When integrity is in question or fluid is suspected, ultrasound or MRI can help define the problem and sharpen the plan. Device details, prior operative notes, and a timeline of changes round out the picture. You should leave a consultation knowing the diagnosis in plain terms and why the proposed steps match it.
Incisions often follow prior scars. Dissection protects the small vessels that keep the skin and nipple–areola healthy. Pocket work proceeds in sequence: release what binds, define what stretches, test with sizers, then secure boundaries. Reinforcement—when used—is shaped to support the lower pole without showing at the edges. Fat grafting is placed in thin passes to improve contour and mask rippling where needed. Protocols that control contamination and manage the pocket environment are standard; they matter for contracture risk over time.
Most people go home the same day when done in a dedicated, accredited setting.
The arc depends on scope, but the pattern is consistent. The first days focus on swelling control, pain management, and incision care, plus short walks for circulation. Weeks one to two often allow desk work if the plan permits; arms stay close, and lifting limits protect the repair. Weeks three to six add gradual activity, still centered on a support bra that matches the surgical plan. Shape steadies over months as scars mature and the capsule relaxes.
Pocket repair alone is often a few weeks of moderated routine; add capsulectomy, lift, mesh, or a plane change, and the timeline extends. The point is not to rush the win—stability beats speed.
A well-planned revision can ease tightness, restore softness, and steady the shape. It can correct drift that fights every bra, refine lift lines, and quiet rippling near the neckline. It won’t return tissue to a pre-surgery state. You may see a faint contour shift in direct light, feel a change in sensation, or carry a scar that fades but doesn’t vanish. Define success up front, in specific terms tied to symptoms and shape. Match the implant strategy to the support your tissue can provide now. Accept staging when it improves safety or longevity.
Patterns that often point to revision: an implant that rides high or tight months after healing; lateral drift that shows in tank tops; lower-pole stretch that the bra can’t tame; rippling that peeks at the neckline; or a long-standing size and profile that no longer fits your frame. Some patients choose explant with lift for comfort and a smaller footprint, sometimes with small-volume fat grafts to soften edges. Others keep implants and rebuild support for a stable result.
Skip scripts. Ask for your diagnosis in plain language; the exact plan to protect blood supply; the role of mesh—if any—in your case; how the plan changes if contracture returns; the week-by-week recovery for this operation; and when staging would beat a single session. Good answers tie back to your anatomy and your goals, not a template.
Dr. Smith’s framework is simple: protect circulation, rebuild structure, and choose devices that match the support you have. Success is how the breast sits in real life—standing, walking, sleeping—not only how it looks on the table. He favors the smallest move that solves the problem and uses reinforcement when it clearly improves stability. Capsular contracture and pocket malposition remain the top drivers of reoperation nationwide; clear planning and careful technique lower, but do not erase, recurrence.
Keep a short list: what you’d change, what you’d keep, and what worries you most. Bring device details if you have them. When you’re ready, a consult in Irvine can translate those notes into a plan you understand—and a timeline that fits your life. No pressure. Information first.
For a deeper look at procedure options, visit our breast augmentation revision page. You can also learn more about our practice and approach from our plastic surgeon in Irvine.
Contact Andrew Smith, MD FACS Plastic and Reconstructive Surgery in Irvine, Orange County to schedule your consultation.
