Something is wrong with a breast implant when the breast changes after it has settled: firmer or higher, lower or off to the side, rippled at the edge, a different size, painful or swollen. Almost every one of those changes has a name, a cause and a fix, usually a breast revision or an implant removal. A few need to be seen within days; they are listed below.
The Problems by Name: How Each Shows and What Fixes It
Capsular contracture: a breast that turns firm, round or high
Every implant is wrapped in a thin layer of scar tissue, the capsule; contracture is that capsule tightening until it squeezes the implant. The Baker scale, plainly: grade one, soft and natural; grade two, a little firm but looks normal; grade three, firm and visibly rounder or higher than the other side; grade four, hard, painful and distorted. Grades one and two are watched and massaged; three and four are fixed by removing the capsule (a capsulectomy) and usually exchanging the implant, often into a fresh pocket so it is less likely to return. Our post on capsular contracture covers the causes and Dr. Cat's prevention protocol.
Rupture and deflation, including the silent rupture
A torn saline implant empties over hours or days; the breast visibly shrinks and the salt water is absorbed without harm. A silicone rupture is usually silent, because the cohesive gel keeps its shape inside the capsule, which is why the FDA advises women with silicone gel implants to have an MRI or an ultrasound five to six years after placement and every two to three years after that, and why Dr. Cat recommends exchanging silicone implants about every 8 to 10 years. A ruptured or deflated implant is exchanged, with or without the capsule. Our comparison of saline vs silicone implants covers the difference.
Malposition: bottoming out, double bubble, lateral drift and symmastia
Bottoming out is the implant sliding below the breast crease, so the nipple points upward and the volume sits low. A double bubble is a second fold under the natural crease, or breast tissue sagging off the front of an implant that stayed high. Lateral drift is implants that fall toward the armpits; symmastia is two pockets joined across the middle so the cleavage disappears. All four are fixed by rebuilding the pocket with internal sutures, plus an internal support material when the tissue is too thin to hold the repair.
Rippling and visible edges
Rippling is the folded edge of an implant showing through the skin, usually at the outer side or the top of the breast. It is most common with saline implants, implants over the muscle, and slim women with little cover. The fix adds coverage rather than swapping the implant alone: moving it under the muscle, exchanging saline for a cohesive silicone gel, fat grafting over the thin areas, or an acellular dermal matrix (a sheet of processed tissue) inside the pocket.
Too big, too small, and "wrong size" regret
Size regret is the most common reason for a revision that is not a complication. Implants too big for the chest sit wide and drag the tissue down; implants too small leave the upper breast empty. Both are fixed with an exchange, sometimes with a lift when the skin has stretched, and the new size is chosen by measurement rather than cup letter; our guide to breast implant sizes explains how the width of your breast sets the range.
Asymmetry after augmentation
One side higher, larger or shaped differently can be an implant that has not dropped, a capsule tightening on one side, a pocket made differently from its pair, or a difference between the breasts that the first operation did not correct. Finding out which is the point of the examination. If the unevenness was there before any surgery, our page on breast asymmetry covers how it is planned for.
Breast implant illness and explant with capsulectomy
Breast implant illness (BII) is the name patients, and now the FDA, use for symptoms reported by some women with saline or silicone implants: fatigue, brain fog, joint and muscle pain, rashes, anxiety and others. No test confirms it, so it is diagnosed by ruling out other causes; the FDA says the symptoms and their cause are not yet understood, and that some women report them reversed after removal. The operation is an explant with capsulectomy; Dr. Cat removes the whole capsule in almost every explant and does not perform en bloc capsulectomy as a treatment for BII. Our post on breast implant illness covers the symptom list and the work-up.
BIA-ALCL
Breast implant-associated anaplastic large cell lymphoma is a rare cancer of the immune system, not a breast cancer, that develops in the capsule around an implant, almost always a textured one, usually years after placement. It typically shows as a sudden swelling of one breast from fluid around the implant, sometimes a lump or pain. The FDA does not advise removing textured implants that cause no symptoms, and found early it is usually treated by removing the implant and the whole capsule.
When implants are exchanged
Implants are long-term devices, not lifetime ones, and the chance of a rupture or a capsule problem rises the longer they are in. Dr. Cat recommends exchanging silicone implants on a schedule, about every 8 to 10 years, to reduce the chance of a leak, because a silicone rupture is often silent. Saline implants announce a leak by deflating and are replaced when that happens or when you want a change. In between, either kind is replaced for a reason (a contracture, a position change, a size you no longer want); our posts on how long breast implants last and how often breast implants should be replaced go through the reasons.
When to See a Surgeon, and What Is Urgent
See a surgeon within days for a sudden change in one breast: swelling, redness, warmth, fever or pain in the first weeks after surgery, which can mean bleeding or infection, or a breast that swells quickly months or years later, which needs an ultrasound. A deflated saline implant is not dangerous, but exchange it before the pocket shrinks around the empty shell. Make an appointment within weeks for new firmness, a change in position or shape, a lump, or new rippling. Size, unevenness or a look that has aged can wait for a planned consultation.
The Fixes
Breast revision
A breast implant revision in Beverly Hills with Dr. Cat covers every problem above that keeps an implant: an exchange for a new size or type (she uses Mentor implants); removal of a contracted capsule; rebuilding a pocket that has bottomed out, drifted or joined in the middle; and coverage for rippling. She operates through your existing scars, tests both pockets for symmetry before the new implants go in, and places them with a no-touch technique. The surgery takes three to seven hours under general anesthesia with a board-certified anesthesiologist. Recovery mirrors a first augmentation: a daily routine in about a week, activity at four weeks, and the implants settled at four to six months.
Explant, with the capsule
A breast implant removal in Beverly Hills takes the implants out through the existing scar and, in almost every case, removes the whole capsule with them; when the full capsule cannot be freed safely from the chest wall, Dr. Cat removes nearly all of it. Drains stay in for about a week. The breasts look deflated at first and reshape over roughly six months; some patients then want nothing more, some want a lift, and some choose fat transfer to the breast for volume.
A lift with the revision
Large implants and years stretch the skin, so an exchange for a smaller implant, or a removal, often leaves the breast lower than you want. A breast lift after implant removal or alongside the new implant reshapes the breast in the same operation; Dr. Cat adds it when the nipple sits at or below the crease or there is a lot of loose skin. After an explant it can also be staged a few months later, sometimes a smaller lift or none.
What Dr. Cat Looks For at the Revision Consultation
A revision consultation is with Dr. Cat, in person or virtually for patients who travel, and it is $1,500, credited toward surgery. She goes through the original implants (make, size, surface and placement) and when the problem started. She examines both breasts for firmness and the Baker grade, where each implant sits against the crease and the midline, how thick the tissue is over the edges, whether the breast tissue has slid off the implant, and where the nipple sits, and she may ask for blood work or breast imaging before surgery. Then she tells you which fix applies, what a revision cannot do (thin tissue stays thin; a stretched breast needs a lift, not a bigger implant), and whether she would remove rather than replace.
Before and After
Our breast revision before and after photos show corrections of contracture, malposition, rippling and size, many of them for patients whose first surgery was done elsewhere.
Cost in One Line
Dr. Cat's surgeon's fee for a breast revision (implant exchange with capsule work) is $60,000 to $75,500, for an explant with capsulectomy $19,500 to $23,500, and for a simple implant removal and replacement $19,500 to $21,500; the operating room and anesthesia are quoted at your consultation, and our breast revision cost guide explains what moves the price, and the financing page covers payment plans. Surgeon's fees are typical ranges: a more complex case can cost more, and your fee is set at your consultation and is final only in your written quote.
Frequently Asked Questions About Breast Implant Problems
How can you tell if something is wrong with your breast implants?
Compare each breast with how it looked and felt once it settled. New firmness, a higher or rounder look, a shift downward or sideways, ripples, a change in size, a lump, pain or swelling all mean something has changed and should be examined. A silicone rupture can be silent, so keep to the imaging schedule even when nothing feels different.
What are the first signs of capsular contracture?
Mild firmness or tightness in one breast, most often two to twelve months after surgery, sometimes with the implant sitting higher or looking rounder than the other side and an ache when you stretch or lift. Early contracture is easier to treat than late, so report it as soon as you notice it.
Can capsular contracture be fixed?
Yes. Grades three and four are treated by removing the tightened capsule and usually exchanging the implant, often in a fresh pocket so it is less likely to return. Milder grades are sometimes managed without surgery. It can recur, so the prevention protocol matters the second time too.
Can breast implants cause autoimmune problems?
The FDA has found no link between silicone implants and connective tissue disease, but it records reports of fatigue, joint pain, rashes and brain fog from women with saline and silicone implants, called breast implant illness. No test proves the connection. If other causes have been ruled out, removal with capsulectomy is an option Dr. Cat discusses openly.
Will Dr. Cat take me if another surgeon placed my implants?
Yes. Many of her revision and explant patients had their first surgery elsewhere. Bring your implant card and operative report if you have them; if not, she plans from the examination and imaging.
Talk to Dr. Cat About Your Implants
If your implants have changed, start with a free discovery call: book your free discovery call or phone (310) 858-8808. Then look through the breast revision before and after photos and read about breast revision surgery in Beverly Hills.
Medically reviewed by Dr. Cat Begovic, MD, FACS, board-certified plastic surgeon. Last reviewed September 2026.