What is breast revision surgery?
Breast revision surgery is a second operation on a breast that has already been augmented. A first breast augmentation places an implant in a fresh pocket; a revision works through the scar tissue the first surgery left, corrects what went wrong, and usually places a new implant. Depending on the problem it includes a capsulectomy (removal of the scar capsule), a capsulorrhaphy (internal sutures that rebuild the pocket), Strattice reinforcement, an exchange of implants, a change of pocket plane, or a lift with an areola reduction.
The line between a revision and its neighbors decides the operation and the price. New implants in a soft breast with a good pocket is a breast implant exchange, the simplest second breast surgery. A previous lift redone, with the implants left alone, is a revision breast lift. Implants taken out for good, almost always with the whole capsule, is breast implant removal. A capsule that must come out, a pocket that must be rebuilt, or a lift needed with new implants is a breast revision. Our page on breast implant problems describes the signs of each.
Reasons for breast implant revision
Most of Dr. Cat's revision patients had their first surgery elsewhere, and several of these problems usually arrive together.
Capsular contracture
Every implant is wrapped in a thin layer of scar tissue, the capsule. Contracture is that capsule tightening until it squeezes the implant: the breast turns firm, rides higher and looks distorted. It is the most common reason for a breast revision and has its own section below.
Bottoming out and double bubble
Bottoming out is the implant sliding below the natural crease, so the nipple points upward and the volume sits too low. A double bubble is a second fold below the crease, or breast tissue sagging off an implant that stayed high. Both are corrected by rebuilding the pocket.
Symmastia (uniboob): implants that have merged across the middle
Symmastia is two implant pockets that have joined across the breastbone, so the cleavage disappears and the implants meet in the middle. Dr. Cat closes the joined pocket with capsulorrhaphy sutures that reattach the tissue to the chest wall along the midline, reinforced with Strattice when the tissue is thin, usually with a narrower implant.
Breast implant rippling
Rippling is the folded edge of the implant showing through the skin, most common with saline implants, implants over the muscle and slim patients with little cover. Dr. Cat adds coverage rather than swapping the implant alone: the implant moved under the muscle, saline exchanged for silicone gel, or Strattice placed over the thin area.
Implants too wide, too high or too far apart
An implant wider than the base of the breast sits into the armpit or toward the middle; an implant that never dropped sits high; pockets made too far apart leave no cleavage. Each is corrected with a pocket made to the width of your chest and an implant chosen by measurement.
A change of size, shape or filling
Size regret is the most common reason for a revision that is not a complication. When both capsules are soft and both pockets are right, a change of size, shape or filling is a simple exchange; when a large step down leaves loose skin, or a large step up needs the pocket adjusted, it is a revision.
Sagging over an implant
After pregnancy, breastfeeding, weight change or years under a heavy implant, the breast slides off the implant: the nipple sits at or below the fold while the implant stays high. A new implant does not fix that; Dr. Cat adds a periareolar or full lift and reduces a stretched areola.
A tuberous breast operated on elsewhere
Tuberous breasts, constricted by tight internal fibers, get a double bubble or a cone shape on top of the implant when the fibers are not released. Correcting that means the release, a pocket repair and a periareolar lift, as in case BRV-0902 below; Dr. Cat's tuberous breast correction page explains the anatomy.
Old saline implants, rupture and deflation
A saline implant announces a leak by deflating over a day or two; a silicone rupture is often silent, found on an ultrasound or MRI, which is why Dr. Cat recommends exchanging silicone implants about every 8 to 10 years. Old saline implants are exchanged for silicone while the capsule and pocket are dealt with; when gel has escaped a torn shell, the capsule comes out too.
Capsular contracture: what it is and how Dr. Cat corrects it (capsulectomy)
Surgeons grade contracture on the Baker scale: grade one, soft and natural; grade two, a little firm but normal-looking; grade three, firm and visibly rounder or higher than the other side; grade four, hard, painful and distorted. The first signs, mild firmness or tightness in one breast, most often appear two to twelve months after surgery. Grades one and two are watched and massaged; grades three and four are corrected surgically. Our post on capsular contracture covers the causes and Dr. Cat's prevention protocol; at UCLA she co-authored a study on montelukast and capsular contracture in the Aesthetic Surgery Journal.
Dr. Cat corrects a grade three or four contracture with a capsulectomy: the implant and the hardened capsule come out in full, rather than the capsule being cut and left behind, and a new implant goes in, often in a fresh pocket or under the muscle instead of over it, so the contracture is less likely to return. A pocket the capsule has stretched is repaired in the same surgery, as in case BRV-0848 below. Recurrent contracture after more than one surgery elsewhere is a large part of her revision practice; she does not perform en bloc capsulectomy, the term generally used to describe surgery for breast implant illness.
Who is a good candidate for breast revision surgery?
The first question is time: Dr. Cat's general rule is at least six to twelve months after the first surgery, so the swelling is gone, the scars have matured and the implants have settled, unless a complication such as a hematoma, an infection or a deflated implant needs earlier surgery.
You may be a good candidate if
- One or both breasts have turned firm, high, round or painful since they settled
- An implant has dropped below the fold, drifted toward the armpit or joined its neighbor across the middle
- The edges of your implants show, or your breast has slid off its implant
- Good health, a stable weight, no nicotine, and three months past breastfeeding
A different operation, or not yet, if
- Both breasts are soft and in position and you only want a different size or filling: a simple implant exchange
- The complaint is the previous lift rather than the implants: a revision of the lift
- You want the implants out for good: implant removal with capsulectomy
- You are pregnant, breastfeeding or planning a pregnancy in the next year
- You want a tummy tuck or a Brazilian butt lift the same day: Dr. Cat stages those separately
How Dr. Cat performs a breast revision
Dr. Cat is a board-certified plastic surgeon who completed two surgical residencies, one in head and neck surgery, microvascular and facial reconstructive surgery, and advanced training in general plastic and reconstructive surgery, Harvard-educated and UCLA trained. In her words, breast revisions are incredibly challenging, demanding detailed analysis of the breast anatomy, as well as extensive experience and technical skill.
The plan comes from the examination
Dr. Cat grades the firmness of each capsule, checks where each implant sits against the crease and the midline, measures the base width of each breast and the tissue over the implant's edges, and checks whether the breast has slid off the implant and where the nipple sits.
Through your existing scars
The revision incisions sit over your previous incisions, in the crease under the breast or along the edge of the areola, so no new scar is added. The old implants come out and each pocket is inspected; a hard, thick or calcified capsule is removed in full, and a soft capsule in a good pocket is left alone, with the field kept clean and the tissue handled gently.
Pocket repair: capsulorrhaphy and Strattice
A pocket that has bottomed out, drifted sideways or joined its neighbor is rebuilt from the inside. Capsulorrhaphy is a row of internal sutures that closes the part of the pocket the implant should not occupy and reattaches the tissue to the chest wall. Where the tissue is too thin or too scarred to hold sutures, Dr. Cat places Strattice, a sheet of acellular dermal matrix, as an internal support that carries the repair while your own tissue grows into it. A complex breast revision with Strattice is the most involved of her second breast surgeries.
Dual plane, sizers and the new implants
When the plan calls for it, Dr. Cat completes a dual plane pocket: the upper part of the new implant goes under the chest muscle, which hides the edge and lowers the chance of another contracture, while the lower part sits under the breast tissue so the implant settles into a natural slope. She uses Mentor implants, 175 cc to 700 cc, sized to the base width of your breast, tests both sides with temporary sizers until they match, and places the final implants with a no-touch technique.
The lift and the areola
When the nipple sits at or below the fold or the areola has stretched wide, the last step is a periareolar or full lift, done after the new implants are in place so the skin is tailored to the final shape; cases BRV-0411, BRV-0479 and BRV-0902 below each had one.
Anesthesia, surgery day and where it happens
A breast revision takes three to seven hours, depending on what needs correcting, under general anesthesia with a board-certified physician anesthesiologist and local anesthetic in the breast, so you wake numb rather than sore, in Dr. Cat's QUAD A accredited surgery center on Rodeo Drive, one major surgery per surgical day. A breast revision usually means the first night in a plastic surgery aftercare center, with nursing care and the bra and dressings checked; a short revision may go home the same day with someone to stay with you, which Dr. Cat decides at your consultation.
Breast revision recovery timeline
Recovery after a breast revision mirrors a first augmentation for most of Dr. Cat's patients.
- Surgery dayYou wake in a surgical bra, numb rather than sore, and are walking within a few hours; usually the first night in the plastic surgery aftercare center, with nursing care, and home with someone to stay after a short revision.
- Days one to threeDr. Cat sees you the day after surgery. Most patients manage with Tylenol. Sleep propped up, wear the bra day and night, walk often.
- One weekBack to your daily routine and a desk; arms kept quiet, no exercise.
- Two weeksDr. Cat checks the incisions and starts silicone scar care; light activity resumes.
- Six weeksCleared for exercise. The implants are settling and most of the swelling is gone.
- Two monthsThe custom-fit support bra that held the repositioned implants comes off.
- Four to six monthsThe implants have settled and the final shape shows; the scars fade for about a year. Then yearly check-ups, the FDA screening scans for silicone implants and a planned exchange about every 8 to 10 years.
Risks of breast revision surgery, and how Dr. Cat reduces them
A revision carries the risks of a first augmentation plus the ones scar tissue adds.
What can go wrong
- A hematoma in the first days (one breast suddenly larger, tighter and more painful) or an infection
- Capsular contracture returning around the new implant, more likely after a revision than a first surgery
- A pocket repair that stretches again under a heavy implant, or fluid around a Strattice sheet
- Asymmetry, rippling in thin tissue, or a size that does not match what you pictured
- Changes in nipple sensation, slower healing through scar tissue, a scar that widens, and more risk to the nipple with a lift
- A blood clot in the leg, rare and serious, and anesthesia risks
How Dr. Cat reduces these risks
- Planning from the examination, the implant card, the operative report and imaging
- The whole capsule removed when it is contracted, a fresh or dual plane pocket, a no-touch technique, and her prevention protocol for contracture
- A new implant no wider than the base of your breast, at a volume the repaired pocket can carry, with Strattice where the tissue is thin
- A clean, bloodless field, a meticulous layered closure and silicone scar care from two weeks
- A physician anesthesiologist in her QUAD A accredited surgery center, one major surgery that day, and follow-up visits from the day after surgery
Breast revision before and after: what to look for
In breast revision before and after photos, look first at the problem that brought the patient in, then at whether the after photo shows one natural breast: the crease at the same height on both sides, cleavage with a gap, no second fold, the nipple centered, and softness in the side view.
The six cases below are Dr. Cat's, most of them first operated on elsewhere. BRV-0997: capsular contracture with wide, flat implants; capsulectomy, pocket repair with capsulorrhaphy and Strattice, new silicone implants. BRV-0848: a grade four contracture with bottoming out and wide pockets; complete capsulectomy, pocket repair, Strattice and 350 cc implants. BRV-0719: contracture in both breasts; capsulectomy, Strattice and an exchange to 650 cc. BRV-0411: bottomed-out saline implants replaced with 475 cc silicone, with capsulorrhaphy, Strattice and a lift. BRV-0479: sagging and wide implants; capsulorrhaphy, new implants and a lift. BRV-0902: saline implants of twenty years on untreated tuberous breasts; dual plane pockets, capsulorrhaphy, a periareolar lift and 650 cc implants. Open each in Dr. Cat's breast revision before and after photos.
How much does breast revision surgery cost in Beverly Hills?
Dr. Cat's surgeon's fee for breast revision surgery with capsule work is $60,000 to $75,500; the implants, any Strattice, the operating room and the physician anesthesiologist are quoted at your consultation, because the operating time depends on your anatomy and on what is treated together. 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. A revision with Strattice is $87,000 to $90,000. The other second breast surgeries have their own surgeon's fees: a simple implant exchange $19,500 to $21,500, implant removal with capsulectomy $19,500 to $23,500, an explant with a lift $55,000 to $70,000, and a lift with implants $55,000 to $65,500 full or $30,000 to $35,000 periareolar.
A revision costs more than a first augmentation with implants, whose surgeon's fee is $17,500 to $22,500, because it is longer and harder: the surgeon works through scar tissue and removes a capsule or rebuilds a pocket before a new implant can go in. Please do not shop a revision on price a second time: an implant swapped inside a contracted capsule comes back as a third surgery. Our breast revision cost guide covers the national picture; a revision of cosmetic implants is not covered by insurance.
Consultation fee, deposit and financing
A revision consultation with Dr. Cat is $1,500, credited in full toward your surgery. Your date is reserved once your quote and pre-op paperwork are signed and the $2,500 deposit is paid; quotes are valid for six months. The practice partners with Cherry, its primary financing partner, and also accepts CareCredit and Alphaeon Credit; see financing and payment plans.
Your revision consultation with Dr. Cat
It starts with a free 15-minute discovery call with our Patient Concierge, who books your consultation: in person on Rodeo Drive or, for out-of-town patients, a private video consultation through OnPatient, the HIPAA-secure patient portal. Bring your implant card and operative report if you have them; if not, Dr. Cat plans from the examination and imaging. She listens to what you hoped for and what you got, examines both breasts, may ask for blood work, a mammogram from within the previous 12 months or breast imaging, and tells you plainly whether you need a simple exchange, a revision or a removal, with an itemized written quote.
