Breast augmentation results are overwhelmingly positive. About 92 percent of patients are still satisfied at 10 years, according to Allergan. Still, about a third of breast augmentation patients will have a revision surgery. From addressing aging implants, size of the breast or a changing body, there are plenty of reasons someone might get another breast augmentation. This is what you need to know before you have your secondary breast augmentation.
Featured Experts
- Bradley Bengtson is a board-certified plastic surgeon based in Grand Rapids, MI
- Mark Jewell is a board-certified plastic surgeon based in Eugene, OR
- Michael Edwards is a board-certified plastic surgeon based in Las Vegas
- Olga Bachilo is a board-certified plastic surgeon based in Bellaire, TX
- Joseph A. Russo is a board-certified plastic surgeon based in Newton Centre, MA
- Aviva B. Preminger is a board-certified plastic surgeon based in New York
Maintaining Good Results
Breast augmentations have a high satisfaction rate, even at 10 years post-op.
“Life with implants is generally a positive experience for patients and they want to maintain their results over long periods of time,” says Eugene, OR plastic surgeon Mark Jewell, MD. “It is not unusual for some patients to undergo several maintenance surgeries over the course of several decades. I have patients who have elected to maintain their breast augmentation starting in their 20s and extending into the seventh and eighth decade of life. Secondary surgery is therefore useful to help maintain their outcome with newer-generation implants.”
Implant exchange or a breast lift may help maintain results that may be impacted by aging.
Revising Results
While rare, breast augmentations can result in an asymmetrical look or issues like capsular contracture. The good news is, these issues can be corrected with a secondary breast augmentation.
“I like to take a full hour during the consultation process,” notes Las Vegas plastic surgeon Michael Edwards, MD. “During that time, we discuss their goals, but also what improvements I can make surgically—these are things that they often do not think can be changed, like breast firmness or malpositioned implants.”
Changing Size
While there are plenty of reasons someone might need another breast augmentation, according to Bellaire, TX plastic surgeon Olga Bachilo, MD, one reason stands out. “The number one reason patients get a re-augmentation is because they decide to go with a different size,” she explains. “That’s usually to go larger, but it can be a patient wanting to go smaller.”
Newton Centre, MA plastic surgeon Joseph A Russo, MD explains that patients may choose smaller implants than they mean to as a result of the try-on process. “This could happen because when they try on the implants, they are not used to seeing themselves with larger breasts and it seems out of proportion initially,” he says. “The try-on process, because we’re placing an implant over the skin to give them [an] idea of the result, can also be a little skewed. When they actually have the surgery, the implants are placed under the muscle and being compressed, so they look slightly smaller.”
On the other hand, when patients want to go smaller, the stress of implant weight on their tissues may be a factor. “Implant choice is a critical part of breast augmentation and revision,” Dr. Edwards says. “We want an implant size that won’t stress their tissues, that their bodies can handle easily. That’s the primary reason I see women go smaller.”
Time for a Lift?
“Over time, with things like age, gravity, weight loss and breastfeeding, the position of those implants have changed and patients are no longer happy with the way they look,” explains New York plastic surgeon Aviva B. Preminger, MD. “These are complicated cases and may call for revision breast augmentation.”
Patients who previously have had a breast augmentation may be looking for a breast lift. But it’s also usually a good time to replace implants.
“After patients have children and age some, they may be looking for a breast lift,” Dr. Bachilo adds. “Implants are exchanged at the same time. I always recommend changing the implants at the time of lift because at that point implants are approaching the 10-year mark, and the risk of breast implant rupture goes up with the age of the implant. I don’t want my patient to have one surgery and [a] few years later end up needing a replacement for rupture.”
Preventing Capsular Contracture
“Capsular contracture involves the formation of excess scar tissue around the implant,” Grand Rapids, MI plastic surgeon Bradley Bengtson, MD explains. “It’s not a matter of the body rejecting the implant, but rather the body’s response to the implant, creating a barrier around it.”
If your first breast augmentation resulted in capsular contracture, the good news is that revision is possible. “In capsular contracture cases, we need to take out [the] capsule, sometimes we use mesh for additional support,” explains Dr. Russo.
That excess scar tissue can be deforming and even painful. That’s why preventing it is a top priority during a secondary breast augmentation.
Dr. Bengtson’s approach to reducing capsular contracture involves eliminating fluid from the surgical pocket. “We’ve identified that capsular contracture is often due to the presence of blood or fluid in the surgical pocket, or sometimes low-grade bacteria,” Dr. Bengtson notes. “By implementing our specialized protocol to minimize these factors, we have successfully reduced the rate of capsular contracture to less than half a percent.”
What to Expect from a Secondary Breast Augmentation
“Recovery is usually easier than the first breast augmentation because there’s less surgery,” Dr. Russo says. “Usually, the pocket is already created. In those cases, it is simply a matter of taking one implant out and replacing it with another.”
If your case is more complex and involves capsular contracture or a malpositioned implant, it’s important to keep your expectations realistic.
“Secondary operations are always more risky and may yield less than desired outcomes,” Dr. Bachilo says. “I always explain that to the patient and also stress that we are trying to fix something and often we cannot get to 100 percent resolution. We try our best for symmetry, but breasts are not perfectly symmetric. As we always say in plastic surgery—breasts are sisters and not twins.”
Ultimately, secondary breast augmentations are highly personalized procedures.
“Each revision augmentation is a unique situation,” Dr. Edwards says. “And getting the best result is a matter of considering the patient, not just day one after surgery, but months and even years down the line. We want these results to last, that’s why every step of the process is so important, from picking the implant and considering the anatomy to bio-dimensional planning.”
