Breast Revision
Breast Revision Overview
When you decided to have a breast augmentation, you had a vision in mind. You spent hours thinking about how you wanted to look and feel after your surgery. You carefully choose your implants and your plastic surgeon, and you eagerly anticipated the day that vision would be reality. You may have expected this procedure to be the end of your breast enhancement journey — but this is not always the case.
Dr. Matthew J. Nykiel is a board-certified plastic surgeon with double subspecialty training in cosmetic and reconstructive breast surgery. This comprehensive training background makes him uniquely qualified to perform breast revision surgery in Newport Beach and Upland.
Wondering whether explant or implant exchange could be the next step for you? Book a consultation with Dr. Nykiel to find out if you are a candidate for breast implant revision surgery.
What Is Breast Revision Surgery?
Breast revision is a surgical procedure that alters the results from a previous breast surgery. In most cases, a revision is performed to exchange or remove (explant) breast implants. This is often done for cosmetic reasons, such as improving breast shape, size, projection or symmetry if the initial procedure produced unsatisfactory results or a formerly desirable result has changed over time.
Revision surgery can also be a response to complications. Breast implants are not lifetime medical devices. Eventually, they may need to be removed, replaced or upgraded to correct an issue that has developed. Anyone interested in breast implants must understand that additional surgery may be required in their lifetime, and that secondary surgery is often more challenging to perform than primary surgery.
Why Choose Breast Revision?
Patients seek breast revision surgery for a variety of reasons, including:
Capsular Contracture
Capsular contracture occurs when the body forms thick, tight scar tissue around an implant. This can cause the implant to move into an unwanted position and distort the appearance of the breast, or make the breast feel unnaturally hard. The tightening of the capsule can be quite painful for some patients.
Changing the Implant Size, Shape or Style
Over time, your tastes may change, and you may decide that you want to exchange your current breast implants for new implants. The desire to go larger or smaller is one of the most common reasons for breast implant revision surgery. Another common cosmetic motivation for revision surgery is changing one type of implant (saline, silicone, gummy bear) for another.
Rippling
Visible rippling can develop for several reasons. Patients who are thin may struggle with rippling because they do not have enough breast tissue to cover their implants. Rippling can also occur if an implant is too small to fill the breast envelope, if the tissue stretches so that it can no longer hold the implant firmly against the body, or if the implant folds.
Double-Bubble
The double-bubble deformity creates the appearance of a two-tiered breast with a noticeable dividing line between the implant and the breast tissue. Double-bubble can occur due to normal aging and descent of the breast, or when a breast implant sits lower than the natural fold (inframammary crease) where the breast meets the chest wall.
Symmastia
Symmastia occurs when breast implants are too close together and meet in the middle of the chest, creating the appearance of a single, large breast. It is mainly a cosmetic issue, but can sometimes cause discomfort or pain.
Bottoming Out
“Bottoming out” describes what happens when an implant sinks down to the lower part of the breast. This causes the bottom of the breast to bulge outward and can make it look as though the breast is resting on the upper abdomen. Bottoming out also makes the nipples appear to point up, rather than out.
Rupture or Deflation
Saline implants can rupture and leak. While the saline itself is not a health concern, a leak can leave behind deflated, sagging breasts. Rupture is less obvious with silicone implants because the gel-like material does not leak easily out of the implant shell. Silicone implant rupture is often identified with an imaging test, such as an ultrasound or MRI.
Improving the Natural Look or Feel
Ideally, breast implants will not be placed too high, too low, too close together or too far apart. The outline of the implant will not be visible through the skin and the implant will not be felt beneath the skin. If one or more of these issues is a concern, revision surgery can improve the natural look and feel of the breasts.
Changes in Breast Tissue
Breast augmentation cannot freeze your breasts in time — they will continue to change, just like every other part of your body. Aging, pregnancy, breastfeeding and weight fluctuations can cause your breast tissue to thin or lose elasticity, necessitating revision surgery to maintain the most beautiful results.
Implant Removal
Some women decide they no longer want breast implants of any kind. Their decision may be due to unsatisfactory results, health concerns, weight changes, changes to their lifestyle or relationships, changes in their aesthetic preferences or any number of other personal reasons. Breast implants can be removed in an “explantation” procedure.
Am I a Candidate for Breast Revision in Newport Beach?
Ideal candidates for breast revision typically meet the following conditions:
- Experiencing complications or unsatisfactory results from a prior breast surgery
- Good overall health, with no serious medical conditions that could impair healing or increase surgical risks
- Realistic expectations about the possibilities, limitations and complexities of revision surgery
- Appropriate timing in regards to the previous breast surgery, plans to become pregnant and/or plans to lose weight
A Note From Dr. Nykiel
There are many reasons why patients choose to have their breast implants removed or exchanged. In my practice, these are four of the most common reasons I see:
Scar Tissue (Capsular Contracture)
This is the number one reason for implant removal in my practice. Capsular contracture can occur at any time, but there’s a noticeable increase in cases around the six-month mark after surgery and again at five years post-surgery.
Age
Around the age of 60, many of my patients reassess their implants. Often, they have already replaced their implants once or more than once, and they no longer want to continue with replacements or maintenance as they get older.
Personal Preference
Some patients simply find that they do not like the look or feel of their implants. This can happen shortly after the procedure due to an unsatisfactory result or many years down the line due to changing preferences.
Other Complications
Complications such as infections, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) or breast implant illness (BII) may lead to the decision to remove implants. These are less common but significant factors that we take seriously.
I prioritize understanding each patient’s unique journey. Revising your breast augmentation is a deeply personal decision, and my role is to provide the best care and support for you throughout the process.
What Are the Treatment Steps for a Breast Revision?
Breast implant revision is not a routine, one-size-fits-all procedure. It requires a thoughtful, thorough and exacting approach, and must be tailored to the individual patient’s needs and desires. During your Newport Beach breast implant revision consultation, Dr. Nykiel will listen closely to your concerns and provide honest feedback about your options.
All breast revision procedures involve anesthesia and incisions. The location and length of the incisions will be determined by the specific revision technique used. When it is possible, Dr. Nykiel will place the new incisions over the old incision sites to minimize new scarring.
Techniques used may include implant removal or replacement, scar tissue removal, reshaping of the breast tissue and adjustment of the pocket that holds the implant. Incisions are meticulously closed to promote good scar healing.
What Techniques Does Dr. Nykiel Use During a Breast Revision?
Your surgical plan will be crafted based on your discussions with Dr. Nykiel during your consultation. It may involve one of the following techniques:
- Simple Removal — extraction of the breast implant, leaving the surrounding capsule intact
- Partial Capsulectomy — removal of the implant and part of the capsule surrounding it, often used to address mild cases of capsular contracture
- Total Capsulectomy — removal of the implant and all of the capsule, often to correct more severe capsular contracture or other capsule-related complications
- En Bloc Capsulectomy — a meticulous technique in which the implant and the entire capsule are removed together as one unit
- Implant Removal With Breast Lift — combination procedure to address sagging or “deflated” appearance that can occur post-implant removal
Depending on your needs, your procedure may also involve techniques such as internal pocket adjustment, changing the placement of your implants or correction of a specific deformity.
What Anesthesia Is Used During Breast Revision Surgery?
Breast revision surgery is performed under general anesthesia to ensure you are comfortable and unaware during the procedure. A board-certified anesthesiologist will administer the anesthesia and monitor your vital signs throughout the procedure to maintain your safety.
“Dr Nykiel is the greatest plastic surgeon!! I had butt implants 2 years ago and I came back to get a revision for breast implants. I’m so happy with my results!!”
— Jessica C.
What Goes Into the Recovery Process?
Recovery after breast revision surgery is similar to recovery following a primary breast augmentation, but it can be more extensive. Plan to take at least one week off work, school or social activities.
Proper care and attention during the recovery process can significantly impact the outcome. For the first few days, rest should be prioritized. Light movement is encouraged to promote circulation, but strenuous activities must be avoided. Pain is managed with prescribed medications.
You will need to wear a special front-closure surgical bra to reduce swelling and support your breasts. Continue to wear it until instructed otherwise. You may also have drains placed to prevent fluid from building up. If so, the drains will stay in place for one to two weeks. Dr. Nykiel and his team will explain how to care for the drains and incisions.
Incisions take 24-48 hours to “seal”. After this point, you can shower. Full incision strength is not reached until four to six weeks post-surgery. Heavy lifting and more vigorous exercise can be resumed after this, provided Dr. Nykiel has given clearance.
How Is Pain Managed During Breast Revision Recovery?
At Butts By Design, we understand that effective pain management is key to a comfortable recovery process. Dr. Nykiel has developed his own pain management protocol to ensure our patients experience minimal discomfort and a smoother recovery.
Some pain medications are administered in the preoperative phase. This has been shown to significantly enhance post-surgery pain control. Additional medicines are used during the surgery, including specialized numbing agents that last for several days.
After the procedure, you may be prescribed a combination of medications that target pain from different angles:
- Gabapentin (Neurontin) to address nerve-related pain
- Diazepam (Valium) to address muscular discomfort
- Celecoxib (Celebrex) to address inflammation and cellular signaling pain
- Hydrocodone (Norco) to address general pain and discomfort
- Tylenol to address cellular signaling pain
This multi-faceted approach allows our patients to focus more on healing and less on managing pain, contributing to a more positive recovery experience.
What Are the Risks of Breast Revision Surgery?
Understanding the risks associated with surgery is a crucial part of the process of empowering our patients with information about their chosen procedures. The risks of breast revision surgery include:
- Infection
- Scarring
- Asymmetry
- Changes in nipple sensation
- Breastfeeding complications
We prioritize your safety and satisfaction, and part of that commitment involves being transparent about the risks and how we mitigate them. We want you feel informed, confident and secure in your decision to have your breast revision with us.
A Note From Dr. Nykiel
Breast revision surgery presents unique challenges. Secondary surgeries are inherently more complex than primary surgeries due to the presence of scar tissue and changes in tissue anatomy. These factors make predicting outcomes more challenging and require a nuanced approach to surgery.
Often, revision patients come with a mix of disillusionment and heightened apprehension. The success of revision surgery relies heavily on effective communication. I work hard to provide my patients with a comprehensive understanding of what to expect, address their concerns and fears, and set realistic goals.
My dual training in aesthetic and reconstructive breast surgery allows me to address these challenges with a unique perspective. I can draw on both backgrounds to navigate the complexities and achieve natural, elegant results, even in secondary or tertiary surgeries.
When Will I See the Final Results of My Breast Revision?
Just like with breast augmentation, the results of your breast revision surgery may need time to “settle.” This process can take anywhere from one to three months.
In general, straightforward revisions need less settling time, and the final result can sometimes be seen in less than four weeks. Complex revisions — for example, if the implant position is changed or the fold is rebuilt — require more settling time. In these cases, it may take two to three months for the final result to emerge.
Scars heal in stages. While they won’t disappear completely, they will fade significantly and become less noticeable, particularly given that their placement allows them to be concealed under most clothing and swimwear. Adhering to postoperative care instructions is crucial for optimal scar healing. Scars continue to mature and fade for up to 12 months.
How Long Are the Results of a Breast Revision Expected to Last?
The results of a breast revision surgery can be long-lasting. However, your skin and breast tissue will continue to change with age, and the appearance of your breasts will change with them. You may choose to have additional procedures, such as a breast lift, in the future to address age-related changes and restore a more youthful look.
If you have new implants placed, remember that they, too, will have a lifespan. The FDA recommends that implants be replaced after 10 years. You may also need them replaced or removed if you start to experience complications. No implant can be guaranteed to last a lifetime.
For a safe and beautiful outcome, your breast implants should be monitored at routine follow-up evaluations and whenever you notice changes. You may reach out to us any time you have questions or concerns.
Dr. Nykiel is the best! This is the second surgery Dr. Nykiel did for me. I got an implant exchange with scar revision and I feel amazing. He is really honest about any questions you have. His staff is great too, they make you feel very comfortable. I recommend him 100%.”— Vanessa F.
Contact Our Board-Certified Breast Revision Surgeon
You don’t need to live with breasts that no longer make you feel confident and beautiful. With a talent for delivering elegant and natural results, Dr. Nykiel is one of the most accomplished breast surgeons in Southern California. He has proudly devoted his career to helping patients in Newport Beach, Upland and the surrounding areas look and feel amazing.
To get started, call Butts By Design at 949-416-0038 or schedule your consultation online. We offer in-person appointments at both our locations, as well as virtual consultations for your convenience.