Breast Implant Revision Sydney, Brisbane & Canberra

Why Breast Implant Revision May Be Needed

Changes to the breasts are natural over time, and those with implants are no exception. Life events such as ageing, weight fluctuations, pregnancy, and hormonal changes continue to affect the breast tissue and implants. There are various reasons why revision surgery may be appropriate.

1. Size Change

Preferences may shift over time due to lifestyle changes, body composition evolution, or personal aesthetic goals. Some patients seek smaller implants to address discomfort or achieve a more natural appearance, whilst others may desire larger implants for increased fullness.

Dr Turner uses Tissue-Based Planning combined with Vectra 3D imaging to help ensure the new implant size aligns with the patient’s chest wall dimensions and skin elasticity, which may help reduce the risk of complications such as bottoming out or rippling.

Note: Size change alone is considered a cosmetic procedure and does not qualify for Medicare rebates.

2. Implant Rupture

Implant rupture occurs when the outer shell of a breast implant breaks, causing the implant’s contents to leak.

• Saline implants: Rupture is usually noticeable because the breast quickly deflates as the saline is absorbed by the body.
• Silicone implants: Modern cohesive gel implants may experience ‘silent ruptures’ where the silicone remains contained within the scar tissue capsule, causing no immediate visible changes.

An MRI scan, which may be rebated by Medicare when referred by a specialist, can confirm rupture. Revision surgery involves removal of the ruptured implant and typically replacement with a modern, TGA-approved cohesive gel implant.

3. Capsular Contracture

Capsular contracture is the most common complication following breast augmentation surgery. It occurs when the scar tissue (capsule) that naturally forms around the implant tightens excessively, potentially causing the breast to become hard, painful, or misshapen.

Capsular contracture severity is classified using the Baker Grading System:

• Grade I: Breast soft, implant not palpable (normal)
• Grade II: Breast somewhat firm; implant palpable but not visible
• Grade III: Breast firm; visible firmness and distortion
• Grade IV: Breast hard, painful, with significant distortion

Modern capsular contracture rates have significantly decreased, with current estimates around 5% within 10 years post-surgery. Risk factors include smoking and vaping (which may double the risk), pregnancy, and delayed wound healing complications.

Dr Turner typically performs a total capsulectomy (complete removal of the fibrous capsule) combined with a plane change technique, placing the new implant in a fresh, unscarred tissue plane to help reduce recurrence risk.

4. Implant Malposition

Implant malposition refers to implants that have shifted out of their intended position within the breast pocket, resulting in abnormal appearance or asymmetry. This can occur due to surgical technique issues, implant characteristics, natural body changes over time, or the weight of the implant causing migration.

Revision surgery involves repositioning the implant and reconstructing the breast pocket. Dr Turner often uses the Internal Bra technique to hold the implant in the correct anatomical position long-term.

5. Symmastia

Symmastia occurs when breast implants are placed too close together, causing the skin between the breasts to stretch or detach from the chest wall. This eliminates the natural separation between the breasts and creates the appearance of merged breasts.

This condition is often caused by over-dissection of the breast pocket during surgery or the use of implants that are too large for the patient’s chest. Revision surgery involves complex pocket reconstruction to reestablish the medial boundary of each breast pocket.

6. Wide Cleavage

Wide cleavage occurs when implants are positioned too far apart, resulting in a noticeable gap between the breasts. This may occur due to the patient’s natural anatomy, improper implant placement, or an implant that is too small for the chest wall.

Treatment options include repositioning the implants closer together or adding fat grafting to the cleavage area to help achieve better fullness.

7. Double Bubble Deformity

Double bubble deformity occurs when the breast implant shifts below the natural inframammary fold (the crease where the breast meets the chest), creating a visible second fold. This can distort the breast’s appearance, making the lower part appear unnatural.

Correction typically requires adjusting the implant position, reconstructing the breast fold using the Internal Bra technique, and potentially fat grafting to camouflage the second fold.

8. Waterfall Effect

The waterfall effect occurs when the natural breast tissue sags or droops over the implant, creating a discrepancy between the position of the breast tissue and the implant. This typically develops due to ageing, weight fluctuations, or pregnancy.

Revision surgery for the waterfall effect often involves a breast lift (mastopexy) to reposition the breast tissue, combined with implant adjustment to help restore alignment.

9. Animation Deformity

Animation deformity occurs when breast implants placed under the chest muscle (submuscular) move or distort visibly when the pectoral muscles are flexed. This can be aesthetically displeasing and uncomfortable during physical activities.

The standard approach for correction is plane conversion from submuscular to prepectoral placement. Dr Turner’s technique involves carefully releasing the pectoralis major muscle from the implant, creating a new prepectoral pocket, and placing the implant in the new position with appropriate support.

Breast Implant Removal (Explant Surgery)

Breast implant removal, also known as explant surgery, is a procedure in which breast implants are surgically removed. Patients may choose removal for various reasons, including changes in aesthetic preferences, discomfort from ageing implants, development of complications, or health concerns.

Breast Implant Illness (BII)

Breast implant illness refers to a collection of diverse, non-specific symptoms that some patients with breast implants experience. The TGA and healthcare providers acknowledge these symptoms as systemic symptoms associated with breast implants (SSBI).

Commonly reported symptoms include:

• Chronic fatigue
• Joint and muscle pain
• Cognitive symptoms (brain fog, memory difficulties)
• Headaches
• Skin issues
• Anxiety or mood changes

Research has shown that many patients experience significant symptom improvement following implant removal and capsulectomy, though results vary between individuals.

Capsulectomy Approaches

Partial Capsulectomy: Removes only the problematic portions of the capsule whilst leaving healthy tissue intact. This approach involves shorter surgery time and faster recovery.

Total Capsulectomy: Complete removal of the entire fibrous capsule surrounding the implant. This is typically performed for capsular contracture, implant rupture, or BII concerns. The excised tissue is sent for histopathology examination.

En Bloc Capsulectomy: A specialised technique where the implant and entire capsule are removed as one intact unit. This approach may be appropriate for certain patients, though it requires a larger incision and may not always be technically feasible depending on capsule adherence.

Surgical Techniques

Dr Turner utilises a range of advanced surgical techniques to address the specific challenges of revision surgery.

The Internal Bra Technique

The Internal Bra is a critical component of Dr Turner’s revision strategy, particularly for correcting bottoming out or supporting implants in patients with compromised tissue elasticity.

This technique creates a hammock-like support structure within the breast pocket to reinforce the inframammary fold and lateral walls. It may utilise:

• Biocompatible mesh scaffolds: Materials such as Tiloop or Galaflex are sutured to the fascia and breast tissue. Over 12-18 months, the mesh dissolves whilst stimulating the body to create a new, organised collagen layer that provides long-term support.
• Suture techniques: Heavy gauge permanent or long-lasting sutures used to plicate the capsule and define the fold in less severe cases.

Implant Exchange

Implant exchange involves the removal of existing breast implants and insertion of new ones, which may differ in size, shape, or material. The new implants can be placed in the same breast pocket or, if necessary, in a newly created one to achieve better positioning.

Pocket Revision

Pocket revision involves modifying the breast pocket to either tighten or adjust the capsule. This technique is commonly used to correct wide cleavage, symmastia, or bottoming out.

The breast implant pocket may also be changed from a subglandular (above the muscle) position to a submuscular (below the muscle) position or vice versa. This plane change can provide different tissue coverage and may help reduce certain complications.

Breast Lift (Mastopexy)

A breast lift may be performed in combination with implant revision to address sagging or drooping. Excess skin is removed, and the breast tissue is lifted and reshaped. The nipple and areola may also be repositioned to a more central location on the breast mound.

Fat Grafting

Fat grafting involves harvesting fat from areas such as the abdomen, thighs, or flanks using liposuction. The fat is then processed and injected into the breast to add volume, smooth rippling, or improve tissue coverage over the implant.

Implant Selection

Dr Turner uses TGA-approved, high-quality implants with established safety profiles and longitudinal clinical data.

Mentor Implants

Dr Turner predominantly utilises Mentor breast implants, which have over 40 years of manufacturing experience and FDA approval. Mentor implants feature:

• Siltex surface: A low-textured (micro-textured) surface that provides gentle tissue adherence to help stabilise the implant and reduce the risk of rotation, whilst maintaining a favourable safety profile compared to older macro-textured surfaces.
• MemoryGel technology: Cohesive silicone gel that maintains its shape even if the shell is compromised, significantly reducing the risk of silicone migration.
• Warranty support: Mentor offers a lifetime replacement policy for confirmed rupture, providing additional peace of mind for patients.

Motiva Implants

Dr Turner also uses Motiva implants, which feature:

• Nanotextured surface (SilkSurface): An advanced surface technology designed to promote tissue integration whilst minimising inflammatory response.
• Progressive gel: Cohesive silicone that aims to provide a natural feel and movement.
• Ergonomic designs: Implant options that may adapt to body position and movement.

Choosing the Right Implant

The choice between Mentor Siltex and Motiva nanotextured implants depends on individual patient factors, including anatomy, tissue characteristics, and aesthetic goals. Dr Turner will discuss the most appropriate implant option for your specific situation during your consultation.

Medicare Coverage

Medicare rebates are available for certain medical complications but are strictly regulated. A valid GP referral is required for all Medicare claims.

Medical Indications (Potential Medicare Rebates)

• Capsular contracture (Grades III & IV) with documented hardness, pain, or disfigurement
• Implant rupture or leakage confirmed via imaging
• Implant extrusion
• Infection
• Severe implant migration or malposition
• BIA-ALCL concerns

Cosmetic Indications (No Medicare Rebate)

• Size change due to personal preference
• Shape change for aesthetic reasons
• Post-pregnancy aesthetic changes without documented medical complication

Relevant MBS Item Numbers

• Item 45548: Breast implant removal as an independent procedure
• Item 45551: Removal with capsulectomy (excision of at least 50% of capsule; specimen sent for histopathology)
• Item 45553: Removal and replacement (highly restricted; requires original implant for breast cancer/developmental abnormality OR documentation that removal alone would cause unacceptable deformity)

For more detailed information about Medicare coverage, see our guide: Will Medicare Cover My Breast Implant Removal?

Recovery After Breast Implant Revision

Recovery from revision surgery is typically longer than primary augmentation due to the more extensive tissue dissection often required. Most patients can return to office-based work after approximately two weeks, with light exercise resuming around week six. Full recovery, including return to high-impact exercise and upper body workouts, generally occurs by week twelve. Final aesthetic results typically emerge between six to twelve months as implants settle and scars fade.

For comprehensive recovery information, see: Recovery After Breast Augmentation Surgery

Risks and Complications

As with any surgery, breast implant revision carries potential risks. These will be discussed in detail during your consultation with Dr Turner.

General surgical risks include swelling, bruising, infection, bleeding, scarring, and anaesthetic risks. Procedure-specific risks include asymmetry, changes in nipple sensation, recurrent capsular contracture, implant malposition, and the potential need for further revision surgery.