Breast Revision Surgery in Bellevue, WA

It may involve adjusting or removing implants, repairing the implant pocket, correcting scar tissue, adding a breast lift, or refining contour with fat grafting, depending on each patient’s needs. Because revision surgery is more complex than an initial procedure, it requires careful planning and an experienced, board-certified plastic surgeon to restore natural shape, balance, and support.

They are quite common, as a large number of initial breast implant procedures will eventually require some type of revision surgery.

These concerns can be divided into two general categories: 1) problems related to the breast implant(s), or 2) changes in the shape and position of the breasts due to aging, breastfeeding, weight loss, or weight gain.

Breast Implant-Related Issues

Breast revision surgery can address a variety of breast implant-related concerns, including:

• Capsular contracture
• Silicone gel implant rupture
• Saline implant deflation
• Implant malposition, such as implant displacement or bottoming out
• Visible or severe palpable rippling of the breast implant due to thinning out of breast tissue (especially found in above muscle implants)
• Stretch deformity
• Desire to change the size of the breast implants
• Desire to remove the breast implant
• Concerns about Breast Implant Illness (BII), requesting implant removal

Capsular Contracture

Historically, about 15+ percent of all women who undergo breast augmentation suffer from capsular contracture at one time or another. Thankfully, newer techniques and procedures, as well as better breast implants, have reduced this risk to less than two percent in good practices. The exact cause of capsular contracture is not completely understood; however, there is increasingly strong evidence that it results from the body’s response to chronic inflammation, due to slow tightening of the capsule caused by bacterial contamination around the implant.

In Dr. Stephens’ hands, the treatment for capsular contracture requires complete surgical removal of the surrounding tissue that forms the breast capsule around the implant, called total capsulectomy. With the capsule removed, a surgical repair of the breast pocket is necessary to restore the shape of the breast. Dr. Stephens repairs the pocket through the original incision using a special dissolvable mesh called GalaFlex™, made of a slowly dissolving suture material that leaves an extremely strong reinforcing structure around the implant.

Breast Implant Rupture and Deflation

Breast implant rupture and deflation require breast revision surgery and replacement of the implant(s). Breast implant rupture and deflation can occur as a result of the following reasons:

• Implant Age: The most common cause of implant failure is the wear and tear of the implant as it ages. Implants have folds, and ruptures typically occur due to fold failure. The FDA requires breast implants to be studied for the first ten years. Historically, breast implant failure rates in ten years are less than ten percent. However, the new Motiva breast implant has a failure rate of less than one percent.
• Breast Implant Trauma: Excessive squeezing, car and boating accidents or a direct blow to the breast can also result in breast implant rupture. Interestingly, breast implants can withstand a significant force, even with trauma resulting in broken ribs or severe contusions and still stay intact.
• Breast Implant Wear and Tear: Over time, older implants may simply wear out due to continued movement and stresses on the implant shell, creating weak points.
• Over-filling or Under-filling Saline Breast Implants: Not properly filling a saline implant to the manufacturer’s recommended capacity can also lead to premature breast implant failure.

Breast implant rupture of newer breast implants is less common. In most cases, the breast manufacturers may warrant their breast implants for a number of years, but older implants may not be covered. We will discuss whether your breast implants are covered by a breast implant warranty.

Breast Implant Displacement

Displacement of the breast implant usually occurs due to the natural gravity and wear and tear of the breast tissue from the implant’s movement over time. It is more common in women with a more rounded or angled rib cage, where the breasts fall off to the side. Also, some women may have weaker or thinner breast capsular tissue, which may make it more difficult to support the implant. This is a common problem and typically requires a pocket repair called “capsulorrhaphy”. Dr. Stephens often uses GalaFLEX™ reinforcement to ensure that the pocket stays stable around the implant.

Above vs. Below Pectoral Muscle Implants

“Pre-pectoral” (above the muscle) breast implants may have less support in the lower part of the breast because they are not supported by deeper tissue. With loss of connective tissue support within the breast structure and thinning out of the breast tissue, this may result in visible rippling throughout the breast and breast distortion that lacks aesthetic shape and natural breast contour. This may require tissue support with STRATTICE™ Reconstructive Tissue Matrix (RTM) for severe thinning out of the breast tissue and placement of the implant below the muscle.

“Sub-pectoral” (below the muscle) breast implants may fall outward toward the sides of the chest over time due to gravity, implant movement, or weakening of the supporting capsule, resulting in lateral displacement. This typically requires surgical implant pocket repair (capsulorrhaphy), often reinforced with dissolvable mesh or biologic tissue support to restore proper implant position, symmetry, and long-term stability.

Bottoming Out of the Breast Implant

Bottoming out occurs when the inframammary fold tissue separates from the chest wall due to gravity or weak tissue. The implant moves below the natural boundaries of the breast fold, requiring surgical repair to reposition it. Dr. Stephens typically uses dissolvable GalaFLEX™ mesh to reinforce the tissue to support the fold in most cases.

Stretch Deformity

The effect of breast implants on stretching out weaker breast tissue in the lower part of the breast above the breast fold is called a “stretch deformity.” If severe enough, this can be surgically repaired, typically utilizing GalaFLEX™ mesh to reinforce the breast tissue.

Ptosis or Sagging Breast Tissue

In some women, over time, the breast tissue may fall lower over the breast implant, called a “waterfall deformity.” This can also happen without breast implants when, after a previous breast reduction surgery, there is not sufficient breast tissue support. Breast ptosis is due to gravity acting on the weight of the breast tissue, laxity from collagen loss in the supporting breast ligaments, and thinning of the breast skin. Correcting this requires breast revision surgery with a mastopexy/breast lift procedure. GalaFLEX™ mesh may also help stabilize the breast tissue.

Desire for a Change of Appearance or Size of the Breast

Over time, a woman may just want to change the appearance or size of her breasts. Some women may want to be larger than they are or may want to have smaller breasts. This may require modifying the breast implant pocket, in addition to changing the implant size or projection, with a surgical repair or enlargement of the implant pocket.

Desire to Remove Breast Implants

Sometimes a woman may decide to remove the implant altogether. It may be necessary to perform a breast lift called an auto-augmentation mastopexy, utilizing all of the breast tissue to give the breast shape at the same time. Fat grafting may also be performed to improve volume or shape if sufficient donor fat is available.

Change of Breast Appearance

Over time, a woman may just want to change the appearance of her breasts. Some women want to be larger than they are now, or in some cases, they want a breast reduction.