Why Revision Is Common
Breast augmentation has among the highest revision rates of any elective surgery — industry data and FDA follow-up studies suggest 20–30% of patients undergo at least one revision procedure within 10 years of initial surgery, and higher rates at 20 years. This is not primarily a reflection of poor outcomes but of the nature of implants as non-permanent devices placed in a changing body. Common revision reasons include: implant age/degradation, capsular contracture, change in desired size, implant rupture, BIA-ALCL, weight change, post-pregnancy changes, and aesthetic dissatisfaction.
Implant Exchange
The most common revision procedure is implant exchange — replacing existing implants with new ones, either at the same volume or larger/smaller. In staged extreme augmentation, exchange is built into the protocol: expanders are replaced with larger implants, which may then be replaced with even larger implants in subsequent procedures. Exchange typically involves re-opening the original incision, removing the existing implant, and potentially adjusting the pocket before new implant placement.
Capsulectomy
When contracture is the indication, capsulectomy (removal of the scar capsule) is performed alongside implant exchange. Total capsulectomy removes the entire capsule; partial capsulectomy removes portions. Capsulotomy (releasing rather than removing the capsule) is less commonly performed now due to higher recurrence rates. When BIA-ALCL is diagnosed, total capsulectomy with en bloc removal is the standard of care.
Explantation
Explantation (full implant removal without replacement) may be chosen for medical reasons (BII symptoms, implant illness, complications) or personal preference. After removal, the breast tissue that remains has been stretched by the implant and typically falls or deflates. Many patients undergo concurrent mastopexy (breast lift) to address post-explantation contour. Fat transfer after explantation is also an option for those wanting some restored volume.
