If you have a problem with your current breast implants, or just want to change the size, our experienced, board certified plastic surgeon is here to help. As a reputable San Francisco Bay Area and Walnut Creek breast implant revision specialist, Dr. Joseph A. Mele has performed hundreds of breast augmentation revision surgeries. Your breast augmentation results can be restored in a manner that is proportionate and natural-looking. You can anticipate excellent care and a comfortable experience while visiting our practice. Dr. Mele will determine if you are a good candidate for breast augmentation revision and explain the best method to achieve your goals during your in-person consultation appointment.

What Is Breast Augmentation Revision?

Breast augmentation revision surgery is a cosmetic plastic surgery procedure used to correct problems with breast implants and improve the results of breast augmentation, especially when complications arise. The outpatient procedure, also known as breast implant revision surgery or “breast implant exchange,” can improve the shape, feel, size and location of a woman’s breast implants should they deflate, become hard, or move to a less attractive position after breast augmentation.

Breast Augmentation Revision Before and After Photos

Results shown are specific to each patient and individual results will vary

What Is Involved in Breast Augmentation Revision Surgery?

When performing breast augmentation revision, Dr. Mele first reviews and evaluates your breast surgery history. The size and shape of your breasts before breast surgery, your history of pregnancy and breastfeeding and how this changed your breasts, the previous surgical procedures and breast implants used, as well as how long it took the current problem to develop all influence your breast revision surgery. Once the problem is defined, a specific plan is developed to provide the safest and most predictable outcome. Options for breast revision surgery can fix problems with the breast implant’s pocket (the capsule) and correct problems with the breast implant itself. First, let’s review procedures that fix the capsule which holds the breast implant in place:

What Are the Procedures for Problems with the Breast Implant Pocket (Capsule)?

The breast implant capsule is a pocket of scar tissue that naturally forms around the breast implants. The breast implant capsule is very important in maintaining the breast implants in their proper position. If the capsule is too big, the implant will move into the wrong position. It can end up too low, too medial (too close together) or too lateral (too far apart). If the breast capsule is too small, the result is a hard, tight breast implant, which is immobile, and it may end up stuck in a less ideal position. Capsular contracture occurs when the breast implant pocket constricts around the breast implant.

A capsule that holds the breast implant in place, but is soft and not palpable, is the most common result. This is a grade I capsule. The second most common capsule is a grade II capsule, which still holds the breast implant in the proper position, but is slightly firm and resists movement. Grade III capsules are firm and may push the implant out of its ideal position. The least common capsule is a grade IV capsule. A grade IV capsule is like a grade III capsule, but is also tender. Grade III and IV capsules are the types that require surgical revision to restore a more aesthetic result.


A capsulotomy is the opening of the capsule (the pocket around the breast implant). It is used to expand the capsule in cases of breast implant malposition, when the breast implant is in the wrong position. A capsulotomy is used most often to lower the implant when the breast implant’s pocket is too high, or to bring the implants closer together when the pockets are too lateral. A capsulotomy may also be necessary as part of the repair for bottoming out, if the upper pocket has closed.

Capsulotomy can also be used for the treatment of capsular contracture in selective cases when the capsule is thin, but tight; however, a capsulectomy is often preferable. The differences between a capsulotomy and capsulectomy are described below, beginning with the two methods of capsulotomy: open and closed.



While a capsulotomy involves making cuts in the capsule to allow the pocket to expand, a capsulectomy is the removal of the capsule. During a complete capsulectomy, the entire lining of the breast implant pocket is removed. A partial capsulectomy, as the name suggests, is removal of a portion of the capsule. Complete capsulectomies are most often performed for the treatment of capsular contracture, when the capsule is thick. Capsular contracture is when the scar pocket around the breast implant becomes too tight. A breast pocket that is tight all around the implant can cause the breast to feel hard, and in some cases cause pain. A pocket that is tight in just one area can move the implant into a less desirable position (malposition). For example, a capsular contracture of the lower pole of the capsule will push the breast implant up. Depending on the problem, a complete or partial capsulectomy may be recommended.


Capsulorrhaphy is the surgical term for tightening the capsule. A capsulorrhaphy is performed when the capsule is too big, and is often used to correct breast implant malposition. Signs of the capsule being too large include:

By reducing the pocket where it is too big, the position of the breast implant can be improved, and a more attractive result is possible. In cases where the capsule is thin, or the repair is tenuous, a patch may be used to reinforce the capsulorrhaphy. More details of the main types of capsulorrhaphies and the materials available for reinforcement are discussed below.

Direct Capsule Modification


Augmented Capsule Modification

What Are the Procedures for Problems with Breast Implants?

Sometimes the capsule is perfect, and the problem is the breast implant itself. Breast implants are not lifetime devices. That is to say, the lifespan of your breast implant may be shorter than yours. Breast implants can wear out or get damaged and may require maintenance from time to time. Changing size is one of the most common reasons for breast implant revision surgery. A change in size may be desired even when there is nothing wrong with the breast implant or the breast capsule. Sometimes breast augmentation is no longer desired. The normal increase in weight that occurs with aging may lead to an increase in breast size and a desire to have your breast implants removed. Breast implant replacement and breast implant removal are discussed further below.

Breast Implant Replacement – Breast Implant Exchange

Breast implant replacement involves a few simple steps. The previous incision can often be used. The existing breast implants are removed. The capsule is inspected, and often modified, to accommodate the new breast implants. Malposition of the previous breast implants can often be addressed before the new breast implants are inserted. Recovery is usually just a few days, and the postoperative pain is often significantly less when compared to the recovery after primary breast augmentation.

Reasons for breast implant replacement include:

Breast Implant Removal

Breast implant removal may be elective or emergent. Elective reasons for breast implant removal include:

Non-elective reasons for breast implant removal include:

Breast Implant Warranties

All three US-based breast implant manufacturers have a warranty program for their breast implants. Natrelle® (Allergan), Mentor® (Johnson & Johnson) and Sientra® (Silimed) all have generous warranties, including lifetime breast implant replacement. If your breast implant ever leaks, a new one will be supplied for replacement absolutely free. If a breast implant leaks within ten years of your initial breast augmentation, financial assistance may be available to help pay the surgical costs associated with breast implant replacement. Warranty information is available below via the supplied links. For the latest details, please consult with your plastic surgeon or check your breast implant manufacturer’s website. Breast implant warranties are frequently updated.

Natrelle® Breast Implants (Allergan)

Mentor® Breast Implants (Johnson & Johnson)

Sientra® Breast Implants (Silimed)

Recovery from Breast Augmentation Revision – What to Expect

Breast augmentation revision surgery encompasses a large variety of procedures, so the recovery is variable. In general, recovery from most revision surgery is easier than the recovery after the original breast augmentation.

For revisions when minimal capsular modification is necessary, like replacing a deflated breast implant or the correction of mild superior malposition, recovery is a few days. For revisions encompassing complete reconstruction of the capsule (like symmastia), severe bottoming out or lateral displacement, repair, and reinforcement of the capsule, recovery may take a few weeks.

Be certain to ask your doctor about the recovery for your specific procedure. Pain control, activities, and weight restrictions should be outlined before surgery so that you can plan accordingly and get the best results.

Breast Augmentation Revision Follow-Up

Like all elective cosmetic plastic surgery, follow-up appointments are an important part of obtaining the best results. From forming the proper breast implant capsule to scar modification, many aspects of your healing can be modified after surgery. While the proper surgical plan and operative technique can set the stage for a great result, follow-up is important for both promoting the best results and for preventing additional problems and complications. We expect to see you in our office for follow-up visits many times after your breast augmentation revision procedure. Initially, your follow-up appointments will be frequent to closely monitor your progress and will be adjusted, as necessary, as you continue to heal. Dr. Mele likes to follow his patients closely to assure the best possible results.

How Much Does Breast Revision Cost?

Breast augmentation revision surgery encompasses many procedures, so there is a wide range of costs. After your consultation, you will be supplied with an operative plan and an estimated cost.

The cost of a procedure is influenced by many factors. Simple procedures tend to take less time and cost less. Complicated procedures take longer and cost more. The operating room and anesthesia charges are based directly on the duration of the surgery, while the surgeon’s professional fee is usually based on the complexity of the operation.

The use of implants and mesh also increases the cost. These are fixed costs and are passed on to the patient. Breast implants often have a warranty, and in cases of breast implant rupture, the implants are often supplied by the manufacturers for free. Be certain to check your breast implant manufacturer’s warranty as they change every few years.

Incidentals such as prescription drugs, dressings, scar creams, and garments may be required. Be certain to ask your plastic surgeon which, if any, are covered in the cost of the procedure.

Contact Our Breast Augmentation Revision Specialist

If you have a problem with your current breast augmentation and are looking to enhance your results, it is important to seek the expertise of a board-certified plastic surgeon such as Joseph A. Mele, MD, FACS. Individuals who decide to undergo a breast augmentation revision with Dr. Mele may anticipate being well cared for in a comfortable and compassionate setting.

Dr. Mele and his staff will do everything they can to schedule convenient appointments, attentively listen to your desires, and fully address your cosmetic plastic surgery concerns.

Dr. Mele will further discuss enhancement options with you during your personal consultation. You will want to bring any information you have about your current breast implants, and obtain your operative reports from previous surgeries, so that Dr. Mele can review them with you. Breast augmentation revision surgery can be combined with body contouring procedures such as breast lift surgery (‘mastopexy’) or tummy tuck surgery (“abdominoplasty”), or other breast and belly enhancement procedures, as part of a Mommy Makeover, which is designed to help a woman regain her pre-pregnancy body.

To learn more about breast augmentation revision surgery, or to schedule an initial consultation with Dr. Mele, please contact us today.

(925) 943-6353
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