Is it time to revise your breast implants after augmentation? Many women are very happy with their breast augmentation. However, a change in weight, pregnancy, and general aging often cause breasts to lose their initial shape and beauty. These changes can impact the results of breast augmentation. Other patients are unhappy with the results of breast augmentation from the start. Often these patients see Dr. Zenn if their original surgeon is unwilling or unable to give them the result they desire.

Breast Augmentation is the most common plastic surgery procedure in the US, and therefore most plastic surgeons perform this surgery. However, revision of breast augmentation requires particular expertise in breast surgery and years of experience fixing problems for all different reasons in all different body types. No one in the Triangle has more experience and proven results with secondary breast surgery than Dr. Zenn.

Common Problems in Breast Augmentation Revisions and What Causes Them

Click on a cause below to learn more about what Dr. Zenn most often treats patients for in Breast Revision cases:


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Treatment Options

Dr. Zenn has many tools at his disposal to treat these problems as he has been in practice, focused on breast surgery for over 20 years. He has seen it all and has successfully helped women who had given up hope after being told nothing could be done.

Breast Implant Removal (with or without Breast Lift and Fat Grafting)

Women often consider simple removal of troublesome implants and this does remove the foreign body and can fix many of the issues of implant firmness and displacement. The ultimate look of the breasts will depend on the amount of remaining breast tissue and how stretched the skin is. In addition to removal, volume can be added with fat grafting (see “Fat Grafting” below) and the stretched skin envelope can be reshaped with a breast lift.

Breast Implant Exchange

Many of the problems that cause poorly shaped breasts can be rectified with implant exchange. Often the implants are moved from under the muscle to a more natural over-the-muscle location in addition to fat grafting to improve the softness and shape of the breasts. If problems are due to an implant that is too big for the chest, implant exchange can downsize to the appropriate size for your chest. Also, scar tissue is removed during this procedure, the cause of capsular contracture.

Acellular Dermal Matrix (ADM) Tissue

After a previous surgery, there may be very little natural tissue to use to hold implants in a more favorable position. ADM is a matrix or scaffold that has intrinsic strength to allow Dr. Zenn to secure implants in a new position. The ADM becomes repopulated with your own cells and tissue over time and literally become part of your breasts for long-term support. An advantage of ADM is lack of scar tissue formation around the breast implant. It appears that the body treats the ADM as “self” and not “foreign” so no scar capsule forms. ADM has become the main treatment for patients with recurrent or severe capsular contracture.

Fat Grafting

Fat grafting is a technique used to thicken areas of natural tissue over the implant to better hide the implant or areas of visible or palpable rippling. It is one of the reasons that implants do not need to be placed under the muscle. Fat grafting is simply a transfer of your fat with liposuction from one area of your body to the breast. Fat cells are processed to remove any impurity, ruptured fat cells, and blood and then are artistically placed to improve the appearance of the breasts. There can be the extra benefit of improved contour in the area of your body where the liposuction is performed.


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Poor Shape

There are several reasons your augmented breast may have a poor shape:

  • Poor shape may be related to the shape of your natural breasts before surgery, with congenital breast shape issues not addressed at the first surgery.
  • Implants may have been misplaced initially and are sitting in the wrong position, giving the breasts an odd appearance.
  • Often, the problem is that the implants are the wrong size or shape for your particular body type.
  • Presence of scar tissue (see “Capsular Contracture”) can distort the shape of the breasts and make them feel firm.
  • The breasts gain weight and size over time as we age. As the tissue increases, the breasts can have droop with the natural breast tissue hanging below the implant.

Droopy Breasts (Breast Ptosis)

If the natural breasts are flat, augmentation makes them bigger with an uplifted shape. However, if breasts have become deflated by weight changes, pregnancy, or aging, augmentation will either re-elevate the breasts and nipple or just fill the volume of the breasts while leaving some droop. Some droop is natural and desirable depending on your age and personal preference. If there is too much droop after breast augmentation, a breast lift would be beneficial. It is better to decide this ahead of time but it is difficult to predict the degree of lift with augmentation alone. For patients who had an augmentation in the past and now have droop from stretch over time, a breast lift would be one way to maintain breast size with an uplifted look.

High Riding Breast Implant (too high)

After breast augmentation, many women are told their breast implants “will settle” and “not to worry” about implants that appear too high. While this is true to some extent, implants should be close to their final position by two weeks. This is when scar tissue forms, acting to hold the implant in its final position. Massage and “breast bands” can help during the first couple weeks. Sometimes high positioning is a result of surgical error in placement or submuscular position that prevents the implant from achieving its proper position.

Capsular Contracture (Firm Scar, Distortion of Breast)

It is natural for your body to form scar tissue around your breast implants. The body recognizes that the implant is “foreign” and surrounds it with scar tissue, called a “capsule.” Because saline and silicone implants are soft, scar tissue around the implants can contract. This is what scars normally do in and on your body. This is especially important with breast implants since they are soft and round, so the contracting “ball” of scar makes the space around the implant smaller, causing firmness and rippling of the implant distorting its shape.

Incomplete Muscle Release (Breast Move, Pushed to the Side)

Too many plastic surgeons place all their implants under the pectoralis muscle.

In this day and age, placing the implant UNDER the muscle is NOT necessary for most breast augmentations. Under the muscle placement can result in unnatural movements of the breasts with normal arm activities, called “animation deformity”. The majority of breast augmentations Dr. Zenn performs are over the muscle (where the breasts naturally sit). The results are natural, the pain is minimal, and the recovery quicker.

For those surgeons who choose to continue to place implants under the muscle, it is important that the muscle is released from its attachments to the ribs below or the implant will always be too high. Too much release risks more breast movement and the possible creation of symmastia (see Symmastia below) so often surgeons are too tentative and do not release the muscle enough. This results in a large gap between the breasts where cleavage is supposed to be. In these situations, the breasts often hang near the arms and point off to the side instead of forward.

Breast Implant Infection or Exposure

These are the most feared complications of breast augmentation. Any bacteria that get onto a breast implant can multiply and ultimately cause infection around the breast implant. Your immune system cannot fight infections in foreign bodies as there is no way for your infection-fighting cells to get to the implant. Infections can appear to improve on antibiotics but that is often the overlying tissues improving and not a clearing of the infection around the implant. Lack of treatment of an implant infection can lead to Toxic Shock Syndrome. For this reason, implant infections must be treated aggressively and often lead to removal of the implant as the only effective and safe treatment. Sometimes, the incision through which the implant is placed opens and the implant becomes visible. By definition, the implant now has bacteria on it and could develop into an infection. This is best treated by surgery and implant removal.

Rippling & Wrinkling of the Breast

As described above, rippling or wrinkling of the breast is due to capsular contracture, or scar tissue formation that has forced the implant to be in a space that is too small. The implant, being soft, yields to this scar tissue and wrinkles. These ripples may be something you feel or may be visible. The amount of natural tissue over the implants determines whether the rippling is visible. For some implants placed under the muscle, rippling occurs only when the muscles are flexed. This can be just as disturbing.

Palpable or Visible Implants

This is usually a combination of excessive scar tissue around implants (Capsular Contracture) and inadequate tissue covering or hiding the implant. Even in successful cases, implants can be palpable on the sides or bottom of the breast as these are the areas of thinnest skin and least amount of natural tissue coverage.

Implant Leak or Rupture

This is a common concern as implants age. With rupture, saline implants will lose volume and go flat over time. This can happen in days, weeks, or months. In this case, implants need to be replaced. For silicone implants, rupture can mean different things depending on their age. Prior to the FDA moratorium on silicone implants in 1992, silicone implants that ruptured would leak silicone that would migrate in the chest and armpit area. This necessitates removal, often requiring more extensive surgeries to remove all silicone and its resultant scar tissue. Implants placed today are “cohesive” or solid and do not migrate if the outer shell is ruptured. Secondary operations today are based on appearance of the breasts and other symptoms such as pain.

Symmastia (Synmastia or Connected Breasts)

This is a loss of the natural cleavage from disruption of the natural connection of the central chest and the breasts. This can be a result of over-aggressive muscle release, surgical error in making the pocket for the breast implant too big, or placing an implant that is too large and migration of the implant centrally over time. This is a very difficult problem to fix. Someone with Dr. Zenn’s expertise is required for a successful result.

“Bottoming Out” or Deformity

The term “bottoming out” refers to too much settling of the breast implant over time so the implant sits below the natural fold of the breast. In this case, the upper part of the breast appears empty, and the nipple appears to be too high on the breast mound. This is due to overly aggressive dissection, dividing the natural fold of the breast which allows the implant to move too low. This also results from choosing an implant that is too big.

Lateral Implant Displacement

Implants can end up in many wrong positions. They can be too high (see “High Riding Implant”), too low (see “Bottoming Out”), and too central (see “Symmastia”). Most commonly, they can be too much to the side or lateral. This may be due to submuscular placement, over-aggressive dissection laterally, or implants that are too big for your chest. Implants that hang too much to side can be a nuisance as your arms continually bump into them. Implants that are too much to the side also give the breasts an unusual appearance as the nipples point too much to the side and there is an unnatural gap between the breasts. In some cases, the submuscular position and continual action of the muscle on the implants push them further and further out to the side.


What should you do if you are unhappy with the results of your Breast Augmentation?

Schedule a consultation with Dr. Zenn. He will show you before and after photos of patients with similar issues. With his extensive knowledge and experience, he will fully diagnose the problem and discuss all options for making your breasts beautiful again.