If you are wondering about breast reconstruction revision surgery, it is a follow-up operation that adjusts, repairs or replaces part of an earlier reconstruction. It is a common part of the process, though not always a sign of a problem.
This page is general information only. For the wider picture of options and timing, see the overview of breast reconstruction on this site.
| Topic | What the sources say |
|---|---|
| Number of operations | Reconstruction often involves more than one surgery. |
| Fat grafting | Often used as a follow-up or touch-up after reconstruction. |
| Fat grafting recovery | Usually an outpatient procedure, so you can go home the same day. |
| Implant lifespan | Implants will not last a lifetime and may need replacing. |
| Capsular contracture | Hard scar tissue can form around the implant. |
| Silent rupture | FDA recommends periodic MRI screenings for women with silicone implants. |
Sources: American Cancer Society and National Cancer Institute. This information can change, so please check the sources for the latest details.
Why one operation is often not the whole journey
Rebuilding a breast is usually staged. The American Cancer Society notes that breast reconstruction often involves more than one surgery, with additional touch-up procedures after the main operation to improve the look and feel of the breast. Those touch-ups can include fat grafting or scar revision, and the nipple and areola can be recreated with a small procedure, medical tattooing, or both.
It helps to separate two ideas. Planned stages, such as exchanging a tissue expander for an implant or adding a nipple, are part of the original plan. Revision surgery is the extra work that comes afterwards, either to refine the appearance or to deal with a problem that has developed.
Research from a large United States study shows how common refinement is. The Mastectomy Reconstruction Outcomes Consortium followed women for two years after a first reconstruction. Among the 76.9% of patients who had no complications, 40.2% still underwent elective revisions. The authors concluded that patients without complications undergo over two procedures on average to reach a satisfactory reconstruction.
Common reasons for revision surgery
Revisions fall into two broad groups: changes made for appearance and changes made to fix a complication. The reasons differ between implant-based and tissue-based reconstruction, but several come up often.
- Asymmetry or contour irregularities. The reconstructed breast may sit differently from the other side or have uneven areas that a surgeon can smooth or reshape.
- Capsular contracture. The body forms scar tissue around an implant, and in some people that capsule tightens and hardens. The National Cancer Institute lists the formation of hard scar tissue around the implant, known as a contracture, among the possible complications of implant reconstruction.
- Implant displacement, rotation or rupture. An implant can shift out of position or break open and leak.
- Implant age. Implants are not permanent devices, a point covered below.
- Scars and skin quality. Healing scars or changes after radiation can affect shape and softness.
A study of tissue expander and implant reconstructions from Siena, Italy, describes how often mechanical problems drive repeat surgery. According to that paper, up to 28% of cases require revision surgery for mechanical complications such as capsular contracture, implant displacement or rotation, and implant rupture.
Revision after implant-based reconstruction
Implants are the most widely used method, so a lot of the published research on revisions concerns them. The National Cancer Institute states that implants will not last a lifetime: the longer a woman has implants, the more likely she is to have complications and to need to have her implants removed or replaced.
A cohort study of immediate implant-based reconstructions followed a large group of women, with a mean follow-up of 62.2 months. In that group, revision surgery was performed in 60% of all breasts, and the mean number of revisions per reconstructed breast was 1.2. The same paper reports that nearly half of the breasts did not require any revision surgery, and that direct-to-implant procedures did not require any surgical revision in 43% of these patients.
The study also looked at risk factors. Smoking, radiotherapy, older age and larger implant volume were each associated with higher rates of revision, while preserving the nipple was associated with lower rates. Findings like these describe groups of patients, not any one person, and each surgical team weighs individual factors differently.
Type of implant is another topic readers often research. An overview of how silicone vs saline breast implants differ is covered in a separate article.
How surgeons approach a capsule or implant problem
The approach depends on what has gone wrong. For scar tissue around an implant, a surgeon may release or remove part of the capsule and replace the implant. The Siena team reported on this technique, using selective capsulotomies with partial capsulectomy, and found that the recurrence rate was assessed at 19% over a follow-up that averaged 59 months.
For a ruptured implant, the usual path is removal or replacement, and the National Cancer Institute notes that the FDA recommends periodic MRI screening for women with silicone implants to detect so-called silent rupture, in which the implant breaks without obvious symptoms. Details about that screening are on the National Cancer Institute reconstruction fact sheet.
When the concern is volume or contour, a surgeon may add small amounts of the patient’s own fat. This approach is described in more detail in the article on fat grafting breast reconstruction.
Revision after reconstruction with the body’s own tissue
Reconstruction using a patient’s own tissue is different from implants, because there is no device to wear out. Even so, refinement is common. In the Consortium study, abdominally based free autologous reconstruction patients underwent the greatest number of elective revisions, with a mean of 0.7 per patient, while tissue expander and implant reconstructions had the greatest mean number of total procedures overall, at 2.4.
The American Cancer Society describes fat grafting as often used as a follow-up or touch-up after breast reconstruction to improve shape and smooth uneven areas, and notes that more than one session may be needed.
Complications, failure and the number of operations
When a complication occurs, the picture changes. In the Consortium data, complications occurred in 23.1% of patients, and 67.1% of those patients underwent elective revisions, a notably higher share than among patients without complications. Patients with complications also had higher odds of elective revision overall.
Total failure of a reconstruction, meaning the breast is removed, is much less common. In the cohort study described above, immediate implant reconstruction failed in 6.7% of all breasts, and radiotherapy was associated with a 1.7-fold increased risk of failure. Radiation is a topic of its own, and the way it interacts with surgical planning is something a care team discusses before reconstruction begins.
These statistics come from specific hospitals and registries, using different techniques and different follow-up times, so they cannot be read as predictions for any individual. Decisions about whether to have revision surgery, when to have it, and which technique to use belong with the reader’s own surgeon and care team.
Questions people often raise before a revision
Readers who are considering a follow-up operation commonly want to understand goals and recovery. Fat grafting is usually done as an outpatient procedure, so the patient can go home the same day, according to the American Cancer Society, while operations on an implant or capsule are a different scale of procedure.
It can also help to write down what feels different, whether in shape, comfort, symmetry or sensation, before an appointment so that the conversation focuses on the person’s own priorities.
Frequently asked questions
Does needing revision surgery mean the first operation failed?
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Not necessarily. Reconstruction is often staged, and the American Cancer Society notes that it often involves more than one surgery, including touch-up procedures after the main operation.
How many revisions do people usually have?
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It varies by technique and by hospital. In one large cohort of immediate implant reconstructions, the mean number of revisions per breast was 1.2, with a wide range from none to many.
Can implants be replaced later?
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Yes. The National Cancer Institute notes that implants will not last a lifetime and may need to be removed or replaced, and that this becomes more likely the longer they are in place.
Is revision surgery only for implants?
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No. Reconstruction with the body’s own tissue also involves refinements. In the Consortium study, free abdominal tissue reconstruction patients had the greatest mean number of elective revisions.
Who decides whether a revision is needed?
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The decision is made between the patient and their own surgeon and care team, based on the individual situation.
