Breast Revision Surgery and the Case for Surgeon Experience

A surgeon revising a breast augmentation operates on tissue that has already healed once around an implant. Scar tissue from the first surgery is often present, and that is one reason the practice of Houston plastic surgeon Leo Lapuerta, MD, FACS warns that a revision can be more painful than the original procedure and more challenging to perform.

Dr. Lapuerta, who is triple board certified and has more than 30 years of experience in breast augmentation, reconstruction, lifts and revisions, treats revision as a corrective operation. The patient guide published by Leo Lapuerta, MD, Plastic Surgery describes it as surgery to address complications or improve the results of a previous breast augmentation or implant surgery.

Problems that bring patients back

The practice attributes many of these problems to poor implant placement by an inexperienced surgeon, and others to issues that develop over time. The practice describes the most common:

• Capsular contracture. Scar tissue around the implant tightens, making the breast feel hard and often uncomfortable. Correction sometimes requires a capsulectomy, which removes that tissue.
• Rupture or deflation. A ruptured saline implant leaks its saline, and the breast deflates. A silicone implant may show no change, so the practice notes that imaging such as an MRI is used to detect a break in its shell, and it recommends routine check-ups in the years after augmentation.
• Rippling. Visible ripples or wrinkles along the side or underside of the breast, which the practice associates with saline implants and describes as most common in slimmer women with thin tissue.
• Double bubble. A rare complication in which the implant drops behind the natural breast crease or rides high and over-drapes, creating a doubled appearance. The practice links it to improper placement in the original surgery or to severe capsular contracture.
• Bottoming out. The implant sits lower than intended, lengthening the distance between the nipple and the fold. Shifting after surgery, aging, weight changes, gravity, chest trauma or excessive scarring can cause it.

Not every revision fixes a complication. Some patients want a different size, texture or shape, or want to switch between saline and silicone. Others decide they no longer want implants at all. Revision is also common after breast reconstruction following cancer, when the first result falls short of what a survivor expected.

The case for experience

Revision puts Dr. Lapuerta’s central argument about plastic surgery to a direct test. He states it this way:

“Experience performing the cosmetic procedure of interest is the best determinant or correlate to a positive surgical outcome as perceived by patients.”

In his view, board certification combined with a high volume of cases and many years in practice is the best guide a patient has. His own record includes more than 30,000 surgical and non-surgical procedures and more than 3,000 before-and-after images available for patients to review. He is Chairman of Plastic Surgery at St. Joseph Hospital and serves as teaching faculty for plastic surgery programs at UT-Houston, the University of Texas Medical Branch in Galveston and Houston Methodist Hospital. The practice also says he has worked with thousands of patients on breast surgery.

He describes his outlook in terms that fit corrective work: “I am a very positive person and I can always see the potential for usefulness and viability where others may see something as broken or undesirable.”

The operation and the weeks after

The first consultation takes place in person at one of his offices, including the downtown Houston office on La Branch Street near St. Joseph Medical Center. He reviews health and goals, explains anesthesia options and builds a plan, which may replace the implants, remove them, or add a breast lift. The practice lists the risks that come with revision, including anesthesia-related complications, breast asymmetry and rare cancers that can form in the capsule around an implant.

Revision is performed under general anesthesia and takes one to two hours, depending on what needs correcting and whether a lift is included. For capsular contracture, the surgeon may need to break up scar tissue. All stitches sit beneath the skin, so there are no sutures to remove, and patients leave with compression garments. The practice describes a private room on surgery day and a private exit to the patient’s car afterward.

Most women return to normal work after a full week of rest. Exercise takes longer: some patients resume in as little as two weeks, while full healing can take up to six weeks. The final appearance shows anywhere from six weeks to six months after surgery.

Timing and candidacy

Good candidates are in good overall health, do not smoke, hold a stable weight and understand what the revision can achieve. The practice notes that most professionals recommend waiting at least six months after an augmentation before a revision, and patients who want to move sooner can ask Dr. Lapuerta to assess their recovery in person.

The practice is direct about durability as well. Replacement implants should last about as long as the originals, the body keeps aging, and capsular contracture can recur and require another operation. A patient who knows those limits before the first revision consultation is in a position to judge the plan she hears there.

This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.