The Second Draft: Breast Surgical Revision With Intent
Revision lives in the quiet space between what you hoped for and what you see in the mirror. The first surgery gets the attention; the years that follow write their own story—scar tissue forming, implants settling, skin and support changing with life. For some, the shape stops matching how they feel. That’s where breast surgical revision belongs: not a redo, but a rewrite with better information.
At Marina Plastic Surgery in Los Angeles, Dr. Justin Perez and Dr. Osita Obi approach revision with restraint and precision. They study what your tissue has been through, how the capsule behaves, whether circulation is robust, and where support has thinned. The goal is clear: a stable, comfortable, and natural silhouette that suits your life now.
Why Revision Is Different
Primary surgery works on tissue that hasn’t been mapped by prior incisions or capsules. Revision navigates a landscape that has already adapted to implants, lifts, or reductions. Scar tissue can tether or tighten. Blood supply may be rerouted by earlier operations. Skin behaves differently after pregnancy, weight changes, or time. Success depends on understanding those rules and planning within them.
Revision also carries a different emotional weight. You’re not choosing change for the first time; you’re asking for clarity, comfort, and balance. The conversation starts with honesty about trade-offs, recovery, and what improvement looks like when the priority is safety and longevity.
The Implant Pocket Question
Every implant sits in a pocket either above or below the muscle. Over the years, that pocket can stretch or drift. Some implants ride too low. Others slide to the sides. Center lines can blur. Bras compensates until they can’t. When pocket behavior drives the shape, the repair focuses on boundaries.
Pocket work can include tightening lax areas, releasing tight bands that pull the device off center, or creating a new pocket where the tissue is healthier. In cases of thin or fatigued support, surgeons may add an internal scaffold with biologic or synthetic mesh. Think of it as rebuilding the room and reinforcing the walls so the implant lives where it should. The goal is a predictable, stable space that holds during movement, sleep, and daily life so the breast looks like it belongs to your body, not to your underwire.
Capsular Contracture In Real Life
A capsule is normal scar tissue around an implant. In some patients, it firms and contracts. Breasts feel tight, shape distorts, and soreness creeps in. This is capsular contracture, a common reason people seek revision.
Correction typically removes or releases the firm portions of the capsule and reassesses the pocket. Many patients benefit from moving the implant to a healthier plane and exchanging the device for one that better matches the new anatomy. Meticulous technique and postoperative care reduce the risk of another contracture. Recurrence remains possible. The decision to proceed weighs that reality against the improvement in comfort and contour most people experience after correction.
Tissue Thinning And Support
With each year—and with each prior operation—soft tissue can thin. Skin loses elasticity. Weight changes leave new patterns of laxity. Thinner coverage shows edges sooner and ripples more easily. Here, reinforcement matters.
Mesh distributes weight across a larger area, so the lower pole resists stretch. Fat grafting can soften transitions and mask rippling, especially in the upper pole. Implant strategy also changes with the landscape; lighter devices or different profiles can ease the load on tissue and keep results looking natural over time.
Asymmetry: Refinement Over Perfection
Perfect symmetry is a myth, but obvious imbalance is a real quality-of-life issue. Revision often blends several moves to bring the two sides into conversation. A lift on one side, implant change on the other, careful pocket work, areolar resizing—the aim is harmony in clothes and in motion. The best results feel quiet: the breast stops drawing attention to itself.
Explant, Lift, And Fat Transfer
Some patients decide to remove implants altogether. Explant with lift reshapes and tightens the breast so the chest reads athletic and proportionate. Fat transfer can restore softness in select areas without large volume. This path prioritizes comfort and low maintenance. It also removes a variable that can change with time and weight.
Timing: Let The Tissue Speak
Time clarifies. Swelling resolves. Scars soften. The capsule stabilizes. For most, waiting about twelve months after the last surgery before another revision improves safety and planning. It also helps you learn which details truly bother you and which ones fade into the background. That knowledge shapes a smarter plan and often avoids overcorrection.
How A Thoughtful Consult Works
A revision consult is part detective work, part design session. Surgeons review your history, including previous operative notes if available. They examine skin quality, implant position, capsule behavior, and nipple–areola circulation. Imaging—ultrasound or MRI—may help evaluate implant integrity or fluid. You talk through goals in concrete terms: more softness; less lateral drift; a smaller, lighter feel; clean lines in a T-shirt.
From there, you hear actual options with trade-offs. Sometimes the plan is straightforward. Sometimes it’s a staged approach that prioritizes blood supply and long-term support. Recovery is mapped in advance with time off, garments, movement limits, and follow-ups so the logistics match your life.
Inside The Operating Room
Revision favors measured moves. Incisions often follow prior scars. Dissection respects the tiny vessels, keeping skin and nipple-areola healthy. Pocket work proceeds in steps: release what’s tight, define what’s loose, test position with sizers, then secure the boundaries. Mesh, when used, is shaped like a sling to support the lower pole without showing at the edges. Fat is grafted in thin layers so it takes and stays soft.
Protocols guard against contamination. Antibiotics, pocket irrigation, and strict sterility lower risks. Most revisions are outpatient. You go home the same day with clear instructions and direct lines of communication.
Recovery You Can Navigate
Recovery depends on the scope of the work. Pocket repairs and exchanges often feel like a few weeks of a modified routine. Add capsulectomy, lift, or mesh, and the arc extends. The first days focus on swelling control, pain management, and incision care. Gentle walking helps circulation. Lifting limits protects the repair. Support bras matter more than you think. Follow-ups aren’t formalities; they are checkpoints where small adjustments preserve your result.
Expectations That Respect Reality
A revision can release tightness, restore softness, and steady the shape. It can correct the displacement that fights you in every bra. It can refine the lines of a lift or quiet rippling that shows at the neckline. It may leave subtle signs: a faint change in contour under direct light, a sensation difference you notice occasionally, a scar line that softens but doesn’t vanish. The right plan weighs those details against the relief and confidence you gain.
Clarity helps. Define success in specific terms. Align implant choices with tissue realities. Accept that staging may deliver a safer and cleaner outcome than a single, aggressive attempt. Costs and time matter; plan around them, not through them.
Who Benefits From This Work
You had an augmentation years ago, and the shape drifted. Capsular contracture made your chest feel armored. Pregnancy or weight change stretched the pocket. You’d like a smaller footprint and less weight. You want implants removed and a lift that fits your frame. Or you want to keep implants and rebuild support so the result lasts. Your priority is a surgeon who thinks carefully, speaks plainly, and operates with a steady hand.
That’s the ethos at Marina Plastic Surgery. Dr. Perez and Dr. Obi build plans that protect circulation, rebuild structure, and keep aesthetics grounded in proportion.
Smart Questions For Your Consult
What’s my diagnosis in clear terms? Which plan best protects the blood supply and long-term support? Do I need mesh, and for what purpose? How likely is capsular contracture to recur in my case? What will recovery look like week by week? If staging is safer, how would you divide the steps? Good answers reference your anatomy and your goals—not a template.
A Few Common Revision Paths Explained
Capsular contracture correction relies on releasing or removing tight scar tissue, often changing the pocket and exchanging the implant. Most patients notice a softer feel and an improved shape, with a known, though reduced, risk of recurrence.
Pocket repair for malposition re-establishes internal boundaries and may add reinforcement when tissue is thin. Implant selection is matched to the rebuilt space so that the position holds over time.
Lift with exchange updates implant size or profile, and repositions the breast mound and nipple for better proportion. Planning centers on preserving circulation while creating clean lines.
Explant with lift removes devices and reshapes native tissue. Some choose small-volume fat transfer for contouring. The look reads balanced and low-maintenance.
The Bottom Line
Breast surgical revision is precise work. It honors history, protects biology, and aims for quiet, durable beauty. In the right hands, the change feels like relief: clothes fit better, movement feels easy, and the mirror reflects a shape that belongs to you.
If you’re ready to explore options, consultations with Dr. Justin Perez and Dr. Osita Obi in Los Angeles focus on clear planning, careful technique, and results that age well.
