How to avoid regret with silicone implant breast augmentation: 3 reasons that lead to revision surgery

Revision surgery is common after silicone implant breast augmentation due to three main reasons: implant displacement, capsular contracture (hardening and shrinkage of the membrane around the implant), and desire to change the size. A Canadian study found that approximately 1 in 10 patients underwent revision surgery within 2–4 years, with the majority citing these three reasons. Though rare, implant-associated anaplastic large cell lymphoma (BIA-ALCL), which relates to implant surface type, is a risk to be aware of.

How often do revision surgeries occur?

Reports indicate that approximately 1 in 10 patients require revision within several years. A Canadian study tracking 319 patients over 2–4 years found that 30 patients (9.4%) underwent revision surgery, with an average time to revision of 1.2 years[1].

In the same study, 89.3% (approximately 9 in 10) were broadly satisfied with their initial surgery[1]. Even when satisfied initially, you should understand that touch-up procedures may be needed later.

What are the most common reasons for regret?

The three most common reasons are implant displacement, capsular contracture, and desire to change size. In the study mentioned above, revision reasons were implant displacement (36.7%), capsular contracture (33.3%), and desire to change size or shape (20.0%)[1].

Medical literature also lists capsular contracture, displacement, asymmetry, rupture, desire to change size, sagging, rippling, and fluid or blood accumulation as reasons for revision[2]. Since desire to change size is not a complication, it is important to discuss size and shape expectations specifically with your surgeon before the procedure.

Why does capsular contracture, which causes breast hardness, occur?

It occurs because the body's membrane that encapsulates the implant as a foreign object becomes hard and contracts. When a silicone implant is placed, the body's foreign-body response always occurs, resulting in membrane formation and potentially capsular contracture[3].

Microscopic bacterial contamination or subtle silicone degradation may intensify this response[4]. When hardness or shape distortion is significant, surgery may be needed to correct it; otherwise, urgent intervention is not necessary[5].

How often do implant ruptures occur?

Rupture rates increase over time. Silicone implant rupture is reported at 8.7–24.2% at 10 years[6].

A study of 614 patients found silicone in the armpit lymph nodes in 13.6% of breasts, which was associated with ruptured implants and longer time since implantation[7]. Even without symptoms, continued scheduled imaging surveillance is recommended.[5].

How concerned should I be about lymphoma (BIA-ALCL)?

It is rare, but risk varies by implant surface type. A meta-analysis found BIA-ALCL in patients with breast implants at 0–1 per 1,000 patients[8].

Approximately 73% of reports involved textured-surface implants, while smooth implants accounted for 3%[9]. Patients without symptoms or diagnosis do not need implant removal for prevention.[9].

Late-onset fluid accumulation in the breast, pain, swelling, skin changes, or lumps can be signs of BIA-ALCL[2]. If you notice such changes, consult your surgeon promptly.

What can happen if the implant is placed under the muscle?

The breast shape may move when you flex your chest muscles (animation deformity). This is more common when the implant is placed under the muscle and rare when placed over the muscle[5].

Muscle movement may also cause pain, cramping, or nipple displacement[5]. If you are concerned, your surgeon can address this with a revision to change the implant plane.[5].

What to confirm before the procedure

There are three benchmarks to consider. First, discuss the final size and shape in concrete detail with your surgeon[1]. Second, clarify the implant surface type and placement plane[5][9]. Third, confirm the schedule for post-operative imaging and who to contact if you notice changes.[2][5].

Breast skin and tissue thickness and asymmetry vary among individuals. During your consultation, confirm with your surgeon what implant size and placement plane is right for you.