Common Reasons for Reconstruction Revision

Shape, Contour, and Symmetry

Over time, asymmetry between a reconstructed breast and the natural breast often becomes more apparent. The natural breast continues to change with age, weight, and gravity, while a reconstructed breast — particularly an implant-based one — does not change in the same way. Asymmetry in size, shape, height, or projection can develop gradually and become meaningful enough to warrant correction.

Contour irregularities, including visible rippling, flat areas, or uneven surfaces, are common in implant-based reconstruction, particularly where soft tissue coverage over the implant is thin. These can be addressed with fat transfer, implant revision, or a combination of both.

Where the natural breast has changed significantly since the original reconstruction, a symmetrisation procedure on the natural side — reduction, lift, or augmentation — can restore balance and is Medicare-rebatable when performed in the context of previous breast cancer treatment.

Implant-Related Complications

The most common implant-related issues requiring revision include the following.

Capsular contracture — hardening of the scar tissue capsule around the implant, causing firmness, distortion, or discomfort. Management involves capsulectomy (partial or total removal of the capsule) with or without implant replacement.

Implant malposition — the implant has shifted from its intended position, sitting too low, too high, or laterally displaced. Correction involves revision of the implant pocket and repositioning.

Implant rupture — confirmed or suspected rupture requires removal and replacement of the implant, with capsulectomy if indicated.

Rippling or implant visibility — thin soft tissue coverage allowing the implant surface to be seen or felt. Addressed with fat transfer to improve coverage, implant exchange, or in some cases conversion to autologous reconstruction.

Refinement After Autologous Reconstruction

Autologous reconstruction using the patient's own tissue generally produces more natural and durable results than implant-based reconstruction, but the initial result is not always perfect and refinement is often beneficial.

Common revision needs after autologous reconstruction include adjustment of flap volume or shape, correction of donor site contour irregularities (for example, abdominal contour after DIEP reconstruction), fat transfer to improve symmetry or surface contour, and revision of the reconstructed nipple or improvement of areola tattooing.

Fat Transfer (Lipofilling)

Fat transfer is one of the most versatile and widely used revision techniques in breast reconstruction. Harvested by liposuction from the abdomen, thighs, or flanks, the patient's own fat is injected into targeted areas of the reconstructed breast to add volume, smooth contour irregularities, soften the feel of the reconstruction, and improve soft tissue coverage over an implant.

Fat transfer is performed as a day procedure and can be repeated as needed. It plays an important role in refining the results of both implant-based and autologous reconstruction, and is often the only revision procedure needed to significantly improve a result.

Nipple and Areola Revision

Where nipple reconstruction has been performed, revision of the nipple mound — to improve projection, position, or symmetry — is occasionally needed as the nipple settles after surgery. Revision of areola tattooing to improve colour, symmetry, or detail is also available through our specialist medical tattooist network.

Conversion from Implant to Autologous Reconstruction

For patients who have had implant-based reconstruction and have developed significant complications, repeated revisions, or are simply unhappy with the implant result, conversion to autologous reconstruction using the patient's own tissue (DIEP flap, PAP flap or other) is a meaningful option. It is a more complex undertaking than a straightforward revision, but for appropriate patients it can provide a durable, natural-feeling result that resolves the ongoing implant-related challenges.

Radiotherapy and Reconstruction

Radiotherapy significantly affects the outcome of implant-based reconstruction over time, causing progressive fibrosis, contraction, and often capsular contracture that worsens the appearance and feel of the reconstruction. Patients who have received post-mastectomy radiotherapy have a higher need for reconstruction revision and a higher rate of implant-related complications than those who have not been irradiated.

For patients with significant radiotherapy effects on an implant reconstruction, conversion to autologous reconstruction is often the most effective and lasting solution, as autologous tissue is generally more tolerant of radiation damage than an implant within a radiated pocket.

What to Expect at a Revision Consultation

At your revision consultation, your surgeon will review your full surgical and treatment history, assess your current reconstruction including imaging where relevant, listen carefully to your concerns and goals, and provide an honest assessment of what revision is likely to achieve.

Not every concern warrants further surgery. Where a revision is likely to produce meaningful improvement, your surgeon will explain the recommended approach, what it involves, and what the realistic expectations are. Where further surgery is unlikely to improve your situation significantly, your surgeon will tell you that honestly.

We encourage patients to bring any operative notes, discharge summaries, and imaging from their previous procedures to the consultation, as this information greatly assists surgical planning.

Medicare and Health Fund Rebates.

Revision surgery of breast Implants placed due to a breast cancer diagnosis is rebatable through medicare and most private health insurance policies.

Revision surgery of breast implants placed for cosmetic purposes alone do not attract rebates through medicare and health funds and are considered cosmetic surgery.  We are not a cosmetic surgical practice and will suggest seeing one of our plastic surgery colleagues if the desired procedure is purely cosmetic.

Simply removing cosmetic breast implantis not considered cosmetic  (and is rebated by medicare and most health insurance policies), but once the breasts are then lifted, or new implants are inserted the procedure is classified as cosmetic.

What to Expect After Implant Removal

The appearance of the breasts after implant removal varies considerably between patients and depends on the factors described above. We encourage every patient considering explantation to have a frank and detailed conversation with their surgeon about realistic expectations before proceeding.

Recovery from implant removal is generally straightforward. Most procedures are performed as day surgery or with one overnight stay. Bruising and swelling are expected for two to three weeks. Most patients can resume light activities within one week and return to full activity within four to six weeks. A supportive bra is worn throughout the recovery period.

Booking an Appointment

A GP referral is required for a specialist reconstruction revision consultation. Medicare and private health insurance rebates apply to revision procedures performed in the context of previous breast cancer treatment. Your surgeon will advise on the rebate position for your specific procedure at consultation.

This page is intended as a general guide only and does not replace personalised medical advice. Reconstruction revision decisions are highly individual and should always be discussed with your specialist.