Breast Revision Surgery in Thessaloniki and Athens, Greece

Breast revision surgery, most often revision breast augmentation, is an operation for when a previous augmentation did not give the result you wanted or has caused problems. It can involve changing the implant, treating the capsule around it, moving the implant to a different pocket, or removing silicone implants with or without new ones.

It is more demanding than the first operation, because the tissues have already been operated on, and the technique depends on what is causing the problem. Where possible I avoid removing the implants; we decide on removal together, once the problem has been confirmed and the alternatives have been looked at.

The reasons for revision or removal fall into three groups: medical, such as capsular contracture and rupture; aesthetic or personal, such as a result you are not happy with or a wish for a different size; and preventive, when the implants are many years old.

Capsular contracture

The capsule is the normal membrane that forms around every implant. When it hardens and tightens, it changes the shape of the breast and causes pain and firmness. The cause is not fully understood. It is the most common medical reason for revision.

Implant rupture

After some years the implant shell can wear. The silicone is a cohesive gel and does not spread into the tissues, but the implant needs to be removed or replaced. Diagnosis is based on examination, MRI and ultrasound.

Poor aesthetic result

Common problems are the wrong size, implant displacement, the implant dropping below the fold (bottoming out), rippling, symmastia (the breasts meeting in the middle), double bubble and asymmetry. The solution is tailored to you: replacement, removal with replacement at a second stage, a breast lift or fat transfer.

Anaplastic lymphoma (BIA-ALCL)

A rare form of lymphoma, not breast cancer, linked mainly to textured implants. It usually appears years after surgery, with swelling or a fluid collection. Diagnosis is by ultrasound and needle aspiration, with PET-CT in addition. When it is found early, treatment is usually removal of the implants together with the whole capsule. The yearly breast check also picks up changes in the implants.

Breast implant illness

Some women report tiredness, poor concentration, sleep problems, joint and muscle pain or hair loss. A link with implants has not been proven, but it cannot be ruled out. The diagnosis is made by exclusion. If symptoms last more than 6 months, we discuss removal with total capsulectomy; in many women the symptoms settle within months.

Preventive replacement

Replacement about every 10 years used to be recommended, for older-generation implants. Today there is no fixed time for replacement. I have seen implants with no problem at all after 30 years, and ruptures before 10. Replacement is needed when a problem or a change in the breast appears, and after 15 to 20 years it is worth discussing a preventive change.

Revision suits women who have a problem after augmentation, such as hardening, pain, displacement or rupture of the implant, or who want a change of size or implant removal. We usually wait 6 to 12 months after the first operation. The decision is made after a clinical examination and imaging.

Preparation starts with a consultation in which I review your previous operation and examine you, followed by up-to-date imaging of the implants and routine tests. You leave the consultation with a written plan and quote. Stopping smoking and reviewing blood thinners are part of preparation, and the surgery date is set once the tests are done.

What happens at the consultation?

I review the history of your previous operation (implant type and age, pocket, incision), the position and laxity of the breast, the condition of the capsule and the quality of the skin. If you have your implant card, please bring it. We discuss what bothers you, what can realistically be corrected, whether new implants will go in or the implants will be removed, and whether the correction will be done in one or two stages. You receive a written plan and quote.

What tests and instructions apply before surgery?

You need recent imaging of the implants (ultrasound or MRI), blood tests and a check for general anaesthesia. Smoking increases complications: stop 4 weeks before and 4 weeks after. Blood thinners or antiplatelet medicines are stopped only by the doctor who prescribes them. The surgery date is set after the tests.

Breast revision is done under general anaesthesia and takes 1 to 3 hours, depending on the correction. The key decision concerns the capsule around the implant: whether it is removed completely, partly or kept, and whether new implants go in during the same operation or at a second stage.

The technique depends on the cause. For bottoming out I change the implant pocket; for recurrences I use a biocompatible mesh in the lower pole.

Total capsulectomy

The whole capsule is removed together with the implant. It is the operation of choice for severe capsular contracture, lymphoma, breast implant illness and difficult aesthetic problems, because it returns the breast to its state before the implants. It is more demanding, with a higher risk mainly of bleeding, and drains are usually needed for a few days. For this reason, when new implants are needed, I usually prefer to place them at a second stage.

Partial capsulectomy or capsulotomy

Part of the capsule is removed or opened, mainly in the lower pole, when the capsule has no serious problem. It is useful when changing the pocket (above or below the muscle). It is less traumatic than total capsulectomy, with a lower risk of complications.

Capsule preservation and capsulorrhaphy

When the capsule has no problem and we simply want new implants, of the same or a different size, we keep it. This is a simple, short and minimally traumatic operation with a quick recovery. It can be combined with capsulorrhaphy, meaning stitches inside the capsule, or with multiple small stitches on its inner surface, to make the pocket smaller or shape it better.

Two-stage replacement

In serious problems, such as severe capsular contracture, rupture or complex aesthetic problems, I first remove the implants, usually together with the capsule, and place the new ones after about 6 months. This makes the course more predictable, with fewer complications.

Removal of silicone implants without replacement

When you want your implants removed for good, removal is usually combined with total or partial removal of the capsule. Some of the volume can be replaced with fat transfer, in the same operation or later. If there is laxity, which often shows more once the implant is out, a breast lift is added; see the breast lift page. Fat survival is not predictable, so a second session may be needed.

Pocket change and biocompatible mesh

Changing the pocket, for example from above to below the muscle, gives a new space and better cover, and helps with bottoming out, rippling and capsular contracture. In difficult cases a biocompatible mesh supports the lower pole; recovery then needs more care.

Incisions and stitches

I usually use the existing scar or the fold under the breast, so that no new scar is added. If a breast lift is done at the same time, the incisions are those of the lift. The stitches are internal and absorbable, so they do not need removing.

Combined procedures

Revision is often combined with a breast lift (augmentation mastopexy), when the breast has sagged over the years, and with fat transfer for rippling, a wide gap at the breastbone or double bubble. For choosing a new implant and pocket, see also the breast augmentation page.

Hospital stay

No overnight stay is needed. You go home the same day, with someone to accompany you, wearing the special support bra, and if drains have been placed we show you how to care for them. You must not drive after general anaesthesia.

Recovery after breast revision usually takes 5 to 10 days and depends on the operation. You can return to desk work in about 5 days and to exercise after 4 to 6 weeks or longer. After a total capsulectomy, drains are usually needed for a few days.

When	How you feel	What you can do
Days 1–2	Simple replacement: almost no pain; partial capsulectomy: discomfort similar to that after augmentation	Support bra; avoid lifting and sudden arm movements
Days 3–7	Mild discomfort; after total capsulectomy the drains are removed at a check at the practice	Simple painkillers; desk work at about 5 days
Days 7–10	Daily life returns to normal in most cases	Everyday activities; no heavy lifting
Weeks 2–6	Discomfort settles gradually	Walking; extra care if the pocket was changed, or capsulorrhaphy or mesh was used
Weeks 4–6 or later	Feeling almost normal	Gradual return to exercise, following my instructions
Months 3–6	The breast takes its final shape	Normal activity; with two stages, the new implants go in at about month 6

Most patients travelling from abroad should plan to stay in Greece for 5 to 10 days. There is no overnight hospital stay: you go home, or to your hotel, the same day, with someone to accompany you. Recovery usually takes 5 to 10 days, depending on the operation.

You can usually fly home from day 5. If a total capsulectomy was done, drains usually stay in for a few days, and they come out at a check at the practice before you travel. The stitches are internal and absorbable, so there is no appointment for stitch removal.

Before you fly I see you for a check-up the day before your flight. After that, follow-up continues by video call at 10 days, 1 month, 6 months and 1 year. If you have a two-stage replacement, the new implants are placed about 6 months later, which means a second trip to Greece.

At home, arrange help for the first days, since you should avoid lifting and sudden arm movements, and keep wearing the support bra. Plan to take about 5 days off desk work and to stay away from exercise for 4 to 6 weeks.

The result of breast revision is visible straight away, but the final shape develops over 3 to 6 months. The problem usually improves considerably, although the result is less predictable than after a first augmentation, and capsular contracture can come back.

After removal without new implants, if the breast was small and without laxity before augmentation, it usually returns to how it was before. New implants are not lifelong and are monitored with the yearly breast check and, when something is suspected, with MRI. A future pregnancy or a large change in weight can change the shape of the breast again.

Breast revision carries a higher risk than the first operation, because the tissues have already been operated on. Total capsulectomy has a higher risk of bleeding, especially when new implants are placed in the same operation. I explain the risks for your own case at the consultation, based on your history.

Complication	How common	Prevention and treatment
Haematoma (hematoma)	Rare; more likely after total capsulectomy, in the first 48 hours	Review of medicines that affect clotting, drains, new implants at a second stage when needed; if it occurs, it is drained, because blood around the implant can lead to early capsular contracture
Fluid collection (seroma)	Not common, mainly after total capsulectomy	Drains for a few days; needle drainage if needed
Infection	Rare	Antibiotics; implant removal only if it persists
Recurrent capsular contracture	Can recur	Appropriate management of the capsule and a change of pocket; if it recurs, a further revision
Implant moving or dropping again	Not common	Capsulorrhaphy, change of pocket, biocompatible mesh in persistent cases
Asymmetry or further surgery	More likely than after a first augmentation	Realistic planning; correction at a second stage
Delayed wound healing	Rare, more likely in smokers	Stopping smoking; local wound care
Skin or nipple necrosis	Rare, mainly when combined with a breast lift	Stopping smoking, careful planning of incisions
Change in nipple sensation	Usually temporary	Usually returns within months; rarely permanent

Smoking. I do not operate on heavy smokers for breast revision unless they stop smoking 4 weeks before and 4 weeks after surgery. Smoking significantly increases wound-healing complications and skin necrosis.

Blood thinners. Tell me if you take blood thinners or antiplatelet medicines; you stop them only in agreement with the doctor who prescribes them.

We do not publish prices. The cost depends on the cause of the problem and the extent of the correction: what is done with the capsule, whether new implants are placed, in how many stages, and whether it is combined with another procedure. You receive a quote after the consultation.

• Management of the capsule: preservation, partial or total capsulectomy.
• Whether new implants are placed, and their type.
• Whether the correction is done in one or two stages.
• A change of pocket or the use of a biocompatible mesh.
• Combination with a breast lift or fat transfer.

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