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At our practice in San Francisco, California, we specialize in breast revision surgery to help patients achieve their ideal results for their breasts after past breast surgery. Whether you are dealing with capsular contracture, breast implant rupture, breast asymmetry, or changes in your breast size or appearance over time, Board-Certified Plastic Surgeon Dr. Karen Horton is here to guide you through the process. Revision surgery is tailored to address complications such as implant malposition, deflation, or excess skin following an initial procedure. Our goal is to help you feel confident and comfortable with your appearance by aligning your results with your unique aesthetic goals.
Revision breast surgery, also known as revision mammaplasty, encompasses a range of procedures aimed at enhancing or improving the appearance of breasts that have undergone prior surgery. This type of surgery can address aesthetic concerns or physical symptoms such as tightness or discomfort. Whether performed for cosmetic reasons or as part of post-reconstruction care, revision surgery demands the expertise, precision, and skill of an experienced Plastic Surgeon such as Dr. Horton.1
As a female Plastic Surgeon, Dr. Horton intimately understands how a woman’s feelings about her breasts can influence her self-image and her femininity. Our ultimate goal is to help you feel better, look better, and give you the results you are seeking! Dr. Horton’s skill and experience in complicated breast reconstruction surgery is directly applied to all types of breast revision, whether reconstructive or cosmetic.
Cosmetic breast revision may include improvement or modification of breast implants, reshaping breasts that have previously had a lift or reduction done, or correction of unsightly breast scars. Revision of previously reconstructed breasts can involve a variety of techniques as determined by your personal goals and the specifics of previous breast reconstruction attempts. Correction of previous breast surgery can also basically make previously operated-on breasts look and feel more beautiful!
Improvement of the appearance of the breasts has psychological benefits for a woman in addition to improvement in quality of life! While there are no absolute guarantees regarding the final outcome of breast revision, our goal is to create the most aesthetic outcome with the best possible symmetry and a natural result that is proportional to the rest of the body.
If you have recently undergone breast augmentation, breast lift, breast reduction or reconstruction surgery and are looking for a correction, a period of at least six months should pass before having a major revision, as swelling and changes in shape can take this long to resolve and for all scars to become mature. However, you may come in for a consultation at any time to learn about your options and to plan for the future.
Ideal candidates for breast implant revision surgery include:
Whether you are addressing complications or seeking to align your results with your evolving aesthetic goals, revision surgery can help restore your confidence and satisfaction.
If I could give 10 stars I would! I came to Dr. Horton after several breast surgeries. My mother and sister both died from breast cancer. I had a prophylactic double mastectomy 9 years ago. The implants were under the muscle which seemed fine at first but caused me discomfort, distortion and finally frozen shoulder from the scar tissue. Had several surgeries and procedures to try to fix, and finally my surgeon decided to take out the implants and put them over the muscle. As soon as I woke up I had pain and distortion of my left breast. I couldn't work out and had to wear two bras for a year and a half all the time until I found Dr. Horton. From my initial consultation, I felt hope for the first time! She fixed my breasts! Woke up with the pain gone and my breasts in the right position! Even my shoulder felt better right away! She did nipple grafts 6 months later and still with me until we finish with some tattooing to complete the procedure! She is always available to text and is ALWAYS positive! I can't recommend her more highly!
„Patients often choose to undergo breast implant revision surgery to address concerns such as implant rupture, asymmetry, or dissatisfaction with their breast size or shape after their initial breast augmentation surgery. Revision surgery aims to correct complications, improve symmetry, and align results with each patient’s aesthetic goals.3
Some women with saline breast implants may wish to have them replaced with silicone gel implants to make their breasts look and feel most natural. While there is no rule that implants should be changed at a certain time (breast implants are not like car tires that need replacement every 10,000 miles!), they are a medical device, and as such may not last forever.
Dr. Horton will help you determine whether implant replacement is appropriate, and will go over with you in detail the various options for implant types, shapes and sizes that are most proportional and best suited to your body.
Learn About “Breast Implant Illness” Learn About the FDA’s Labeling Requirement for Breast Implants
Learn more about Breast Implant Illness (BII) treatment & the latest recommendations from The Aesthetic Society on Dr. Horton’s blog.
Adjustment of the breast implant “pocket”, called “capsulorrhaphy”, may be done to create better symmetry or to improve the appearance and position of previously augmented breasts to one that is more natural and aesthetic. This can involve opening the pocket (“capsulotomy”), removing scar tissue on the inside (“capsulectomy”) or creating a new pocket on top of the muscle (converting to a prepectoral plane) for implants that are under the muscle and causing pain or deformity.
Other women may wish to have their implants removed for individual reasons (personal preference, weight gain or increased age). Removal of breast implants, called “explantation”, is a straightforward procedure, but the shape of the breast may be somewhat flat or deflated afterward in some cases. A breast lift or internal reshaping surgery using the “auto-augmentation” technique may therefore be recommended after implant removal to reshape the breast tissue and to create the most aesthetically pleasing breast shape.
Read more about selecting the right breast implants for you in Dr. Hortons blog!
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Capsular contracture occurs when scar tissue tightens around a breast implant, which may develop due to factors like infection or a hematoma. The current thinking behind what causes most cases of capsular contracture is called the “biofilm theory” – if bacteria develop around a breast implant, the body responds by forming additional scar tissue as a protective measure to contain the bacteria in one place.4 This condition can cause the breast to feel firm, alter its shape, or, in severe cases, result in discomfort or noticeable deformity. To address this, a surgical procedure called “capsulectomy” is performed to remove the scar tissue and is commonly included in breast implant revision surgery.5
It is possible to re-attach the pectoralis major muscles back to their native location on the chest wall and to place new implants on top of the muscle, converting the implants from the submuscular plane to the subglandular plane (for augmentations) or prepectoral plane (for reconstructions after mastectomy). This type of revision will eliminate the animation deformity that occurs with muscle flexion and usually rids patients of discomfort related to the muscle contracting tightly over the implant. This is called a “capsulectomy” since it also removes constricting scar tissue and creates a new pocket for the implant.
Intraoperative view of a breast revision surgery. This patient experienced pain and deformity from her submuscular implants. The pectoralis major muscle has been returned to the chest wall on the right, and a new implant has been placed in the subglandular position. *
In Dr. Horton’s own words:
“A great percentage of my practice involves breast revision; sometimes I feel like I’m hosting my own reality show—’Botched, San Francisco’—since I see so many unsatisfactory surgery results after both cosmetic surgery and breast reconstruction. And there is always hope: we can usually make things much better!
Most breast revisions I perform involve replacing muscles to the chest wall and placing new implants on top of the muscle. Results look and feel more natural, the motion deformity is gone, usually all symptoms of pain and tightness vanish, and women are able to resume all upper body activities without any restrictions at 4-6 weeks after surgery.
While the only potential trade-off USED to be a slight increase in rippling of the implant, with our newest higher-fill and more cohesive silicone gel implants, this is rarely—if ever—a problem now! Learn more about these newest implants in my blog post about the newest, safest, softest and least-likely-to-ripple 7th generation silicone implants.”
Dear Dr. Horton, I LOVE my reconstructed boobs!! You ought to have BILLBOARDS in breast care centers worldwide! Thx so much. PS - Thank you for putting up with me! I am fully cognizant your work is extraordinarily skillful, courageous (the radiated breast etc) + artistic, and I am so grateful to you. Thank you so much.
„This video shows severe deformity of the breast skin and the chest wall resulting from implants being placed under the muscle after mastectomy and breast reconstruction performed elsewhere. Unfortunately, most surgeons put implants under the muscle, which creates chronic tension of the muscle, obvious deformity, sometimes pain and forces women to stop doing activities which accentuate this muscle contraction—like exercising or using their arms.
Breast implants originally placed under the muscle, whether for cosmetic or reconstructive purposes, can be relocated above the muscle. This adjustment can enhance the breasts’ appearance and help relieve symptoms associated with submuscular implant placement.
There are many advantages of the subglandular breast implant placement compared to the submuscular location. Conversion of implants to a subglandular position (on top of the pectoralis major muscle) often creates a more natural look and feel to the breasts. Likewise, completely submuscular tissue expanders or permanent implants placed for reconstruction after cancer can be converted to a location on top of the muscle to achieve a more natural look and feel of the reconstruction.
Natural droop of the breasts can occur after having children, after major weight loss or with increased age, resulting in a saggy, droopy appearance to the breasts, and the nipple and areola lying lower on the breast. A breast lift (mastopexy) will raise the nipple to a more aesthetic position and reshape the breast tissue using the “auto-augmentation” technique, where breast tissue is lifted and reshaped internally. Likewise, even women who have had prior breast surgery (augmentation, reduction or lift) may develop droop to their breasts over time that can be improved by a mastopexy.
Scar appearance is largely influenced by genetics, but scars that are stretched, prominent, or unsightly after breast surgery can often be improved through revision procedures. Scar revision may be performed alongside breast revision surgery or as a standalone treatment. Post-surgery, scar therapy is often recommended to optimize results. Visit our section on Scar Therapy to learn more about achieving the best possible scar outcomes.
Some breast cancer survivors with unsatisfactory implant reconstructions or with implant-related complications may wish to have conversion of their breast reconstruction to a flap. Microsurgical free flap breast reconstructions have a number of advantages, described in detail in our section on Flap Reconstruction.
Enhancements to previous flap reconstruction may include minor adjustments to create a more natural or symmetrical appearance or to refine the flap donor site. Techniques such as tissue rearrangement, liposuction, or scar revision are often used. In some cases, flap augmentation is performed to add projection to the breast reconstruction. Visit our Breast Reconstruction section to learn more!
Breast revision may include lifting sagging breasts that have undergone previous surgery, revising a past breast reduction, or improving scars from earlier procedures.
To enhance the overall contour, liposuction can be used to address excess fatty tissue in areas like the underarm or back “bra roll” regions. Incorporating liposuction into breast revision can help achieve a more balanced appearance while minimizing scar length for an optimal aesthetic outcome.
Learn more about mammograms after breast surgery in this blog by Dr. Karen Horton.
Read More
Dr. Horton will place surgical drains to provide an outlet for the fluid that builds up in the pocket created for the breast implant. We urge you to read Dr. Horton’s blog post on surgical drains and watch all of the accompanying videos so that you are well prepared to care for your drains after surgery.
The first step in preparing for breast revision surgery is your initial consultation with your Board-Certified Plastic Surgeon. During this appointment, we will get to know you personally and will take a complete medical and surgical history. Your surgeon will give you a realistic idea of what breast revision can and cannot achieve and will go over all options with you in detail so that you can make the most informed decision. We will explore your reasons for seeking revision of your breasts, we will examine in detail the aspects you would like to correct or improve, and if you are an appropriate candidate for surgery, your options will be described in detail.
Once your breast augmentation revision is scheduled, we will give you detailed instructions about how to prepare for surgery day as well as what you can expect during the recovery process.
Breast revision surgery is a personalized procedure designed to address concerns from a previous breast augmentation or reconstructive surgery. The process typically involves the following steps:
Each surgery is customized to meet our patients’ individual aesthetic goals, with careful attention to creating balanced, natural-looking results.
Recovery from breast revision surgery varies based on the complexity of the procedure and the specifics of your treatment plan. Most patients can expect some swelling, bruising, and mild discomfort during the first week, which can be managed with prescribed medications.
Here’s what you can anticipate during your recovery:
The timeline for full recovery and final results can take several months as swelling subsides and your breasts settle into their new shape. Our team will guide you every step of the way, ensuring you are comfortable and confident throughout the healing process.
Please visit our photo gallery to see before and after breast revision results!
Dear Dr. Horton, I am thrilled with my results. You are the only doctor who listened to me in over 25 years regarding my breast surgery. When I first saw them yesterday - I was a bit in shock. I didn't expect to see smaller, normal looking breasts. Given all they have been through, you are truly a miracle worker to make the result look so good. I can't wait to put on a dress........or some clothes I've dreaded wearing for years. I can't wait to feel like me again. It's been way too long. Again - I'm so thankful to you for listening to me and giving me the results that I've always wanted!
„Dr. Horton instructing her breast revision patient to show her breast implant massage and how soft the implants feel. Note the revision of nipple and areolas including recent tattoo that creates symmetry to the reconstruction without the need for additional scar revisions.
The cost of breast revision surgery can vary depending on the complexity of the procedure, the surgeon’s expertise, and the surgical facility. During your consultation at our San Francisco office, we will provide a detailed cost breakdown, including any adjustments for implant size changes or additional procedures like a breast lift.
If you are dissatisfied with the results of your initial breast augmentation surgery or experiencing complications such as implant rupture, deflation, or implant malposition, you may be a good candidate for breast implant revision surgery. Patients should be in good overall health, not currently breastfeeding, and have realistic expectations about the outcomes.
Common reasons include:
Ready to explore your options for breast revision surgery? Schedule a consultation with Dr. Karen Horton to achieve results that align with your unique aesthetic goals. We proudly serve patients from San Francisco, California and throughout the Bay Area.
1 American Society of Plastic Surgeons. What is breast implant revision surgery? Available: https://www.plasticsurgery.org/cosmetic-procedures/breast-implant-revision. Accessed November 26, 2024.
2 American Society of Plastic Surgeons. Who is a good candidate for breast implant revision? Available: https://www.plasticsurgery.org/cosmetic-procedures/breast-implant-revision/candidates. Accessed November 26, 2024.
3 Seminars in Plastic Surgery. Revision Breast Augmentation. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186996/#. Accessed November 26, 2024.
4 American Society of Plastic Surgeons. What is capsular contracture and how can it be treated? Available: https://www.plasticsurgery.org/news/blog/what-is-capsular-contracture-and-how-can-it-be-treated. Accessed December 9, 2024.
5 Susini P, Nisi G, Pierazzi DM, Giardino FR, Pozzi M, Grimaldi L, Cuomo R. Advances on Capsular Contracture-Prevention and Management Strategies: A Narrative Review of the Literature. Plast Reconstr Surg Glob Open. 2023 Jun 9;11(6):e5034. doi: 10.1097/GOX.0000000000005034. PMID: 37305202; PMCID: PMC10256414. Available: https://pubmed.ncbi.nlm.nih.gov/37305202/. Accessed November 26, 2024.
Dr. Karen Horton has either authored or reviewed and approved this content.
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Dr. Karen M. Horton
2100 Webster St UNIT 520
San Francisco, CA 94115
Phone: 415.923.3067
We are located in the Pacific Heights District in the Pacific Professional Building.
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Saturday-Sunday: Closed
Monday:
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Tuesday:
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Thursday:
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Friday:
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Saturday:
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Dr. Karen M. Horton
2100 Webster St UNIT 520
San Francisco, CA 94115
Phone: 415.923.3067
We are located in the
Pacific Heights District
in the Pacific Professional Building.
SHOP SKIN CARE*Please note: Our office is no longer a Participating Provider for insurance. We can provide a financial quote for what anticipated surgical fees will be after your consultation.
