Revisional Procedures Demand An Expert

Breast Augmentation is the most common plastic surgery procedure in the US, and therefore most plastic surgeons perform this surgery. However, the revision of breast augmentations requires a particular expertise. Surgeons must have years of experience in correcting all sorts of complications in a variety of different body types. No one in Raleigh, North Carolina, comes close to the experience and proven results of Dr. Zenn in revisional breast procedures.

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Sometimes Touch Ups Are Necessary

Many patients are very happy with their breast augmentations. However, changes in weight, pregnancies, and general aging typically cause breasts to lose their initial shape and beauty. These changes can negatively impact the once-great results of the initial breast augmentation. 

Other patients are unhappy with the results of their breast augmentation from the start. Often these patients see Dr. Zenn if their original surgeon is unwilling or unable to give them the result they desire. Breast augmentation revision can correct problems with existing implants.

Common Reasons To Seek Breast Augmentation Revision

Dr. Zenn performs breast revisions in Raleigh for the following issues:

  • Poor Shape
  • Droopy Breasts (Breast Ptosis)
  • High-riding breast implant (Too High)
  • Capsular contracture (Firm Scar, Distortion of Breast)
  • Incomplete Muscle Release (Breast Move, Pushed to the Side)
  • Breast Implant Infection or Exposure
  • Rippling & Wrinkling of the Breast
  • Palpable or Visible Implants
  • Implant Leak or Rupture (Saline/Silicone)
  • Symmastia (Connected Breasts)
  • “Bottoming Out” or Deformity
  • Lateral Implant Displacement

Treatment Options for Breast Augmentation Revision

Dr. Zenn has many techniques at his disposal to treat the various problems that arise with breast augmentations, which he has gained over his nearly 30-year career as a board-certified plastic surgeon focused on breast procedures. Dr. Zenn has seen it all and has successfully helped patients who had long given up hope that anything could be done about their breasts.

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Breast Implant Removal (with or without Breast Lift and Fat Grafting)

It is not uncommon for patients to want the removal of troublesome implants. Taking out implants will often fix issues of implant firmness and displacement. The ultimate look of the breasts will depend on the amount of remaining breast tissue, and how stretched the skin is.

In addition to implant removal, volume can be added to the breasts with fat grafting, a process where fat is harvested from another part of the body and inserted into the breasts. A breast lift may also be part of the procedure, to ensure proper placement of the breast on the body.

Breast Implant Revision By Means of a Breast Implant Exchange

Many of the problems that result in misshapen breasts can be rectified with a breast implant exchange. Often the new implants are placed over the pectoral muscles, a location that looks and feels more natural and comes with fewer complications when compared to implants placed under the muscle. Fat grafting can also be performed to improve the softness and shape of the breasts. If problems are due to overly large implants, an implant exchange can downsize to the appropriate and desired size for your chest. Also, scar tissue can be removed during this procedure, which is the leading cause of the often painful condition called capsular contracture.

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Surgical Mesh Repair

After a previous surgery, there may be very little natural tissue to hold implants in position. Surgical mesh, either synthetic (i.e., Galaflex) or natural acellular dermal matrix (ADM), allows Dr. Zenn to secure implants in a new position on the chest. Over time, The surgical mesh/ADM becomes repopulated with your own cells and tissue and becomes part of your breasts for long-term support. One advantage of surgical mesh/ADM is a lack of scar tissue formation around the breast implant. The body appears to treat the surgical mesh/ADM as “self” and not a foreign body, so no scar capsule forms. Surgical mesh/ADM has become the preferred treatment for patients with recurrent or severe capsular contracture.

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Breast Augmentation Revision May Require Fat Grafting

Fat grafting is a technique used to thicken areas of natural tissue over the implant. This procedure hides the implant if it is visible or shows signs of rippling under the skin. Fat grafting allows for above-the-muscle placement more often.

Fat grafting is simply a transfer of your fat, harvested via liposuction, from one area of your body to the breast. Fat cells are processed to remove any impurities and then are artistically placed to improve the appearance of the breasts. An added bonus to fat grafting is an improved contour in the area of your body from where the liposuction was performed.

Breast Augmentation Revision To Fix Poor Shape

There are several reasons why your augmented breast may appear misshapen. For some patients, breasts increase in weight and size as part of aging. As the breast tissue increases, the breasts can droop, with the natural breast tissue hanging below the implant.

Poor breast shape can also be related to the shape of your natural breasts before the primary breast surgery, especially if congenital breast shape issues were not addressed during that first procedure. Sometimes implants are misplaced initially and sit in the wrong position on the chest, giving the breasts an odd appearance.

Other times, the problem is that the implants are the wrong size or shape for a patient’s particular body type. The presence of scar tissue (see “Capsular Contracture”) can distort the shape of the breasts as well, and make them feel firm and sore.

Augmentation Revision For Droopy Breasts (Breast Ptosis)

Before, if the natural breasts were flat, augmentation made them bigger with an uplifted shape. However, if breasts become deflated due to weight changes, pregnancy, or aging, augmentation can either re-elevate the breasts and nipple or just fill the volume of the breasts while leaving a degree of droop.  Some droop is natural and desirable, depending on your age and personal preference.

If there is too much droop after a breast augmentation, a breast lift would be beneficial. It is better to decide this ahead of time, but it is difficult to predict the degree of lift with augmentation alone. For patients who had an augmentation in the past and now experience drooping  breasts, a breast lift would be one way to maintain breast size with an uplifted look.

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Revise a High Riding Breast Implant

After a breast augmentation, many women are told their breast implants will settle, and not to worry about implants that appear too high. While this is true to some extent, implants should be close to their final position by two weeks. This is when scar tissue forms, acting to hold the implant in its final position. Massage and “breast bands” can help during the first couple weeks. Sometimes, high positioning is a result of surgical error in placement or submuscular position that prevents the implant from achieving its proper position.

Capsular Contracture (Firm Scar, Distortion Of Breast) Requires Breast Augmentation Revision

It is natural for your body to form scar tissue around your breast implants. The body recognizes that the implant is “foreign” and surrounds it with scar tissue called a “capsule.” Because saline and silicone implants are soft, scar tissue around the implants can contract (Contraction is a normal part of scarring anywhere on the body.)

In some instances, the scar tissue that develops around an implant causes firmness and rippling of the implant as well, distorting its shape. This can be painful in addition to looking odd, and usually leads the patient to seek breast augmentation revision surgery to remove the capsular contracture.

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Incomplete Muscle Release (Breast Moves, Pushed To The Side)

Too many plastic surgeons place implants under the pectoralis muscle. In this day and age, placing the implant under the muscle is not necessary for most breast augmentations. Under-the-muscle placement can result in unnatural positioning of the breasts with typical arm movements, called “animation deformity.” 

The majority of breast augmentations Dr. Zenn performs are over the muscle, where the breasts naturally sit. The results are natural, the pain is minimal, and the recovery is quicker. For surgeons who choose to place implants under the muscle, it is important that the muscle is released from its attachments to the ribs below, or the implant will always be too high. 

However, too much muscle release risks more breast movement and the possible creation of symmastia, a condition where the breasts merge together. Because of this, surgeons are too tentative and do not release the muscle enough. This results in a large gap between the breasts where cleavage is supposed to be. In these situations, the breasts often hang near the arms and point off to the side instead of forward.

Rippling and Wrinkling of the Breast

As described above, rippling or wrinkling of the breast is due to capsular contracture, or scar tissue formation that has forced the implant to be in a space that is too small. The implant, being soft, yields to this scar tissue and wrinkles. These ripples may be something you feel or see. The amount of natural tissue over the implants determines whether the rippling is visible. For some implants placed under the muscle, rippling occurs only when the muscles are flexed.

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Breast Augmentation Revision For Infection Or Exposure

Infection and exposure are the most feared complications of breast augmentation. They require immediate breast implant revision surgery. Bacteria that enter a breast implant can multiply and ultimately cause infection around the breast implant. The immune system cannot fight infections in foreign bodies, as there is no way for your infection-fighting cells to get to the implant.

Infections can appear to improve with the use of antibiotics, but improvements often only occur in the overlying tissues improving and not a clearing of the infection around the implant.

Lack of treatment of an implant infection can lead to Toxic Shock Syndrome.

For this reason, treating implant infections aggressively often leads to removal of the implant as the only effective and safe treatment. Sometimes, the incision through which the implant is placed opens and the implant becomes visible. By definition, the implant now has bacteria on it and could develop into an infection. The treatment recommendations for this implant problem is surgery and implant removal.

Palpable Or Visible Implants

Palpable or visible implants typically occur due to a combination of excessive scar tissue around implants (capsular contracture) and inadequate tissue covering or hiding the implant. Even in successful cases, implants can be palpable on the sides or bottom of the breast, as these are the areas with the thinnest skin and the least amount of natural tissue coverage.

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Breast Implant Leak Or Rupture

This is a common concern as implants age. With rupture, saline implants will lose volume and go flat over time.

This can happen in days, weeks, or months. When this happens, replacement implants are necessary. 

For silicone implants, rupture can mean different things depending on their age. Prior to the FDA moratorium on silicone implants in 1992, silicone implants that ruptured would leak silicone. The loose silicone would then migrate around the chest and to the armpit area. This necessitated extensive surgeries to remove all silicone and its resultant scar tissue. 

Today, plastic surgeons use only “cohesive” or solid silicone breast implants. If a rupture of the outer shell occurs, these solid silicone breast implants do not spread out. Secondary operations today are based on the appearance of the breasts and other symptoms such as pain or discomfort.

Breast Augmentation Revision For Symmastia (Connected Breasts)

Breast symmastia is the medical term for two breasts that merge into one. This condition is due to a disrupted connection between the central chest and the breast tissue. Symmastia can be a result of over-aggressive muscle release caused surgical error when creating the pocket for the implant. Too big of a pocket allows migration of the implant toward the center of the chest over time.

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“Bottoming Out” Or Deformity Of Breast Implants

The term “bottoming out” refers to too much settling of the breast implant over time, resulting in the implant sitting below the natural fold of the breast. In this case, the upper part of the breast looks flat and empty, and the nipple appears too high on the breast mound. Bottoming out is caused by overly aggressive dissection, or dividing the natural fold of the breast; this allows the implant to move too low. This condition also results from choosing an implant that is too big for your body type.

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Lateral Breast Implant Displacement

Breast implants spread too far apart can give the breasts an unusual appearance, causing nipples to point outward rather than straight ahead. “Side hanging” breast implants create a larger-than-normal gap between the breasts, which can look unsightly and awkward. In some patients, the submuscular position and continual action of the muscle pushes implants further out to the side over time.

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Dr. Zenn's Breast Revision Patient Reviews


I can not say enough good things about this doctor and his staff. To say he is an amazing doctor would be an understatement, he is a miracle worker! I had a prophylactic nipple sparing mastectomy with immediate reconstruction by a different plastic s...


Dr. Zenn ROCKS! I have been a patient for almost 2 years, consisting of 5+ surgeries with Dr. Zenn to complete my reconstruction process after numerous failed attempts by another surgeon.


I interviewed a number of plastic surgeons throughout N.C. regarding breast reconstruction before making a decision. From my first visit I found Dr. Zenn to be highly competent, compassionate, professional and dedicated to meeting my needs and desire...

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Are You Unhappy With A Previous Breast Augmentation?

The next step for you is to meet with Dr. Zenn at Zenn Plastic Surgery in Raleigh, North Carolina. Dr. Zenn will carefully examine your breasts and diagnose the problem, and then form a tailored plan for breast revision to give you the beautiful, youthful and full breasts you deserve.  Contact our office today to schedule a consultation for your breast revision in Raleigh.

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