A large part of my week is not first-time augmentation. It is revision.
Women come in years after surgery done somewhere else, and they describe the same handful of things. One breast riding high. A firmness that crept in. A sense that the implant has wandered off where it should be. Or simply, it has been ten years and they want a change.
These are not vanity complaints. They are mechanical problems with mechanical fixes, and they deserve a straight answer rather than a shrug.
What That High, Hard Lump Usually Is
When the description is one side that sits high and feels firm, almost like a lump, it is usually a capsular contracture.
Here is what is happening. Whenever we place an implant, the body forms a capsule of scar tissue around it. That is normal and even helpful, because it keeps the implant in place. But sometimes that capsule, driven by inflammation or an old low-grade infection, tightens and hardens around the implant. It squeezes the implant up and in, and the breast goes firm.
If it hurts, the contracture is more severe. No pain is actually a good sign. And it surprises people that this can show up long after the original surgery, sometimes many years later, but it does.
How I Actually Fix It
The repair is more than swapping the implant. I go in, remove the hardened capsule, take out the old implant, and place a new one.
When I do that and switch the patient to a Motiva implant, the risk of contracture recurring drops below one percent. The nano-surface on these implants provokes a much lower inflammatory response, which is the whole reason the recurrence rate falls so far.
To lower it further, I will often place a mesh, an internal bra layer of support, over the area. With that combination, recurrence approaches zero. And if you want to change size while we are in there, we usually can, through the same incision.
Revision Decisions at a Glance
| What You Notice | What It Often Means | The Usual Move |
|---|---|---|
| One side high and firm | Capsular contracture | Remove capsule, exchange implant, often add mesh |
| Implants past ten years | Older-generation wear | Exchange to Motiva, reassess size and position |
| New, fast asymmetry over weeks | Worth imaging | Ultrasound or MRI, then a plan |
| Several prior surgeries | Disturbed tissue planes | Careful planning, honest expectations |
“Should I Just Swap Old Implants?”
If you are at the ten-year mark with older-generation implants, an exchange is reasonable, and it is a good moment to reassess size and position at the same time. I often move patients from an older implant to a Motiva, which lasts much longer and carries far less contracture risk.
“I Have Had Several Surgeries Already. Is It Too Late?”
No. I see patients whose first operation was decades ago with several since. More history does not mean nothing can be done. It means I plan carefully and stay honest with you about what is realistic. Revision is harder than a first augmentation because the tissue planes are already disturbed, which is exactly why it should be planned, not rushed.
Why the Implant Surface Is the Whole Story
When patients ask why a Motiva exchange drops the recurrence rate so far, I bring it back to one thing: the surface. The Motiva implants I use have a nano-surface called SmoothSilk, which produces the lowest inflammatory response of any implant I know of. Capsular contracture is fundamentally an inflammatory problem. The capsule hardens because the body keeps reacting to the implant. When the implant barely provokes a reaction, the capsule that forms stays soft and thin.
That is the mechanism behind a sub-one-percent recurrence rate, and it is why I rarely reach for an older-generation implant during a revision. There is no reason to put back the kind of implant that contributed to the problem.
A Revision Is Often an Upgrade
Patients arrive bracing for damage control, and they are surprised when I tell them a revision is frequently a chance to end up better than the original. The new implants are soft, the gummy bear type, and they move with the body and settle into a natural teardrop when you stand. So while we are correcting the contracture, we can also correct a size you never loved, a position that sat too high, or an asymmetry that was there from day one. The same incision usually does all of it.
On Imaging, and Doing More at Once
If you are feeling a change, an ultrasound or MRI helps me confirm whether the implants are intact and whether what you feel is a contracture, scar, or something that needs more attention. I review your imaging before I commit to a plan.
A firm, high, or newly asymmetric implant, especially a change over a few weeks, is worth coming in for. And if you also want to refine your waistline, we can add liposuction and use J-Plasma to tighten the skin in the same setting, so it is one recovery instead of two.
Why I Take Revision Seriously
I am a double board-certified plastic surgeon with a Mayo Clinic plastic surgery fellowship, and I have been a Castle Connolly Top Doctor for thirteen consecutive years. Revision rewards a surgeon who slows down. I want to examine you and review your imaging before I promise anything, because the tissue tells me more than a photo ever will.
See the Patient-Facing Versions
For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com. For the practice overview, see the version on swplasticsurgery.com.
Ready to Talk?
If something feels high, hard, or out of place, do not sit on it. Come let me take a look.
Call the office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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