Breast implant revision surgery is common. Particularly now with women who were early adopters, their implants are having issues with poor position, hardening (capsular contracture) and other things. I do a lot of revisionary work in my practice. Some common things to think about when you are doing that next surgery…
1. Downsizing. If you are not droopy, then you can likely downsize with a simple exchange. If you have thinning of the skin, you are droopy (you can pass the pencil test), or you have visible ripples and wrinkles, you may not be able to just put in a smaller implant without doing some other kind of procedure such as changing the plane or lifting and tightening the skin.
2. Changing the plane of the breast implant. Many women with implants placed long ago were placed in front of the muscle. I generally steer away from placement in front of the muscle: higher rates of capsular contracture, less natural look, ripples and thinning in the cleavage area, and other issues. But when you are redoing an implant, the thinking about “best” becomes complicated. If you go to behind the muscle, especially with a smaller implant, the cosmetic result may be bad because your skin may be thin, loose, or droopy. So for many women I need to keep it in the same plane to avoid having to do a larger surgery like a lift or other creating other issues with the skin.
3. Capsular contracturerisk is lower under the muscle. If you haven’t had issues with capsular contracture with your current implants, then it is a less compelling reason to change the plane. If capsular contracture has been an issue, you need to try to throw the kitchen sink at avoiding it again. Things which lower the rate of capsular contracture: inframammary incision, saline implant, behind the muscle, antibiotics at surgery, avoiding blood/fluid around the implant. Again, everyone is different and there are multiple things to consider: for example if you already have an incision, I would try to reuse your current incision if possible to avoid creating a new scar.
But please see a surgeon if you are unhappy or want a change. I have patients who wait years for fear of what the next surgery will be like and for most it isn’t bad.