When revision surgery is worth considering

Revision is how implant culture tells the truth: some results need a second day. That day can be wise. It can also be a restless attempt to finish a feeling. The work is telling those apart.

Reasons that usually deserve a list

• A device that has ruptured, especially with symptoms or messy gel
• Capsular contracture that distorts or hurts
• Malposition: too high, too low, too far into the armpit, a fold that was invented in the wrong place
• A lift that was needed and skipped, now obvious
• Infection or exposure, which are not aesthetic debates
• A size that was a misunderstanding, once swelling has gone and you have lived in your clothes

These are craft problems. They want a surgeon who revises often, not a surgeon who only sells primaries.

Reasons that want more time

• Week-six photographs in bad lighting
• A partner’s opinion that has more to do with their comfort than your plan
• A desire to look like a new photograph you found
• Comparison with a friend who had different tissue

If the pocket is sound and the device is sound, waiting through a season of clothes is not cowardice. It is data.

Explant as a species of revision

Taking devices out is not the opposite of surgery. It is surgery. Skin may need a lift. Volume will drop. Implant illness conversations belong here if they are yours, without a promise that every symptom will clock off with the device.

Price explant as carefully as you priced the first day.

How to choose the second surgeon

You may return to the first. You may not. Pride is a poor reason to stay; familiarity is a good one if they can see the problem. If you change, bring operative notes and device stickers. Check FRACS again. Revision is not a bargain bin.

Ask what they will do differently. “I would just go bigger” is not a philosophy.

Money, again

Revision in Sydney can cost as much as a primary, sometimes more, because pockets and capsules take time. Warranties may help with a device. They will not rent the hospital. Put a number aside at the beginning if you can. Future you is a relative you are responsible for.

A test for restlessness

If you cannot describe the problem in a sentence a surgeon can examine — “the left sits two centimetres higher”; “the fold scar is on the breast, not in the crease”; “it is hard and spherical” — you may be describing a mood. Moods are real. They are not always an incision.

If you can describe the problem, and two specialists see it, you are allowed to stop enduring it.

Revision is not a scandal. Unexamined revision is. Bring measurements, time, and a second opinion. Leave the idea that a first operation must be the last.

What to bring to the revision consult

Operative notes, device stickers, a timeline of when the problem started, photographs in consistent light, and a sentence you can say without crying. You may still cry. The sentence helps the surgeon find the anatomy in the feeling.

If two consults cannot find a physical problem and you are still desperate, pause the theatre and widen the team. A third incision is a poor antidepressant.

Staging your own expectations

If you need a pocket correction and a lift and a size change, ask whether those belong on one day. Combined revisions are possible and they are crowded. A surgeon who wants to stage is sometimes the conservative one you wanted the first time.

How to tell a friend you are doing it again

You do not have to. If you do, “the implant moved and I am having it put back where it belongs” is enough. You do not owe a narrative of regret or empowerment. Those words are for brochures.

Bring the same seriousness you wished you had brought to the first consult. Revision is not a lesser operation. It is often the more adult one.

A closing note from this desk

Craft problems deserve lists: rupture, distorting capsules, malposition, skipped lifts, size after a true settle. Moods deserve time and sometimes a wider team. Describe the problem in a sentence a hand can examine. Bring notes and stickers.

Revision is not a scandal. Unexamined revision is. Price it like surgery, not like a tweak. The second day is often the more adult operation. It still needs the same FRACS method as the first.

Photographs for the second consult

Same window, arms down, arms up, both profiles. Date them. Do not filter them. A surgeon can work with ugly honesty. They cannot work with a beauty app.

If you cannot look at the photographs without spiralling, ask a friend to hold them and to sit in the consult. The job is to get the anatomy into the room. The feeling can come too. It should not come instead.

If the first surgeon offers a reduced fee and you still do not trust the plan, you may leave. Loyalty is not a clinical indication. A reduced fee for a plan you do not believe in is how people buy a second disappointment cheaper.

Ask how long they want you to wait after a pregnancy, a big weight change, or an infection before the second list. Timing is part of the craft. A rushed revision is how a pocket that could have been saved becomes a story about being unlucky.

If you are revising for size alone, live in the new clothes for a season first. If you are revising for a pocket in the wrong place, do not live there for pride. Pride is a poor plane. Anatomy is a better one. Ask two people to name the anatomy before you pay a second deposit.

If two specialists see a pocket problem and you still delay because you are embarrassed, remember that revision is ordinary in this field. Embarrassment is optional. Anatomy is not.