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Los Angeles | Beverly Hills

Breast Augmentation Revision

Dr. Hughes fixes a wide array of issues including implant malposition due to lateralization of the implant or the high riding implant. Dr. Hughes has corrected both variations of double bubble deformity and bottoming out. He has also performed very difficult symmastia and animation deformity repairs. Finally, Dr. Hughes has a particularly large experience in treating capsular contracture. Finally, Dr. Hughes has successfully treated implant rippling with fat grafting, dermal matrix placement, replaning procedures, and implant substitution.

dr. kenneth hughes voted among best breast surgeon in beverly hills and los angeles

Dr. Kenneth Hughes in Los Angeles and Beverly Hills has a great deal of experience in breast augmentation revision surgery. He has authored numerous journal articles and textbook chapters on these subjects, and he routinely performs complicated breast augmentation revision surgeries. There are a wide variety of breast augmentation deformities that can result from a previous breast augmentation surgery. Dr. Hughes has years of experience reconstructing and revising all of these deformities, and he has specialized fellowship training from Harvard Medical School’s Beth Israel Deaconess Hospital.

Dr. Kenneth Hughes, MD has performed thousands of breast augmentations and hundreds of breast augmentation revisions. Dr. Hughes’s fellowship in plastic surgery at Harvard Medical School’s Beth Israel Deaconess Hospital involved a great number of breast augmentation revisions referred to the Harvard Hospitals as a result of it being the elite tertiary care center in the country.

Dr. Kenneth Hughes was voted among the best breast surgeons in Beverly Hills and Los Angeles. Dr. Kenneth Hughes offers the full array of breast surgeries including breast augmentation with implants, breast augmentation and breast lift combination surgeries, breast implant revision surgeries, breast lifts, and breast reduction procedures, along with inverted nipple correction surgeries.

cost of breast augmentation revision in los angeles, beverly hills

  • Breast augmentation revision costs between $15,000 to $25,000.  The cost is largely determined by need for implant replacement, pocket revision, capsulectomy, skin adjustment, and placement of a dermal matrix.

Please note that pricing and cost for Breast Augmentation Revision may vary based on the individual needs of the patient.

types of revisions

implant malposition

Breast implants can be placed and positioned in many ways. The most common malposition issues encountered by Dr. Kenneth Hughes, MD in Los Angeles, CA include lateralization of the breast implant and inadequate dissection of the inferior or inferomedial pole, leading to an implant “riding high.” The lateralized implant is easily corrected with capsulorrhaphy sutures to repair the pocket and block the implant from migrating laterally. The implant that is riding high can be corrected with additional dissection of the inferior or inferomedial portions of the muscle.

double bubble and bottoming out

Double bubble and bottoming out are variants on a theme and may result from overdissection of the pocket below the inframammary fold.

Double bubble describes the condition in which the breast implant becomes visible below the natural breast fold, thus giving the appearance of two breast folds. This double bubble can be corrected by repairing the inferior aspect of the pocket with capsulorrhaphy sutures to bring the implant up to the original inframammary fold. Sometimes, an acellular dermal matrix like Alloderm or Strattice may be necessary to reinforce the repair. In cases of constricted breasts or tubular breasts or tuberous breasts, the fold must frequently be lowered to get an adequate result, and the double bubble may be an inevitable outcome or require correction by other means. Sometimes a breast lift may be appropriate to bring sagging tissue up to reduce the appearance of the second fold. Sometimes the old fold remodels without further intervention. Sometimes the old fold can be altered in other means such as fat grafting.

Bottoming out involves the implant moving below the inframammary fold over time without causing two distinct folds. Sometimes this is the result of weak patient tissues, too large an implant, or a combination of both. The repair involves suturing the pocket with capsulorrhaphy sutures and possibly adding an acellular dermal matrix for reinforcement (Alloderm, Strattice). The implant size may need to be reduced as well.

symmastia and its repair

Symmastia or (uniboob) results when the implants meet in the center of the chest due to overdissection of the medial pectoral fibers. The treatment is very difficult and involves suturing the pectoral fibers back to the chest wall with or without acellular dermal matrices such as Alloderm or Strattice. The implant size will likely need to be reduced as well to eliminate pressure on the repair.

capsular contracture

Capsular contracture occurs when the normal capsular tissue which surrounds the breast implant begins to deform the surrounding breast and can lead to pain as well. It results from an exaggerated scar response to a foreign prosthetic material. Capsular contracture occurs in 3 to 5% of primary breast augmentations.

The amount of capsular contracture can be graded according to severity.

Grade I:
-No palpable capsule
-The augmented breast feels as soft as a natural one.

Grade II:
-Minimal firmness
-The breast is less soft; the implant can be palpated, but it is not visible.

Grade III:
-Moderate firmness
-The breast is harder; the implant can be palpated easily, and distortion can be seen.

Grade IV:
-Severe contracture
-The breast is hard, tender, painful, and cold. Distortion is often marked.

Capsular contracture remains the most common complication of breast augmentation, with rates reported between 0.5% and 30%. Despite extensive research, the cause of capsular contracture remains unknown. Two main theories address the underlying cause: subclinical infection and hypertrophic scarring. Hypertrophic scarring is thought to be secondary to a hematoma, seroma, or silicone gel bleed.

Surgical placement of the prosthesis in a retropectoral pocket has repeatedly been proved to decrease the risk of capsular contracture. This has led many surgeons to preferentially use the subpectoral plane.

Antibiotic irrigation of the implant pocket arose in response to the infectious theory of the cause of capsular contracture and the theory of biofilm as the genesis of capsular contracture.

Capsular contracture is corrected surgically by removing the capsule (anterior and posterior capsulectomy) and the implant is changed as a minimum treatment for first time capsular contracture formers. When patients form more than one capsule, acellular dermal matrices can be considered to reduce the risk of recurrent contracture in addition to capsulectomy and more form stable implants. Occasionally, the implants must be removed in severe cases or multiple recurrences that have been optimally addressed.

Dr. Hughes has performed hundreds of these difficult capsulectomy and capsular contracture revision cases, and he will give your best outcome.

implant rippling

Implant rippling occurs with time as the tissues are thinned by the implant in usually thinner patients.
Rippling may be observed in both saline and silicone implants. This may be more prominent in saline implants, but rippling usually occurs after a period of years after breast augmentation as the breast tissue is thinned by the implant.

Silicone is regarded to have less rippling. Implant rippling can be reduced with more form-stable implants. Gummy bear implants do not have the issues of rippling and should be considered for any patient who has rippling issues.

In some patients, a change of implants may be appropriate. However, changing the implant is frequently not enough, and the revision breast augmentation may require fat grafting (a form of natural breast enlargement that we offer) or placement of acellular dermal matrix to camouflage the implant.

animation deformity

This animation deformity can occur when scar tissue causes tethering of breast tissue, skin or fat to the gliding muscle plane as it moves over the implant. The treatment can involve scar release with interposition graft or matrix, change of planes for the implant, or repair of the pocket or muscle to prevent a contraction deformity.

patient testimonial

I got breast implants 2 years ago from another surgeon and have been very unhappy with them. They were different sizes, didn’t look right on my body, and he messed up the placement of one of my nipples. I finally got them redone with Dr. Hughes. I couldn’t be happier with the results. He is focused on his work above all else, which I respect. He is also concerned for the health and safety of his patients with aftercare. Thank you Dr. Hughes, I can’t wait until they are healed. I am finally thrilled with my breasts!

dermal matrices in breast augmentation revision

Complicated breast augmentations, particularly secondary, may require dermal matrix coverage. Revision augmentation that may require more soft tissue coverage from tissue thinning may be good candidates as well. Various types of dermal matrices exist that differ in intraoperative preparation, method of storage and price.


AlloDerm incorporates skin from a human cadaver that undergoes removal of the epidermis and other cells; this reduction in antigenicity provides for a negligible incidence of graft failure and tissue rejection. The resultant product is a biological acellular matrix that favors cell repopulation and rapid revascularization.

During the process of regeneration, Alloderm is incorporated into the pre-existing tissue in four stages: 1) Damaged tissue is targeted by circulating stem cells. 2) Once damaged tissue is located, stem cells are deposited and proceed to adhere to the matrix. 3) Differentiation into tissue-specific cell types occurs. 4) A new matrix is formed from the differentiated cells which allows for tissue regeneration.

AlloDerm has been commonly employed for wound coverage, fascial defect repair, and post-mastectomy breast reconstruction uses, but its indications are rapidly expanding into a multitude of areas in which soft tissue camouflage is required for contour defects.


Strattice is porcine dermis denuded of cells that contributes to the propagation of an antigenic response. Strattice is a reconstructive tissue matrix that supports tissue regeneration used primarily in implant-based/tissue expander reconstruction of the breast.


DermaMatrix is human skin in which both the epidermis and dermis are removed from the subcutaneous layer of tissue in a process utilizing sodium chloride solution while preserving the original dermal collagen matrix. This reduces the incidence of rejection and inflammation. Once DermaMatrix is transferred to the patient; the collagen matrix is infiltrated by the host cells promoting neovasularization and fibroblast deposition.

Acellular cadaveric dermis has remarkably lower levels of inflammatory parameters like capsule fibrosis, vessel proliferation, granulation tissue formation, fibroblast cellularity, chronic inflammatory changes, and foreign body giant cell inflammatory reaction than native breast capsules.

This suggests that acellular cadaveric dermis exhibits certain properties that may reduce formation of a capsule and therefore provides an excellent alternative to total submuscular implant placement.