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Breast Implant Revision
Breast Augmentation: Replacing or Revising Saline and Silicone Breast Implants

Dr. Raffy Karamanoukian, a Board Certified Plastic Surgeon, is a Breast Augmentation expert on Realself. He is available for consultation for the most complex breast implant revision surgeries, including breast implant capsular contracture, breast implant rupture, breast implant exchange, synmastia, saline to silicone exchange, and breast implant capsulectomy.  

Breast implants have a finite lifespan, which means that they will not last forever in your body.  If you had your breast implants placed in your twenties, chances are you will have at least one breast implant revision surgery in the future.  Breast implant revision surgery is designed to enhance the look and feel of your breast implants in the setting of normal aging, breast droopiness, capsular contracture, breast implant rupture, or implant malposition.  There are many reasons for women to seek breast implant revision, the most important of which is that you are simply not happy with the shape, size, and look of your breast implants.

Breast revision requires meticulous surgical technique in order to achieve a natural breast shape while correcting problems such as implant rupture, capsular contracture, and implant malposition.  During your initial consultation, Dr. Karamanoukian will discuss options for implant replacement or natural correction without implants.  Most surgeries for the breast are performed on an outpatient basis in an ambulatory surgical suite located in Beverly Hills or Santa Monica. 



  1. Volume Adjustment: Patients may request to enlarge or downsize their saline or silicone breast implants.
  2. Saline to Silicone Exchange: Change saline breast implants to silicone to improve rippling or feel of the breasts.
  3. Capsular contracture correction: Improve or repair breast hardening.
  4. Implant malposition: To achieve more breast symmetry.
  5. Breast Implant rupture: Exchange a breast implant.
  6. Synmastia: Connection of the two implants in the midline.
  7. Combined Breast Lift: Revising breast implants to match a concurrent breast lift / mastopexy.
  8. Older Implants: If your breast implants are older and there is a chance of a silent breast implant rupture.

Breast augmentation is an outstanding procedure for volume enhancement of the breasts.  In some cases, capsular contracture or variations in how the breast implant 'settles' inside the breast pocket can affect symmetry of the breasts.  If you feel that your breasts are not symmetric in terms of shape, size, or volume, you may be a candidate for a revisional type breast surgery in which the breasts implants are exchanged or the breast tissue tailored to achieve that symmetry.

It is not uncommon for women to 'change their mind' about the size of their breast implants.  This decision can come soon after undergoing breast augmentation, or years later as a result of changes in one's lifestyle or activity level.  Some plastic surgeons will be judgemental about this decision, but Dr. Raffy Karamanoukian believes that since this is an easily correctable decision, it is reasonable that some women will decide to upsize or downsize their implants.  

Choosing the right size breast implant is an important decision and should be made with the advice of close family members or friends.  Dr. Karamanoukian will help you decide on the size of your implants based on mathematical factors including breast width, dimension, volume, and contour.  However, other factors such as patient preference and lifestyle also play an important role.  

If you are considering changing your breast implant size, Dr. Karamanoukian will provide you with a dimensional analysis of your breast size to help you make the right decision.  Changing breast implant size, whether saline or silicone, should not be stressful and can be a truly enhancing decision on your part. 

An important consideration in downsizing breast implants is whether a breast lift is necessary to tailor the entire breast around the new implant. This is not necessarily an issue when upsizing breast implants, but occurs when reducing the volume and dimension of your breast implants.  


Synmastia is a very difficult problem to treat and many women do not know that they have it until it is pointed out by someone they know. Synmastia occurs when the implants are placed too close to one another in the chest midline, causing them to connect into one mound. Synmastia can occur as an early complication if the implant pockets are connected during surgery, or as a late complication because of trauma or gradual weakening of the connective tissue overlying the midline sternum.

Dr. Raffy Karamanoukian performs breast implant revision for a number of different reasons including a lesser known condition known as synmastia (symmastia) which is an iatrogenic breast implant problem caused by medial placement of the breast implants along the chest wall.  Dr. Karamanoukian is a board certified plastic surgeon specializing in cosmetic plastic surgery, including facelifts, rhinoplasty, breast augmentation, breast lifts, breast reduction, breast revision, liposuction, and tummy tuck surgery. 


In some cases, the bilateral breasts connect to form a single unit and obliterate the sternal edge of both implants.  In other words, in synmastia, the breasts seem to merge into one unified breast implant along the midline chest.  Cases of synmastia can be so severe that one implant can actually be transposed into the contralateral site.  Usually these cases are difficult to treat and are caused by overaggressive surgical dissection of the medial side of the breast implant pocket.


In cases of synmastia, the overall goal is to separate the breast implants and the breast along the midline.  This is done by careful dissection of the area and anatomically-placed sutures along the most medial breast implant pocket to separate the breast implants.  This surgery is done under general anesthesia and often requires downsizing of the implant or changing of the implant shape or style.  After synmastia surgery,  patients will often do better with a more higher profile breast implant that lateralizes the breast implant so they do not meet in the midline.  Synmastia surgery is technically demanding and requires thorough preoperative planning for breast implant revision surgery.  Dr. Raffy Karamanoukian provides his expertise in this procedure and is often asked to consult on patients with synmastia.

Synmastia is characterized by midline displacement of the breast implants along the most medial border of the pocket. Correction of synmastia can be performed by changing the pocket from subglandular to submuscular and Dr. Karamanoukian can also employ a new technique the use the tissue capsule to reposition the breast implants more laterally on the chest wall.  Dr. Karamanoukian's experience with synmastia repair will allow you to regain a more natural cleavage line with saline or silicone breast implants.

Breast revision requires meticulous technique to correct results of previous breast surgery such as breast augmentation, breast lift, breast reduction, and breast capsular contracure repair.  Unlike primary breast surgery, breast revision demands a more thorough preoperative evaluation to identify healing patterns that may impact longterm aesthetic results. Dr. Karamanoukian specializes in breast revision surgery, sometimes referred to as corrective breast surgery, in his Los Angeles plastic surgery office. During your preoperative consultation, Dr. Karamanoukian will provide your with options for correction that may or may not require breast implants.  In addition, newer options for scarless or minimally-invasive breast surgery are offered to accomodate those patients who wish to maintain the natural shape and contour of their breasts. 


  1. What is synmastia? Synmastia occurs as a complication of overaggresive breast implant placement in which the medial part of the breast implant pocket is connected over the sternum.  This leads to a connection between the right and left breast that can be seen on the surface in patients.  In more severe synmastia, there is an actual connection between the two breast implant pockets, yielding a common tunnel where the breast implants connect in the midline. Synmastia can be repaired using several different types of procedures to separate the two breast implant compartments.
  2. How does breast implant rupture occur? The exact mechanism of breast implant rupture is not clear in all cases.  However, it is thought that most ruptures occur as a result of blunt trauma or pressure increases; or a gradual wearing of the external lining of the breast implant.  Both saline and silicone breast implants can rupture prematurely.  Dr. Karamanoukian can provide you with expert recommendations regarding your options for treatment.  Most cases will require a breast implant revision to correct the asymmetry and rupture. 

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