Breast Revision Surgery in Beverly Hills | Dr. Daniel Golshani

Every breast surgery, whether augmentation, lift, or reduction, produces changes in the breast tissue that cannot be reversed. The pocket that was created for an implant leaves an anatomical space. The capsule that formed around the implant is scar tissue with its own structural behavior. The skin and glandular tissue that were repositioned during a lift have healed in their new configuration and will behave differently during a secondary procedure than they would have in a virgin breast. The incisions from the original surgery created scars that, depending on their quality and the tension under which they healed, may be adherent, distorted, or hypertrophic.

This altered surgical environment changes everything about the approach to revision. The dissection is more complex because the anatomical planes have been disrupted. The tissue is more fragile because it has already been stretched, repositioned, or resected once. The predictability of healing is reduced because scar tissue heals differently from native tissue. And the margin for error is smaller, because a second operation on a breast that has already been altered has less latitude to compensate for intraoperative surprises than the original procedure did.

This is the reason that breast revision consistently carries higher complexity and higher demands on surgeon skill than primary breast surgery, and why the selection of the surgeon performing a revision is arguably more important than the selection of the surgeon for the original procedure.

The Reasons Patients Present for Breast Revision

Understanding what went wrong, precisely and anatomically, is the foundation of every breast revision plan. Dr. Golshani approaches every revision consultation with a systematic assessment of the presenting concern before any surgical decision is made.

Capsular contracture. The fibrous capsule that forms around every breast implant thickens and contracts in some patients, producing the firmness, distortion, and pain of Baker Grade III or IV contracture. Revision for capsular contracture requires not simply removing and replacing the implant but addressing the capsule itself, and in many cases the technique used in the original augmentation, with comprehensive capsulectomy, pocket modification, and implant replacement in a corrected anatomical position.

Implant malposition. An implant that has shifted from its intended position, whether inferiorly to produce a bottomed-out appearance, superiorly to sit too high on the chest wall, laterally to migrate toward the armpit, or medially to produce synmastia where the two implants touch or cross the midline, requires correction of the pocket itself rather than simple implant exchange. The pocket that allowed the malposition must be repaired internally to ensure the replacement implant sits correctly and stays there.

Bottoming out. One of the most common and most anatomically significant breast revision presentations, bottoming out occurs when the inframammary fold descends and the implant migrates below the lower breast border, placing the nipple in a position that appears too high relative to the breast mound. Correction requires reconstruction of the inframammary fold and internal pocket support to hold the fold in its correct anatomical position, which is precisely where the internal bra suspension technique and acellular dermal matrix play their most significant role.

Symmastia. Symmastia, the convergence of the two implant pockets across the midline, produces the appearance of a single fused breast mound with no cleavage separation. Correction requires meticulous closure of the medial pocket walls and reconstruction of the midline anatomical barrier, supported by internal suturing techniques and, in some cases, the use of acellular dermal matrix to reinforce the closure.

Implant size change. Patients who want to increase or decrease their implant size require a surgical approach calibrated to the change. Increasing size may require pocket expansion. Decreasing size requires pocket tightening, which without internal support will result in the smaller implant failing to fill the existing pocket correctly, producing wrinkling, rippling, and an unnatural appearance.

Implant rupture. A ruptured or deflated implant requires removal and replacement with careful attention to the condition of the capsule and surrounding tissue. Silicone gel rupture with migration beyond the capsule requires capsulectomy as part of the revision plan.

Implant rippling and visibility. In thin-tissue patients, the edge or surface texture of the implant may be visible or palpable through the overlying skin. Correction options include implant exchange for a device with better surface characteristics, conversion from subglandular to submuscular placement, and fat grafting over the problematic zone to add soft tissue coverage between the implant surface and the skin above it.

Revisional mastopexy. Patients who have had a breast lift with recurrent ptosis, early descent of the lifted tissue, or a scar that has widened, migrated, or failed to heal satisfactorily may present for revisional mastopexy. These cases are addressed through the multiplanar scar revision approach, which corrects the scar at multiple tissue depths rather than simply excising and re-closing the surface.

Dissatisfaction with aesthetic outcome. Some revision patients have no complication in the clinical sense. Their implants are intact, their tissue is healthy, and their surgeon did what they planned. The result simply does not look the way the patient hoped, whether because of a size that does not suit their frame, a shape that does not match their anatomy, asymmetry that was not adequately addressed, or an aesthetic outcome that did not translate from the consultation to the healed result. These patients require a revision plan that addresses the specific aesthetic deficit while working within the anatomical context that the prior surgery created.

The Advanced Techniques That Define Dr. Golshani’s Breast Revision Approach

This is what separates a breast revision performed at the level this procedure demands from one performed as a simple repeat of the original surgery. Dr. Golshani employs a specific set of advanced techniques in revision cases, selected based on what the patient’s anatomy and presenting concern require.

Multiplanar Scar Revision

Scar tissue in the breast after implant surgery is not a single-layer phenomenon. The capsule around an implant is the most visible component, but fibrosis and scar tissue formation occur across multiple tissue planes: within the capsule itself, between the capsule and the overlying breast tissue, in the skin incisions from the original surgery, and within the glandular tissue that was repositioned or displaced by the primary procedure.

Multiplanar scar revision addresses this reality by working across all involved tissue layers simultaneously rather than addressing only the most obvious component. The capsule is managed according to the degree of involvement, from partial to total to en bloc removal depending on the anatomy. The fibrotic adhesions between planes are released precisely. The skin scars from the original incisions are revised through techniques that address both the dermis and the deeper soft tissue, not simply the visible surface. And the breast parenchyma is repositioned within the revised tissue architecture to establish a correct anatomical foundation before the closure is performed.

The result is a revision that does not simply address the surface presentation of what went wrong. It addresses the multi-layered tissue reality that produced it.

Internal Bra Suspension

One of the most significant limitations of traditional breast surgery is the reliance on the skin envelope to provide long-term structural support for the breast mound. The skin, as discussed in the context of mastopexy, has no structural memory. It stretches. It relaxes. And in revision cases where the original procedure has already compromised the skin envelope’s integrity, asking it to bear the structural load of a corrected breast position is asking it to do something it was not designed to do.

Internal bra suspension is a technique in which permanent or long-lasting internal sutures are placed within the deep breast tissue and anchored to the overlying fascia and, in some cases, the chest wall, creating an internal scaffolding that holds the breast in its correct position independently of the skin envelope above it. The skin is then closed over this internal support system with minimal tension, protected from bearing the structural responsibility that produces early recurrence of malposition, bottoming out, and ptosis.

Internal bra suspension is particularly valuable in revision cases where the inframammary fold requires reconstruction, where bottoming out needs to be corrected and prevented from recurring, where the implant pocket requires reinforcement after pocket modification, and where the tissue envelope has been weakened by prior surgery and cannot provide adequate support through tissue sutures alone.

Acellular Dermal Matrix

Acellular dermal matrix, commonly referred to as ADM, is a biological mesh derived from processed donated human or animal skin that has had all cellular components removed, leaving a collagen scaffold that the body’s own cells can grow into and integrate as native tissue over time. In breast surgery, ADM is used as an internal tissue reinforcement material where the patient’s own tissue is insufficient to provide the structural support required.

In breast revision specifically, ADM is indicated when the native breast tissue is too thin or too weakened from prior surgery to hold sutures reliably, when the inframammary fold requires reinforcement that internal sutures alone cannot achieve durably, when the implant pocket has been compromised by contracture, malposition correction, or repeated surgery in ways that leave inadequate tissue for stable closure, and in cases of symmastia correction where the medial pocket closure requires biological reinforcement to maintain its integrity against the outward pressure of the implants.

ADM integrates with the surrounding tissue over months following surgery, eventually becoming vascularized and behaving as the patient’s own tissue. It provides both the immediate structural reinforcement needed at the time of surgery and the long-term biological integration that makes the repair durable over years rather than weeks.

Autologous Fat Grafting with G-Stem

Structural correction addresses position and support. It does not address the softness, the natural contour, and the tissue quality that distinguish a breast revision result that looks genuinely natural from one that looks merely corrected.

Autologous fat grafting using Dr. Golshani’s proprietary G-Stem technique restores this dimension. Fat harvested from the patient’s own body, processed to concentrate the regenerative adipose-derived stem cells, and placed with precision in the specific zones where the structural revision leaves the breast insufficiently covered or inadequately volumized, provides the soft tissue layer that naturalizes the result in a way that no other component of the revision plan can.

Common fat grafting targets in breast revision include the upper pole where an implant sits too close to the surface in thin-tissue patients, the lateral border where the implant edge is palpable or visible, the medial zone where volume restoration improves cleavage quality and symmetry, and any areas where the original surgery produced a contour irregularity that structural revision alone does not smooth.

The G-Stem technique’s regenerative component adds an additional dimension: improved tissue quality and skin health in the grafted zones, contributing to the overall naturalness of the result in a way that extends beyond volume alone.

Breast Revision and Insurance Coverage

Breast revision surgery, like breast implant removal, occupies a position where insurance coverage can apply to the medically necessary components of the procedure. The same qualifying presentations that support insurance authorization for implant removal frequently apply to revision: documented capsular contracture causing pain and functional limitation, implant rupture, implant malposition with documented symptoms, and revision of reconstruction-related complications. The elective aesthetic components of revision surgery are generally not covered.

Dr. Golshani’s team assists qualifying patients through the insurance documentation and pre-authorization process, including the preparation of clinical letters of medical necessity and support through appeals when initial authorization is denied.

When Breast Revision Is Part of a Larger Plan

Breast revision rarely exists in isolation from the broader breast and body context:

• Breast Implant Removal and Capsulectomy as the foundational component of revision cases involving rupture, significant contracture, or explantation with immediate revision
• Breast Lift and Multiplanar Mastopexy when ptosis or skin laxity accompanies the implant-related concerns, addressing both the structural implant correction and the tissue repositioning in the same surgical plan
• Fat Transfer to Breast with G-Stem as the volume and contour refinement component integrated into the revision plan
• Nipple and Areolar Reduction and Reconstruction when the nipple-areola complex has been affected by prior surgery or its healing
• Breast Reconstruction for patients whose revision involves reconstructive breast surgery following oncological treatment

The Standard Applied to Every Breast Revision

The most reliable indicator of a technically excellent breast revision is a result that does not look like a revision at all.

Not a breast that looks corrected after having looked wrong. Not a breast that shows the evidence of multiple surgeries in its shape, its scars, or its behavior. A breast that looks like it was always supposed to look this way, positioned correctly on the chest wall, soft and natural in feel, proportionate to the frame it belongs to, and without a single element of the result that announces the complexity of what it took to get there.

That standard is harder to achieve in revision than in primary surgery precisely because the starting point is more challenging. It requires more surgical depth, more technical versatility, and more precise anatomical judgment than any primary breast procedure. Dr. Golshani approaches every breast revision with exactly that level of commitment, because the patient presenting for revision has already been through surgery once and deserves, unequivocally, to leave with the result they were looking for the first time.