NP Aesthetics
Revision surgery in Zurich
Revision surgery does not begin with a procedure, but with an understanding of the starting point: what was operated on before, how the anatomy presents today, how the scar tissue behaves, where an implant lies, what the capsule is like — and what can realistically be improved from this.
What does revision surgery mean?
A revision is any procedure that changes, corrects or reverses a result after a previous operation. This can be a correction of shape, the exchange or removal of an implant, the treatment of a capsular change, or the improvement of a scar situation.
A revision is not a judgement on the first operation. Tissue changes over the years, and even an initially good result can take on a different shape through pregnancy, weight change or ageing.
Why a second operation is planned differently
In a first operation, the tissue layers are untouched. After a previous operation, layers are scarred, the blood supply is altered, and the available skin quality is different. This restricts techniques, sometimes lengthens the operating time and shifts the risk assessment.
That is why a detailed medical history comes first: the number and type of previous operations, the course of healing, previous complications, symptoms, and your own assessment of the result so far.
Symptoms and findings after previous operations
Implant malposition
An implant can sit too high, too low, too far to the side or towards the middle. The cause is usually the shape of the implant pocket, less often a one-sided tissue weakness. The correction depends on whether the pocket must be narrowed, relocated or newly created.
Capsular contracture
A tissue capsule forms around every implant. If it hardens and shrinks, the shape, position and sometimes the sensation change; symptoms range from a feeling of tension to pain. The findings are assessed clinically and supplemented by imaging where necessary.
Implant rupture
A rupture can manifest as a change in shape, but can also exist without symptoms. If suspected, imaging is part of the assessment before a decision is made on how to proceed.
Asymmetry
Differences between the sides can pre-exist, have arisen through the previous operation, or have become more apparent over time. Before a correction, it is distinguished whether the cause lies in the tissue, the implant position or the rib cage.
Scars and tissue changes
Widened, retracted or distorted scars, as well as contour irregularities after liposuction or a lift, are findings in their own right. Scars can be relocated and improved in quality, but not removed.
Possible procedures
Implant replacement
Appropriate when volume is still desired and the change primarily concerns the size, position or condition of the implant. The exchange is often combined with a correction of the implant pocket or treatment of the capsule.
Implant removal
An option when foreign material is no longer desired or repeated procedures are a burden. The shape afterwards depends on the skin envelope, glandular volume and duration of implantation and is discussed beforehand.
Combination with a lift
If the skin envelope is wide, a lift can be performed in the same session or at a later date. With extensive previous operations or uncertain blood supply, a two-stage approach is safer.
Fat transfer as a supplementary option
Your own fat can soften contour irregularities and thin tissue coverage. It does not replace a larger volume; part of the transferred fat is broken down, and several sessions may be necessary. Suitable donor sites are a prerequisite.
Analysis of previous records
Operation reports, the implant passport, photographic documentation and earlier findings are part of the diagnosis. They reveal the technique, implant position, material used and the course so far. If records are missing, the findings are assessed clinically and, where indicated, supplemented by imaging.
What can realistically be improved
Frequently improvable: implant position, size ratio, the feeling of tension with capsular change, excess skin and the position of scars. Not restorable: the anatomy before the first operation.
Asymmetries can be reduced, rarely completely evened out. Scars remain visible. Tissue that has become thinner through previous operations is not made thicker again by a revision.
Risks and limitations
In addition to the general risks of surgery, wound healing problems, seromas, blood supply disturbances of the skin and nipple, and renewed asymmetries are more common in previously operated tissue. Capsular contracture can also recur. The likelihood of further corrections is higher than with a first operation and is discussed openly before the decision.
Recovery
The course depends on the extent of the procedure. After a straightforward implant replacement it is usually shorter than after a combination with a lift or an extensive capsular treatment. Swelling and changes in shape persist for weeks; the final assessment of the result takes place only after months.
When no further operation is the better option
With stable findings without symptoms, with very thin or repeatedly operated tissue, with expectations that cannot be met surgically, or shortly after the previous operation, waiting or observation can be the better path. A consultation can also end with this recommendation.
Costs and personal consultation
The medical consultation for surgical procedures costs CHF 250. If you subsequently book an operation with us, the consultation fee is credited in full against the price of the operation. Following the examination, you will receive an individual cost breakdown that clearly states which services are included.
Frequently asked questions
How long should one wait after the previous operation?
With stable findings and no symptoms, it is usual to wait until swelling and scar maturation are largely complete, because the shape continues to change until then. With acute symptoms this does not apply — then an examination takes place promptly.
Are records of the previous operation needed?
The operation report, implant passport and earlier findings make the assessment considerably easier, because they reveal the technique, implant position and material used. If they are missing, the findings are assessed clinically and, where necessary, with imaging.
Can the state before the first operation be restored?
No. Tissue, scars and anatomy have changed. A revision works with today's starting point and improves certain aspects; it does not restore an earlier state.
Is a revision riskier than the first operation?
Previously operated tissue has a poorer blood supply and is scarred; tissue layers are less clearly distinguishable. Wound healing problems and further corrections are therefore more common than with a first operation. The extent depends on the individual findings.
Can every asymmetry be corrected?
No. Asymmetries can often be reduced, but not completely eliminated; differences between the sides in tissue, scars and the rib cage remain.
Treating physicians
- Dr. med. Michael W. Payne
Specialist in Plastic, Reconstructive and Aesthetic Surgery
- Dr. med. Dr. Phil. Annemarie Nijboer
Specialist in Surgery
A good decision begins with a conversation.
The initial consultation is about clarification, not selling. It does not necessarily end with a surgery date — often it brings the realisation that a different approach, or no procedure at all, is the right choice.
The consultation process
- 01
Discussion
We listen to your concerns, medical history, expectations and what you would like to change about your appearance.
- 02
Examination
A careful clinical examination and assessment of your underlying anatomy.
- 03
Options
Possible procedures, alternatives, limitations and risks — explained clearly and without time pressure.
- 04
Time to reflect
You decide in your own time. Any outstanding questions can be addressed in a further consultation.
Request a consultation
Leave your contact details. Our practice team will call you back during practice hours to arrange a consultation at Klinik Selnau.