A meaningful share of the breast work at Southwest Plastic Surgery in El Paso is revision, not first-time augmentation. Patients arrive years after surgery done elsewhere and describe a familiar set of changes. One breast riding high. A new firmness. A feeling that the implant has shifted. Or simply the milestone of a decade passing and the wish for an update.
Dr. Frank Agullo treats these as mechanical problems with mechanical solutions. Here is how he explains the most common ones.
What a High, Firm Breast Often Means
When a patient describes one side sitting high and feeling firm, almost like a lump, it is usually a capsular contracture.
Whenever an implant is placed, the body forms a capsule of scar tissue around it. That is normal and helpful, because it keeps the implant in position. Sometimes, though, the capsule tightens and hardens, driven by inflammation or an old low-grade infection, and it pulls the implant high and firm. When the contracture is severe it can hurt, so the absence of pain is a good sign. It can appear long after the original surgery, which often surprises patients.
How Dr. Agullo Repairs It
The repair is more than an implant swap. Dr. Agullo removes the hardened capsule, takes out the old implant, and places a new one. When the patient is switched to a Motiva implant, the risk of recurrence drops below one percent, because the Motiva nano-surface provokes a much lower inflammatory response.
To lower the risk further, he often places a mesh, an internal-bra layer of support, over the area, which brings recurrence close to zero. If a patient wants to change size at the same time, that is usually possible through the same incision.
A Quick Guide to Revision Decisions
| What a Patient Notices | What It Often Means | The Usual Approach |
|---|---|---|
| One side high and firm | Capsular contracture | Remove capsule, exchange implant, often add mesh |
| Implants past ten years | Older-generation wear | Exchange to Motiva, reassess size and position |
| New asymmetry over weeks | Worth imaging first | Ultrasound or MRI, then a plan |
| Multiple prior surgeries | Disturbed tissue planes | Careful planning, honest expectations |
Old Implants and Multiple Past Surgeries
If a patient is at the ten-year mark with older-generation implants, an exchange is reasonable, and it is a good moment to reassess size and position. Dr. Agullo often recommends moving to a Motiva, which lasts longer and carries far less contracture risk.
A long surgical history does not close the door. Dr. Agullo treats patients whose first operation was decades ago with several since. More history simply means more careful planning and an honest conversation about what is realistic.
Why the Implant Surface Matters
When patients ask why a Motiva exchange lowers the recurrence rate so much, the answer is the surface. The Motiva implants have a nano-surface called SmoothSilk that provokes the lowest inflammatory response of any implant. Capsular contracture is fundamentally an inflammatory problem, since the capsule hardens because the body keeps reacting to the implant over time. When the implant barely provokes a reaction, the capsule that forms stays soft and thin. That is the mechanism behind a sub-one-percent recurrence rate, and it is why Dr. Agullo rarely puts an older-generation implant back during a revision.
A Revision Is Often an Upgrade
Many patients arrive bracing for simple damage control and are surprised to learn a revision is often a chance to end up with a better result than the original. The Motiva implants are soft, the gummy bear type, and move with the body, settling into a natural teardrop shape when a patient stands. While correcting the contracture, Dr. Agullo can also address a size the patient never loved, a position that sat too high, or an asymmetry that was present from the beginning, usually through the same incision.
Recovery From a Revision
Recovery varies more than a first-time augmentation, because the work inside is more involved. A straightforward implant exchange often recovers within a week of feeling close to normal, while a full capsule removal with mesh support is a larger operation that asks for a more careful few weeks. Dr. Agullo gives each patient a realistic timeline after examining them and reviewing imaging, and the practice offers post-surgical massage to support comfort and healing as recovery progresses.
Imaging and Combining Procedures
If a patient feels a change, an ultrasound or MRI helps confirm whether the implants are intact and whether the issue is a contracture, scar, or something needing more attention. Dr. Agullo reviews imaging before making a plan. A firm, high, or newly asymmetric breast, especially a change over a few weeks, is worth an evaluation.
If the breast has dropped, a breast lift can be combined with the revision. For comfort and healing afterward, the practice offers post-surgical massage as recovery progresses.
About Dr. Frank Agullo
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, completed a plastic surgery fellowship at the Mayo Clinic, and has been a Castle Connolly Top Doctor for thirteen consecutive years. He is also a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Revision is harder than a first augmentation because the tissue planes are already disturbed, which is why he plans it carefully rather than rushing.
See the Other Versions
For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing question-and-answer version, see the companion post on agulloplasticsurgery.com.
Ready to Talk?
If something feels high, hard, or out of place, do not wait. Bring any prior records and come in to Southwest Plastic Surgery.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.
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