Top Surgery Revision
A revision is a second, smaller operation to fix something the first one left behind. For top surgery that usually means a dog ear of loose skin at the end of a scar, a scar that has widened, a nipple that sits a little off, or a dip or bulge in the contour. Occasionally it means something bigger, when a small-scar technique has left skin that never tightened and the chest needs the operation it should have had first time.
Revisions are common enough that you should plan for the possibility rather than treat one as a failure. Surgeons' own figures put the share of people who have some kind of touch-up anywhere from one in ten to one in four, depending on the technique and how you count.
I would say the useful mindset is this. The first operation gets the chest flat. The revision, if there is one, gets it finished. Most are quick, most are done under local, and most people wish they had stopped worrying about it sooner.
At a glance
- Also known as
- Secondary top surgery, scar revision, dog ear removal, nipple revision
- Surgery time
- 30 minutes to 2 hours; longer for a full conversion
- Anaesthesia
- Local for small fixes; general for larger ones
- Hospital stay
- Outpatient
- Back to work
- A few days to 1 week
- Full recovery
- 2–6 weeks depending on what was done
- Scar
- Usually within the existing scar line
- Sensation
- Unchanged by minor revisions
- Typical cost
- $0–$5,000 minor; up to full price for a conversion (United States, self-pay)
Figures reviewed .
On this page
Who it’s for
Anyone whose result has settled and still has something that bothers them. The key word is settled. Swelling, scar redness and nipple puffiness all change for months, and a good surgeon will not revise anything before six months, often a year, because half of what people want fixed at three months has fixed itself by twelve.
The common reasons, roughly in order. Dog ears at the outer end of a double incision scar. A scar that has stretched wide or thickened. Nipples that are uneven, too large, too high or too low.
A contour dip or bulge at the sides or in the middle. Loose skin after peri-areolar or keyhole. Tissue left behind after keyhole. A puffy areola after buttonhole.
Nicotine rules apply exactly as they did the first time. See eligibility.
Before you decide anything
Wait until the one-year mark, or six months at the very least, and compare your monthly photos side by side. A surprising amount of what bothers people at month three is gone by month twelve, and no surgeon will touch it earlier anyway.
How it’s done
Most revisions are minor and done under local anaesthetic in an office or clinic. A dog ear is cut out and the scar extended by a couple of centimetres. A wide scar is cut out and re-closed.
A nipple is trimmed, or lifted and re-stitched. A contour dip is treated with a small amount of fat grafting or liposuction of the area next to it. These take under an hour and you walk out afterwards.
Major revisions are a different thing. Converting a failed peri-areolar or keyhole into a double incision is a full second top surgery, under general anaesthetic, with the same recovery as the first. Moving a nipple a long way, or replacing a failed graft, is somewhere between the two.
Which category you are in decides everything else on this page, so ask the surgeon to be specific about what they are proposing and what it involves.
Before you agree
Ask whether the revision is local or general, and whether it happens in the office or in theatre. The answer tells you whether this is an afternoon or a second surgery, and it changes what you should expect to pay.
Revision recovery
For a minor revision, almost nothing. Local anaesthetic wears off in a few hours, there is some soreness for a few days, stitches come out or dissolve in about two weeks, and you avoid stretching the area for a month. Most people work the next day.
For a conversion or a large nipple revision, expect the recovery you had the first time, drains and vest included. Scars from a revision fade on the same 12–18 month timeline as the originals, so the finished result is a year away again.
| Day 0 | Minor: home within the hour, local anaesthetic wearing off. Major: same as first surgery. |
|---|---|
| Days 1–3 | Minor: soreness, small dressing, back to normal life. Major: drains and vest. |
| Week 2 | Stitches out or dissolved. Minor revisions largely forgotten by now. |
| Weeks 4–6 | Stretching and lifting allowed again. Major revision: vest off. |
| Months 3–12 | New scar segment reddens then fades on the usual timeline. |
After a minor revision
Treat the new bit of scar like it's day one again: silicone gel from week three, sun off it for a year. It's a small area, so it's easy to forget, and it's the bit that will look freshest for the longest.
Revision scars
Minor revisions almost always work within the existing scar. A dog ear removal extends the line by a few centimetres at the outer end. Cutting out a scar replaces a wide, thick line with a thin fresh one along the same path. Nipple work stays inside the areola border.
The fresh segment goes through its own red-and-raised phase while the rest of the scar is already pale, so for a few months you can see where the revision was. It catches up. Silicone gel and sun protection apply to the new bit as they did to the original.
Risks and complications
For minor revisions the risks are small and local. A little bleeding, a small infection, a scar that does not settle as well as hoped. Numbness around the revised area for a few weeks is normal.
Major revisions carry the full set of first-surgery risks again. Hematoma, seroma (fluid under the skin), infection, and for anything involving the nipple, a second chance at graft failure or reduced sensation. The specific risk of revisions as a category is disappointment. Some things, like a scar that thickens because of your skin type, may come back after being revised, and a good surgeon will tell you which fixes are likely to hold and which are not.
Revision results
For the common fixes, the result is the chest you were expecting the first time. Dog ears go, scars thin, nipples match. It is not dramatic, which is the point; a good revision is one nobody notices.
For a conversion, the result is a double incision chest with a slightly more complicated scar history, and the small-scar result you originally hoped for is gone. That is worth understanding before choosing a technique in the first place, and it is why this site keeps mentioning revision rates on the technique pages.
Alternatives to revision
The alternative to a revision is living with it, and for small asymmetries and mild dog ears that is a reasonable choice, especially after a year when the scar has faded. A second option for scars specifically is non-surgical treatment, steroid injection for a thick scar, laser for colour, which a dermatologist or the surgeon can do without another incision.
For loose skin after a small-scar technique there is no alternative that works. The skin does not tighten on its own after the first six months.
Revision cost
This is where the surgeon's policy matters more than the price list. Many top surgery practices include one minor revision in the first year in the original fee, and charge only the facility or anaesthetic cost. Others charge a reduced surgeon's fee. A few charge full price for everything. Ask before the first surgery, not after, and get it in writing.
A conversion from peri or keyhole to double incision is a second full operation and is usually priced as one, sometimes with a discount from the original surgeon. Insurance varies. Some plans cover revisions as part of the original approval; many treat them as new claims.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Many practices include one minor revision in the first year; ask before the first surgery | $0–$5,000 minor; up to full price for a conversion | Sometimes covered under the original approval; often a new claim |
| Thailand A revision means a second trip; some hospitals include minor fixes if you are still in the country | $500–$3,000 minor | Self-pay only for international patients |
Choosing a revision surgeon
For a minor revision, go back to the original surgeon. They know what they did, they usually have a revision policy that works in your favour, and they have an interest in the result looking good. Revisions by a different surgeon happen mostly when the relationship has broken down or the first surgeon is far away.
For a conversion after a failed small-scar technique, it is worth a second opinion, because the surgeon who chose the wrong technique once may not be the one to fix it. The question I would ask any surgeon proposing a revision is what specifically they expect to change, and what they expect to stay the same. Vague promises of improvement are the wrong answer.
At your follow-up
Bring a short list of exactly what bothers you, in order, and ask which items are fixable, which will settle, and which you would be better leaving. You want three separate answers, not a general reassurance.
Frequently asked questions
How common is a revision after top surgery?
Common enough to plan for. Between one in ten and one in four people have some kind of touch-up, depending on the technique. Small-scar techniques have higher rates than double incision. See who it's for.
When can I have a revision?
Not before six months, and most surgeons prefer a year. The result keeps changing until then, and a lot of what looks wrong early fixes itself.
Will my revision be free?
Depends entirely on the surgeon's policy. Many include one minor revision in the first year; some charge facility costs only; a few charge full price. Ask before the first surgery. See cost.
Can a failed peri-areolar be fixed?
Yes, but the fix is usually a double incision, which means the small-scar result is gone. That is the main reason to be honest about candidacy for peri in the first place.