Expert guide: Aesthetic & Cosmetology 2015 26 June 2015 June 2015 27 Despite all of the best efforts of the plastic surgeon, sometimes results are suboptimal. When expectations are not met, it is best to address them by trying to determine the cause of the complication to solve the pa-tient’s problem(s) and minimise the risk of them occurring in the future in other patients.Patients who present for revision breast augmentation generally have high expectations to fix the problem. Unfortunately, sometimes prob-lems are not completely correctable. Therefore, extensive pre-operative counseling and discussion regarding reasonable expectations is of the ut-most importance. Acellular dermal matrices (ADM) and meshes have enabled plastic sur-geons to address complex problems in revision breast augmentation such as thinned tissues, fold malposition and capsular contracture. It pro-vides additional thickness and cover-age to minimise implant palpability and supports the implant to prevent bottoming out or rippling.7 It is also prevents the implant from migrating into a previous pocket when chang-ing the implant from the subpectoral position to the subglandular posi-tion or vice versa. Of added benefit, ADM has also been shown to reduce the rate of capsular contracture. It is the hope that the concepts raised in this article will motivate all plastic surgeons to continue to strive to reduce the rate of revision breast augmentation and for patients to un-derstand some of the complex issues involved in achieving the desired re-sult from a breast augmentation.USA 1. Hedén, Per. “Breast Augmentation with Anatomic High-Cohesiveness Silicone Gel Implants (European Ex-perience).” Chapter 115, pages 1322-1345 in Surgery of the Breast: Principles and Art. Third edition. Scott L. Spear, editor. Wolters. 2011.2. Bengston, Bradley P. “The Highly Cohesive, Style 410 Form-stable Gel Implant for Primary Breast Augmen-tation.” Chapter 116, pages 1346-1365 in Surgery of the Breast: Principles and Art. Third edition. Scott L. Spear, editor. Wolters. 2011.3. Jacobson JM, Gatti ME, Schaffner AD, Hill LM, Spear SL. “Effect of Incision Choice on Outcomes in Primary Breast Augmentation.” Aesthetic Surgery Journal. May 2012. Volume 32(4): 456-462.4. Spear SL, Bulan EJ, Venturi ML. “Breast Augmentation.” Plastic and Reconstructive Surgery. 114: 73e-81e, 2004.5. Tebbetts, J. B. Dual plane breast augmentation: Optimizing implant–soft-tissue relationships in a wide range of breast types. Plast. Reconstr. Surg. 107: 1255, 2001.6. Adams, WP, JL Rios; SJ Smith, Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery Using Triple Antibiotic Breast Irrigation: Six-Year Prospective Clinical Study Plastic & Reconstructive Surgery January 2006; 117(1): 30-36.7. Maxwell GP and A Gabriel. “Use of the Acellular Dermal Matrix in Revisionary Aesthetic Breast Surgery.” Aesthetic Surgery Journal November-December 2009; 29(6):485-93.