BACKGROUND: Patient motivations for revisionary breast surgery following breast augmentation, mastopexy-augmentation, and breast reduction are often overlooked. Most patients presenting for a revision do so because they desire a subsequent improvement in their appearance or wish to correct a problem resulting from the primary operation. OBJECTIVE: We present and analyze the clinical indications for revisionary breast surgery in a series of 134 consecutive cases. METHODS: We retrospectively reviewed the charts of 134 patients who underwent revisionary breast surgery in a single clinic from 1994 to 2009. Patients were grouped based on operative procedure: augmentation (n = 110), mastopexy-augmentation (n = 10), bilateral breast reduction (n = 15), breast malformation correction (n = 1). Three categories were also specified according to the cause for secondary surgery: (1) the surgeon's operative plan was flawed and/or involved a technical error, (2) an independent factor occurred such as ptosis or capsular contracture, or (3) there was a combination of both factors. RESULTS: The most frequent reasons for revisionary surgery among aesthetic implant patients were the development of ptosis (42%), capsular contracture (29%), and lower-pole deformities (19%). Twenty-six percent of patients had a combination of problems. Revision among breast reduction patients was due to volume loss from overresection (40%), nipple-areola loss (27%), and breast asymmetry (27%). The average time between the first surgery and reoperation was 8.9 years for augmentation, 4.3 years for mastopexy-augmentation, and 2.9 years for reduction. In implant patients, the biggest problem leading to revisionary surgery was natural progression (66% augmentation, 90% mastopexy-augmentation). However, among breast reduction patients, 73% of revision requests were a result of problems with surgeon judgment or technique. CONCLUSIONS: Our study demonstrates that although the rate of surgeon-specific problems was high in reduction patients, overall, independent factors were the primary reason patients sought revisionary breast surgery. This may be contrary to commonly held beliefs that attribute poor results and revision requests to incorrect surgical technique and erroneous surgical decision making.