Objectives/Hypothesis To determine the incidence of cochlear implant failure and to examine surgical and audiological outcomes. Study Design Retrospective review, case series. Methods This study sought indications for revision surgery, surgical findings, and outcomes, and audiological outcomes in pediatric cochlear implant patients. Pre‐ and postcochlear reimplantation word recognition performance was analyzed using a modified version of the Pediatric Ranked Order Speech Perception (PROSPER) score. Results Over a 20‐year period, a total of 868 cochlear implants were performed in 578 patients. The overall institutional reimplant rate was 5.9%. The indications for explantation were hard failure (30), soft failure (23), and medical/surgical indication (13). A significant portion of devices belonged to vendor recalled batches (15) or were damaged by head trauma (eight). Full electrode insertion was achieved in all 62 reimplantations. Post‐reimplantation Boston Children's Hospital modified PROSER scores were either stable or improved compared to pre‐reimplantation scores. Conclusions The need for cochlear implant revision/reimplantation is infrequent, but the rate is not inconsequential. Hard and soft device failures account for the majority of reimplants. Surgical complications during reimplantation is low, and post‐reimplantation audiological performance is excellent. Level of Evidence 4. Laryngoscope, 2619–2624, 2018