Breast Implant Exchange: More Than Replacing the Implant

Implant exchange is usually described as replacing a device: one implant comes out, another goes in. In practice it is more often a reassessment of the breast after years of interaction between the implant, the capsule, the native breast tissue and the skin envelope. The question is not only which implant to place, but what has happened to the breast and what the breast needs now.

When is there a reason to consider exchange?

The common reasons are confirmed rupture, symptomatic capsular contracture, implant displacement or malposition, a change in breast shape after pregnancy or weight loss, and a wish to change size, profile or position. Each leads to a different operation, which is why assessment precedes the decision.

Do implants need replacing after ten years?

No. There is no recommendation to replace breast implants at ten years. The United States Food and Drug Administration requires labelling stating that implants are not lifetime devices and that the risk of complications increases the longer they remain in place, and the American Society of Plastic Surgeons notes that a woman choosing augmentation should expect further surgery at some stage in her life. Neither sets a date. Replacement is performed when there is a reason for it, not at the end of a number of years.

On surveillance I follow the FDA and ASPS recommendations and do not impose requirements of my own beyond them. Nor do I think it helpful for a patient to arrive at consultation anxious because of something she has read online. Where there is doubt, the way to resolve it is examination and discussion, and a decision made case by case. About implant ultrasound assessment →

Before exchanging: the implant, the capsule and the breast

At consultation I separate the question into three parts, because they can lead to different conclusions.

The implant. Is it intact? Is it in position? Are its size, profile and position still appropriate for the breast and for what the patient wants now?

The capsule and the pocket. Is there symptomatic capsular contracture? Has the pocket enlarged, migrated or otherwise changed? In which plane was the implant placed at the previous operation?

The breast itself. What has happened to the tissue and the skin envelope over the years, through pregnancy, weight change and the presence of the implant? This is the part most often overlooked, and it usually determines whether exchanging the implant alone will produce the result the patient has in mind.

When is exchanging the implant enough?

Often. Where the breast tissue and skin envelope are in good condition, the nipple sits where it should, and the problem lies with the implant itself or its size, an exchange is exactly what is needed and there is no reason to add to it. This is worth stating plainly: not every implant exchange requires reshaping of the breast.

When does the breast also need lifting and reshaping?

When the change is in the breast rather than only in the implant. If the tissue has spread, the envelope has stretched or the nipple has descended, a new implant will not correct the shape; it will fill an envelope that no longer fits. In these situations a lift and reshaping is considered alongside the exchange. About breast lift and reshaping →

What is done with the capsule?

I do not perform complete capsulectomy. The FDA and the ASPS do not recommend prophylactic capsule removal in women without symptoms, and en bloc resection is reserved for cases of BIA-ALCL. Beyond that, the capsule is available tissue, and the approach I work by depends on using the existing tissue to build the structure of the breast. Where there is symptomatic contracture or rupture with silicone extravasation, the capsule is treated according to the finding, to the extent required and no further.

Exchange, or removal without a new implant?

This question deserves to be raised explicitly rather than assumed away. Some patients come to discuss an exchange and discover that what they actually want is to be free of implants. Removal is not a surrender of breast shape: the implant can be removed and the remaining tissue reshaped. About implant explantation and breast reshaping →

Choosing the new implant

Where a new implant is chosen, the choice follows the dimensions of the breast rather than a number. Base width, tissue quality, thickness of coverage and the plane in which the implant will sit determine which sizes and profiles are candidates. Crisalix 3D imaging is used at consultation to preview the expected result before the decision is made. About 3D imaging →

Recovery

The operation is performed as day surgery. Patients are discharged the same day, and I do not use drains routinely.

How long recovery takes depends on what the operation actually involved: a straightforward exchange differs from one combined with capsular treatment, pocket correction, or a lift and reshaping. In general recovery is easier than after primary augmentation, since there is no manipulation of or injury to the pectoralis muscle and its fascia, where pain receptors are most dense, and no stretching or expansion of the tissues. Most patients operated on before the weekend are driving and managing ordinary daily activity, including desk work, within a few days.

Limitations

Exchanging implants does not halt future change in the breast tissue, and does not guarantee that no further surgery will be needed later in life. A new implant is a new device, with everything that follows from that. The more the operation includes, the greater the extent of recovery and of surgical risk.