Breast Implant Revision and Exchange

Who it’s for

Anyone with implants and a complaint they can be specific about. Specific is doing the work in that sentence. Not liking them is a starting point rather than a plan. The first job of a revision consultation is turning it into something a surgeon can operate on.

The clear-cut cases announce themselves. A breast gone firm, high and sometimes sore. An implant that has slid down, outward, or towards the middle until the two nearly touch.

A rim or a wave you can see through the skin when you lean forward. A saline implant that has visibly deflated. Each of those has an operation waiting for it.

The murkier case is size, and it is the commonest of the lot. Wanting bigger is straightforward as long as your tissue can carry it. Wanting smaller is more interesting. Taking volume out leaves skin that was stretched to hold it, which often turns a simple exchange into an exchange plus a lift.

Timing is a criterion in its own right. Unless something is actually wrong, surgeons want a year from the last operation before touching anything, and the wait earns its keep. Tissue carries on settling, so a chest revised at four months is a chest revised on measurements that were about to change.

Before you book anything

Write down in one sentence what you would want a stranger to notice is different afterwards. These consultations drift into technique within minutes, and having your actual complaint in plain words keeps the operation pointed at it.

How it’s done

Most revisions reopen the scar you already have, so you rarely come out with a new one. What happens underneath is whatever your particular reason demands, and these operations are not interchangeable.

A straight exchange is the shortest of them. The old implant comes out, the pocket is checked and sometimes adjusted, a new one goes in. An hour or so, and easier than the original because the pocket already exists.

A capsulectomy is longer. The scar capsule around the implant is taken out, in part or in whole, because a capsule that has tightened once will tighten around a new implant if you leave it there. Removing it whole and intact, en bloc, gets asked for a lot and is not always possible. A surgeon who says so plainly is being straight with you.

A pocket revision moves the implant instead of replacing it, by closing part of the pocket off with stitches or adding a sheet of supportive material to hold a new position. Changing plane, taking an implant from over the muscle to under it, is the version done for a visible edge.

An explant takes the implants out. With a lift, with fat over the top, or with nothing at all, depending on what is left and what you want. A rupture is generally handled by whichever of the above it needed anyway, with the extra job of clearing silicone that escaped the shell.

Before the consultation

Dig out the card or paperwork from your original operation, the one with the implant make, size and where it was placed. Surgeons can work without it and they plan far better with it, and it is the piece of homework almost nobody thinks to bring.

Revision recovery

Gentler than people brace for, mostly. A pocket that already exists does not have to be made again. An exchange into an unchanged pocket is often the easiest chest operation someone has had, over in a few days of soreness.

The exceptions are real. A full capsulectomy is a bigger operation than the original augmentation was, with more raw surface inside, more bruising, and sometimes a drain. Explant without replacement is physically undemanding. What takes time is standing at a mirror looking at a chest that has now changed twice. Give that its own allowance and do not schedule anything important against it.

Which of these operations you are having moves the timeline below more than anything else does. Take your surgeon's version of it over mine.

In the first month

Keep a short daily note of how the chest feels rather than only how it looks. Firmness and discomfort are what a surgeon needs to hear about early, and they creep up slowly enough that a written line a day catches what memory does not.

Revision scars

Usually nothing new. The old incision is opened and closed again, which is a large part of why surgeons care so much where the first one went. A scar reopened once tends to heal much as it did the first time. Reopened repeatedly, it can widen or thicken, and each round spends a little of the skin's patience.

New scars turn up only when the operation needs them. An explant with a lift brings the lift's pattern with it. An implant that went in through the armpit and now needs a capsule out usually gets a fold incision instead, because the armpit gives too little access. If supportive material is going into the pocket, the incision is often a touch longer than before.

Otherwise the usual rules. Red and firm for a few months, pale over a year, with silicone gel and sun protection helping at the margins.

Sensation after revision

For most revisions, unchanged. Reopening a pocket does not disturb the nerve that supplies the nipple. People who had feeling beforehand generally still have it afterwards.

There is a dose effect worth knowing about. Every operation through the same tissue leaves a little more scar behind in it, and repeated surgery raises the odds of a numb patch that stays. A wide capsulectomy carries more of that than an exchange does, because much more tissue is being dissected.

Explant has a quieter version of the same story. Skin held stretched for years can feel oddly dulled once the pressure comes off it, and most of that returns across the first year.

Risks and complications

The early risks read like the original operation's — bleeding, infection, slow healing. Infection again carries the biggest consequence, because it can mean taking an implant out and waiting months before another goes in.

Then the risks of going back. Contracture recurs. A capsule removed for tightness can form a tight one around the new implant, and the chance of that is higher than it was first time round. A malposition corrected with stitches can relax and drift back. Scar tissue makes dissection harder and bleeding a little likelier.

Silicone that has left a ruptured shell is its own small problem. It can sit in the capsule, and it can reach a lymph node in the armpit. It is usually cleared along with the capsule rather than chased through the tissue. It is not a cancer risk. The plain position is that it gets dealt with, not worried about.

I am not going to give you a number for how often implants need revising, or how long one lasts. The published figures come from cohorts followed for different lengths of time with different devices, and they disagree enough that any single number I picked would mislead you. What is well supported is the direction. It happens often enough to plan around.

Revision results

Judge it at three to six months, the same as the first time. Most revisions land close to the intention, because the surgeon is working on a chest they can see rather than one they have to imagine.

What disappoints depends on why you went in. An exchange upward in size can reveal an edge the old implant was hiding. A pocket correction can look right standing and slightly off lying down, because supportive material is firmer than tissue is. A revision for contracture is the one to hold loosely, since it usually works and it comes with no promise.

Explant deserves plain description. The chest afterwards is smaller than it was before the original operation and softer than either version, with skin that takes months to retract and often does not fully. Some people are relieved by that. Some want fat grafting later to put a little back. Both are ordinary, and knowing in advance that a flat, loose chest is the starting point takes most of the shock out of the first few weeks.

Alternatives to revision

Doing nothing is a real option, and the right one more often than a consultation makes it sound. Rippling you only see leaning forward, a firmness that does not hurt, an implant sitting a fraction lower than its neighbour. Those are things to watch, not to book. A surgeon willing to tell you to come back in a year is worth more than one who agrees with you immediately.

If the only complaint is size and the change you want is small, grafting fat over the implant you already have does it without opening the pocket at all. Smaller operation, with a sore donor area in place of a capsule.

If the tissue has dropped around a perfectly good implant, the operation is a lift and the implant may not need touching. And if what you want is out, explant is not a watered-down revision. It is a decision in its own right, and nobody has to justify it to anybody.

Combining revision with other surgery

Revision pairs naturally with fat grafting, and that pairing is more common than it used to be. A layer of fat over the upper edge of a new implant hides a rim, and after an explant it softens what is left behind. One anaesthetic, one facility fee, one recovery with an extra sore area in it.

It pairs with a lift whenever volume is coming down or the tissue has dropped away from the implant. That is an ordinary plan rather than an escalation.

It does not pair with pelvic surgery, for the same reasons the original operation did not. Infection near an implant is taken seriously, and the two sets of aftercare instructions pull against each other.

Revision cost

This is where people get caught out. A manufacturer's warranty typically covers the device, meaning a replacement implant, sometimes with a limited contribution towards the operation for a set number of years. What it does not cover is theatre, the anaesthetist and the surgeon's time, and those are the bulk of any quote. A free implant can still arrive with a bill in the thousands attached.

Whether your own surgeon charges you turns on why and when. Many practices cover their fee for a problem inside the first year and charge normally after that. Going to a different surgeon than the original one is always a full-price operation. Insurance is inconsistent. A funded augmentation sometimes brings funded revision for a genuine complication with it, and almost never for size regret.

Three things are worth asking before the first operation rather than at the revision. What the warranty actually covers. What the surgeon's own policy is, and for how long it runs. And what a capsulectomy or an explant would cost as a stand-alone operation.

Choosing a revision surgeon

A revision is harder than the operation it follows, and not every surgeon who does augmentations does many of them. The one you want does revisions routinely and takes on other surgeons' work, because that is the practice that has seen the full range of ways this goes.

Ask about capsules specifically. How often they take the whole capsule rather than part of it, when they reach for supportive material in a pocket, and what recurrence of contracture looks like in their own patients. Vagueness in reply to those is itself informative.

Then ask to see explant results, even if you are not having one. Every revision surgeon has patients who ended up there. How willingly they show you that outcome tells you how they will talk to you if your own revision goes sideways. A practice that only shows successes is not showing you its practice.

At the consultation

Ask what they would advise if you chose to do nothing for another year. The answer tells you whether they think your problem is progressing or stable, which is the most useful thing to know before agreeing to an operation.

Frequently asked questions

How long do implants last?

There is no service interval, and the published figures disagree too much to give you one number. See risks.

Does a manufacturer's warranty mean a free revision?

No. It generally covers the device, not the theatre, the anaesthetist or the surgeon. See cost.

Do I need the capsule taken out as well?

Only for particular reasons, chiefly a capsule that has tightened, and how much comes out varies. See how it's done.

What does my chest look like if I just have them removed?

Smaller than before your first operation and softer, with skin that takes months to retract and often does not fully. See results.