Skip to content 
Breast implant replacement, also called implant exchange or revision augmentation, is an operation in which existing breast implants are removed and new implants are placed. It is performed when an implant has ruptured, when the scar tissue around it has tightened (capsular contracture), when the implant has moved out of position, or when a woman simply wants a different size, shape or type of implant. Depending on the problem, the operation may also involve removing or adjusting the capsule, creating a new pocket or lifting the breast.
Breast implants are not designed to last a lifetime. Many women keep their implants without problems for a long time, but over the years the chance of needing further surgery increases. Understanding why an exchange is needed is the key to planning it well.
Common reasons for replacement
Rupture. Modern cohesive silicone implants usually rupture silently. The gel generally stays within the capsule, so there may be no symptoms. Some women notice a change in shape or firmness. Ultrasound or MRI confirms the diagnosis. A ruptured implant is usually replaced or removed.
Capsular contracture. The body forms a thin capsule of scar tissue around every implant. In some women this capsule thickens and contracts, making the breast firm, round, high or painful. It is graded as follows:
| Grade | What it feels and looks like |
|---|---|
| I | Soft, normal appearance |
| II | Slightly firm, looks normal |
| III | Firm and visibly distorted |
| IV | Hard, distorted and painful |
Grades III and IV usually need surgery.
Malposition. The implant may drop too low, move towards the armpit, sit too high or rotate if it is anatomical. The pocket can be corrected with internal stitches, a change of plane or support from a surgical mesh.
Rippling. Visible or palpable folds in the implant edge, more common with thin tissue. A change of plane, implant type or fat transfer can help.
A change of size or style. Many women want smaller or larger implants years later, or want to move from older implants to newer designs.
Concerns about textured implants. Some women with textured implants choose to replace them because of the rare association with BIA-ALCL, even without symptoms. Current guidance does not recommend routine removal of textured implants in women without symptoms, but the decision is personal and is discussed openly.
How often do implants need replacing?
A common belief is that implants must be changed every ten years. That is not the case. If your implants are intact, soft and you are happy with them, there is no medical requirement to replace them at a set time. What is true is that implants are not lifetime devices. Over the years the risk of rupture, capsular contracture and changes in the breast itself increases, and a proportion of women with implants will have further breast surgery at some point. Regular self-examination, attention to changes in shape or firmness and imaging when advised allow problems to be picked up early. For silicone implants, many surgeons recommend an ultrasound or MRI every few years after the first decade, or sooner if symptoms appear.
Replacement combined with a lift
Pregnancy, breastfeeding, weight change and time all affect the breast tissue around an implant. It is common for women having an exchange ten or more years after their first surgery to find that the breast has dropped over the implant, sometimes with the nipple now pointing downwards. Simply replacing the implant will not correct this. A lift at the same time repositions the breast tissue over the new implant, restoring a higher nipple position and a more youthful shape.
Before surgery
Assessment includes a careful examination of both breasts, measurements and imaging, usually an ultrasound or MRI, to check the implants and the breast tissue. Bring any information you have about your current implants, including the implant card, manufacturer, size and date of surgery. This helps plan the new implant and the pocket.
How the operation is performed
The operation is performed under general anaesthesia and takes between one and a half and three hours, depending on what needs to be done.
- Access. The previous scar is usually used, most often in the fold under the breast.
- Implant removal. The old implant is removed. If it has ruptured, any gel is carefully cleared.
- Capsule management. Depending on the situation, the capsule may be left, partially removed (capsulotomy or partial capsulectomy) or completely removed (total capsulectomy). Capsular contracture and silicone-contaminated capsules usually need capsulectomy.
- Pocket correction. The pocket is adjusted with internal stitches, moved to a new plane, or supported with mesh when the tissues are weak.
- New implant. The new implant is placed using a no-touch technique to reduce contamination.
- Closure. The incision is closed in layers.
If the breast tissue has dropped, a breast lift may be performed at the same time. If volume needs to be refined, fat transfer can be added.
Choosing the new implant
The new implant is chosen according to the width of your chest, the quality and stretch of your tissues, the reason for the exchange and your preferences. Going much larger can stretch thin tissues and increase long-term problems. Going much smaller can leave loose skin that needs a lift. More on implant types is on the breast augmentation page.
Preparing for surgery
Stop smoking at least four weeks before and after surgery. Stop blood-thinning medicines and supplements two weeks beforehand after checking with your doctor. Buy front-fastening support bras. If your previous implants had a complication, bring any records and imaging reports.
Recovery
- Days 1–3: tightness and soreness, often less than after the first augmentation
- Days 3–7: gradual improvement; support bra worn day and night
- Week 1: most women return to desk work
- Weeks 3–4: light exercise
- Week 6: full activity, including upper-body exercise
- Months 3–6: implants settle into their final position
If a capsulectomy or pocket correction was performed, drains may be used for a short time and recovery may be a little longer.
Risks
Risks include bleeding, infection, seroma, recurrence of capsular contracture, implant malposition, rippling, asymmetry and changes in nipple sensation. The risk of recurrent capsular contracture is higher in women who have had it before, and removing the capsule and changing the pocket can reduce this risk.
When removal is the better option
Some women decide not to have new implants at all. Implant removal with capsulectomy is an option, with or without a lift or fat transfer. This choice depends on your priorities, your tissue and how you feel about implants now.
Implant replacement in Istanbul
International patients usually stay about seven days, allowing for assessment, surgery and a check before flying. Bring your implant card and any previous imaging reports.
Dr. Mehmet Özdemir is a plastic, reconstructive and aesthetic surgeon holding the EBOPRAS qualification of the European Board of Plastic, Reconstructive and Aesthetic Surgery, with breast surgery among his main areas of focus. He trained in Germany, Poland and Brazil, consults in Turkish, Kurdish, English and German and practises in Bakırköy, Istanbul.
