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On 14



| By

Andrew McGregor, MD

Woman holding breast implants

Breast implant exchange is a common reason for women to seek out consultation with a plastic surgeon. These women have already undergone primary breast augmentation at an earlier part of their life whether it be 5 years or 35 years. Recommendations of exchanging implants every 10 years still hold true. However, many times women exchange earlier or later. This can be due to size change, implants bottoming out, the descent of the breast, or scar tissue known as capsular contracture.  Breast implant exchange cases are complex and add more technical challenges to create an aesthetic breast shape.

Breast implant exchange can have many treatment or decision algorithms as patients’ wishes and breast shape change over time. Patients who have larger implants may want to exchange them for a smaller implant, for example. Or patients may prefer to keep the same size, but want to opt for a more modern silicone implant. Finally, some patients may need to rework the capsules of the breasts. A breast lift or use of meshes are other adjuncts that can be used during breast implant exchange surgery. The following are treatment options for breast implant exchange:


Breast implant exchange may involve removing the implants altogether and not replacing them. This is called explanting the implants. Explant surgery has become a widespread term when discussing removing implants for a diagnosis of breast implant illness. Many times women just want to remove their implants due to the size or heaviness of the implants, or they do not want to have continued follow-up for their implants. Many times as patients age, their breasts become fattier and bigger. Many patients will need a breast lift after explantation if they have droopiness to their breasts called ptosis. Patients should have a full understanding of what their breast shape will be after explantation. Many women find that explantation surgery combined with a breast lift will achieve their desired results. 

Implant Exchange 

Women who are looking to exchange their implants for the same size or bigger tend to undergo implant exchange only without a mastopexy, or breast lift. This usually involves adjusting the pocket by either tightening it with sutures or using meshes to help prevent bottoming out of the implants. Implant exchange may also involve removing the capsule if there is scar tissue called capsular contracture present. This allows your surgeon to create a wider space and usually a slightly larger implant should be used to help fill out the space removed with the capsule. 

Implant Downsize and Breast Lift 

Many women have implants that are large, heavy, and bottomed out. These implants are usually larger and due to the size, women want to replace them with smaller implants to keep their upper pole fullness and size, without the weight of the larger implants. Most of the time, larger implants will stretch the tissue and cause descent of the breast which results in droopiness. Finally, many women's breasts change over the course of their implant journey. Older breasts tend to be fattier and increase in size over the course of their lifetime. Many women feel that they have much larger breasts now compared to when they were younger. Implant downsize combined with a breast lift, or mastopexy is a common procedure. With any implant exchange procedure, pockets may need to be tightened and support mesh may have to be used. 

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