Breast implant exchange or removal

Breast implant exchange or removal is a plastic surgery procedure in which previously placed implants are replaced with new ones or removed completely. Breast implants are not considered lifetime devices, and over time there may be medical or personal reasons for a further operation.

The procedure may also include a capsulectomy, meaning the partial or complete removal of the capsule, the scar tissue the body naturally forms around the implant. Depending on the situation, the operation can be combined with a mastopexy (breast lift), particularly when the skin has become lax. At Detalii Med, in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna.

The procedure may be discussed in situations such as:

• capsular contracture, when the capsule around the implant thickens and tightens and the breast becomes firm, distorted or painful;
• rupture or suspected rupture of the implant, confirmed by imaging;
• implant displacement, asymmetry that has developed over time, or implant edges that are visible or can be felt;
• the wish for a different volume, larger or smaller, or a different profile;
• the wish to give up implants altogether;
• changes to the breasts after pregnancy, breastfeeding or weight fluctuations.

The patient should be in good general health and have realistic expectations.

The procedure can replace a damaged implant, treat capsular contracture, correct the implant position and change breast volume. When combined with a mastopexy, it can lift the breast and reduce excess skin.

It cannot always return the breast to its shape before the first operation. After implants are removed without replacement, the breasts may look smaller, emptier or slightly droopy, especially if the implants were large or had been in place for a long time. Not all old scars can be removed, and a new capsular contracture cannot be ruled out.

At the consultation, the doctor discusses with the patient why she wants the procedure, the history of the original operation and any symptoms. Information about the existing implants is helpful: type, volume and date of surgery, if the patient has it available.

The doctor examines the breasts and assesses the quality of the skin and breast tissue and the position of the implants. Where needed, imaging such as ultrasound or magnetic resonance imaging is recommended to assess the integrity of the implant and the condition of the capsule. Based on these findings, the doctor and patient agree on the appropriate option (exchange, removal, capsulectomy, possibly a mastopexy), the type of anaesthesia and the tests needed before surgery.

Access is usually through the old scar whenever possible, so as not to add new scars. The surgeon removes the implant and, depending on the situation, removes or modifies part of the capsule or the whole capsule.

If replacement is chosen, the space is prepared for the new implant, which may have a different volume or shape, and sometimes the plane in which it sits is also changed. If the implants are simply removed, the surgeon may reshape the remaining tissue or combine the procedure with a mastopexy. Finally, the incisions are closed with sutures, and drains are sometimes placed for a short time. The operation usually takes between one and three hours, depending on its complexity.

The procedure is usually performed under general anaesthesia, administered by the anaesthetist. Before surgery, the patient has a pre-anaesthetic assessment covering her medical history, current medication and test results.

In the first few days, the breasts may be swollen, tender and bruised. Discomfort is usually managed with the medication recommended by the doctor. A surgical or support bra is worn for the period advised, usually several weeks.

Many patients return to light activities after about a week, depending on the nature of their work. Strenuous exercise, lifting heavy objects and sport are resumed gradually, usually after four to six weeks, with the doctor's agreement. Follow-up appointments allow healing to be monitored and sutures to be removed where needed.

Like any surgery, this procedure carries risks, which are discussed at the consultation:

• bleeding or haematoma, infection, fluid collection (seroma);
• delayed healing or scars more visible than anticipated;
• changes in breast or nipple sensation;
• asymmetry, displacement of the new implant or a new capsular contracture;
• after implant removal, an emptier or droopier appearance of the breasts;
• risks related to anaesthesia.

A further procedure is sometimes needed for correction.

Part of the result is visible immediately after surgery, but the final shape develops gradually as swelling settles and the tissues adapt. The breasts usually settle over a few months, and scars continue to fade for a year or more.

How long the result lasts depends on weight changes, pregnancies, age and skin quality. New implants also need periodic monitoring, as recommended by the doctor.

Breast implant exchange or removal is an option for problems such as capsular contracture, implant rupture or the wish for a different volume. The right approach is decided at the consultation, after examination and, where needed, imaging. The result depends on the condition of the tissues, and careful recovery supports good healing.