Breast Implant Exchange

Reasons to exchange implants include:

• Patient preference – usually a change in size or request for the removal
• Implant visibility (rippling and knuckling)
• Implant rupture or significant leakage
• Capsular contracture
• Recurrent seroma
• The breast mound drooping off the implant mound (the waterfall effect).
• Implant moving into an undesirable position
• Delayed infection
• Implant recall
• Anaplastic Large Cell Lymphoma (ALCL)

Patient preference is by far the commonest reason for changing implants, usually to go larger. It is important therefore to get the initial sizing correct. Patients need to be aware that the larger the implant the less natural it will look and the more risk of implant visibility and palpability. Additionally, larger implants may cause the breast to droop.

All surgery comes with risks and care needs to be taken to avoid the risks outweighing any potential benefits. Some patients seek removal because of concerns regarding having foreign material in their bodies or following a scare or simply because they wish to go smaller.

In other cases, it is because of a clinical problem such as leakage or rupture or capsular contracture.

Removing implants in uncomplicated cases is relatively straightforward and can be undertaken either under local or general anaesthetic as a day case procedure. The procedure takes 30 minutes and recovery is very rapid. The breast will be significantly smaller and may appear deflated. A firm sports bra should be worn for 2 weeks. In most cases, the breast settles down extremely well and few patients seek any further surgery.

In more complicated cases when there is a hard capsule or a rupture the removal procedure is best undertaken under general anaesthetic and may require drains and a night’s stay in hospital.

In most cases, patients can feel the edge of the implants by the crease under the breast. This is normal and requires no treatment. Implant visibility may occur over the years as the patient's breast natural tissues shrink or following weight loss. It is more common when the implants are situated in pockets created in front of the muscle. If weight gain is not an option then potential options for treatment include the following:

• Change of implant plane – usually placing behind the muscle

• Change of implant type – to a firmer implant

• Fat transfer to increase tissue coverage.

Which of these, either alone or in combination, is most appropriate will be discussed at the consultation. The timings, recovery, aims and limitations and risks will also be discussed.

Capsular contracture When a breast implant is inserted the body will automatically put a layer of scar tissue (a capsule) around the implant. In most cases, this is of no consequence. However, in some patients, for reasons not fully understood, the scar tissue thickens and squeezes the implant. This is termed capsular contracture. This may occur at any stage following augmentation, though it is unusual in the first year. It can come on slowly or rapidly and affect one or both breasts. In many cases, it is manifest by the firmness of the implant, but in severe cases, the implant becomes hard and painful and the breast shape is distorted.

The surgical options include:

• Release of the scar tissue envelope – capsulotomy

• Partial removal of the scar tissue envelope – partial capsulectomy

• Full removal (often en bloc) of the scar tissue envelope – full capsulectomy

• Change of implant

• Change of implant plane (usually repositioning from in front to behind the muscle)

• Fat transfer to increase tissue coverage

• Removal without replacement in recurrent cases.

All of these options require a general anaesthetic and which is most appropriate, as well as expectations, recovery times, aims, limitations and risks will all be discussed at the consultation.

With the natural changes that occur with ageing, sometimes aggravated by breastfeeding or weight change, the breast tissue can start dropping off the implant mound. This appears to be more common when the implant has been placed behind the muscle and when the patient's natural pre-implant insertion breast was droopy or lax.

The options for treatment if required include:

• Change of implant plane usually from behind to in front of the muscle

• Change of implant size

• Breast uplift surgery.

Over time, the implants can move into undesirable positions. There are many potential reasons, including mild capsular contracture, excessive muscle contraction, lax tissues (sometimes following massive weight loss). Options for treatment are varied and bespoke.

This is a rare problem and usually occurs when there is a focus of infection in another part of the body that has spread to the implant through the blood. The treatment specific to the implant is in most cases urgent removal and delayed reinsertion several months later.