Breast Implant Replacement or Removal

Most patients with breast implants, whether placed for cosmetic reasons or when used in breast reconstruction, will not require removal.  However, breast implants, like any implanted device (such as an artificial hip, heart valve, etc.), are prone to wear and may weaken over many years time.  This was especially true of older implants made in the 70’s and 80’s that had a weaker outer shell and a thinner silicone gel filling than today’s implants.  We have had patients over the years with a variety of implants, both older versions and more contemporary ones, that require removal and/or replacement and have become familiar with the best ways to approach this surgery.

Reasons for removal/replacement

Patients who may need their implants removed or replaced usually see us for one or more of the following reasons:

  • Implant deflation (saline implants)– Saline breast implants can develop a small hole and allow the saline to leak out, especially as they get older.  The loss of volume in a saline implant typically occurs over a fairly short period of time, sometimes just a day or two.  The breast becomes smaller and softer as the body absorbs the saline.  Although not a dangerous situation, patients usually see us because of their concerns over the asymmetry that becomes obvious and seek replacement.
  • Implant deflation (silicone implants)– If silicone implants leak, the capsule that forms around the implant often contains the silicone gel, so there may be no noticeable change in the feel or appearance of the breast. However, the gel can sometimes trigger an inflammatory change in the capsule resulting in a contracture of the capsule and a firm, even painful breast. The silicone gel can also escape from the capsule into the surrounding tissues. This was especially true with the older implants made in the 1970’s and 1980’s, when the gel was much thinner than today’s implants.  In either of these cases, implant removal, with or without replacement, is suggested.
  • Size changes– We have seen patients that were initially very happy with their appearance when they underwent implant placement many years ago, whether for cosmetic or reconstructive reasons, who now desire a size change or implant removal due to changes in their figure due to weight changes or the normal aging process.
  • Implant “upgrade”– Most patients who underwent implant placement in the 1990’s and early 2000’s had saline implants placed.  While the majority of patients achieved good results, some patients have expressed a desire to have these exchanged for silicone implants as these generally have a more natural feel and are less prone to rippling.
  • Capsular contractue–  Patients occasionally will develop a capsular contracture, which is a tightening of the body’s tissue that forms around the implant.  In some cases we can address this surgically and use your existing implants but we generally recommend replacement with new implants especially if they are older ones.
  • Implant problems-  This covers recurrent pain, capsular contracture or other symptoms which are occassionally associated with implants.

The procedure

The surgical procedure of implant removal/replacement ranges from very short (less than 1 hour) to fairly long and complex (3 hours or more).  We perform most of these procedures in the operating room under a general anesthetic on an outpatient basis. Some  implant removals can be performed in our office using local anesthesia.

Prior to your surgery we will obtain as much information as we can about your existing implants.  Of course, if we have placed your original implants we will have this information readily available.  If they were placed elsewhere, we will do our best to find these records with your help.  This information is very helpful in choosing your new implants.

The operative procedure performed depends on multiple factors and we adapt our surgical technique according to your needs.  A brief listing of the possible operations:

  • Saline implant replacement after deflation–  A fairly brief procedure, especially if the implant has just recently deflated.  We can utilize existing scars for our incision, and existing pocket for implant placement.  Minimal pain, short recovery time
  • Silicone implant removal for implant deflation or leakage– More extensive than above, as the breast capsule must be removed in its entirety along with the implant, a fairly tedious process.  The original incision may have to be enlarged to accomplish this.  If new implants are placed, we may have to create a new pocket inside the breast for placement.  If new implants are not placed, a breast lift (mastopexy) may need to be performed to reshape the remaining breast tissue for a cosmetically acceptable appearance.  These procedures tend to be longer with a longer recovery time.
  • En-bloc implant and capsule removal-  In some cases it may be necessary to remove the implant and surrounding capsule completely and an “en bloc” removal is indicated.  This involves removing the implant and capsule as a single unit.  This typically involves a longer incision and potentially longer recovery than with a straightforward implant removal when the capsule is in normal condition.
  • Size change, silicone or saline implants–  Removing an implant and replacing it with a larger size is usually a short, straightforward procedure as we can utilize your existing incision scar and implant pocket.  Recovery time is fairly short, usually a few days.  If your existing implants are removed and significantly smaller ones are placed, you may require a breast lift (mastopexy) to reshape the breast, as there otherwise may be an excess of skin.  If this is the case we will need to utilize incisions longer than your existing scars, and the operative time (and recovery) will be increased.

Common questions

Do implants need to be replaced based on their age?

No.  We only recommend removing or replacing implants if there is a clinical reason to do so.  If you’re happy with your implants and they’re not causing any problems, leave them alone.  As the old saying goes, “If it ain’t broke, don’t fix it!”

Is there any kind of warranty that will help pay for having my implants replaced if they deflate?

Usually, but it depends on when they were placed and the manufacturer.  The current manufacturers have warranties that will replace the implants and help cover the cost of your surgery if they fail within 5-10 years.  There may be other coverage available as well even after longer periods.  We will help you through this process and receive any funds or reimbursement you are entitled to.

Does insurance cover implant removal/replacement?

It often depends on why the implants were originally placed.  If they were placed for reconstruction, insurance companies will usually cover subsequent surgery.  It they were placed for purely cosmetic reasons, you may have to pay for any additional surgery yourself.

5 reasons to have your implant removal or replacement performed at Lawrence Plastic Surgery:

  • Experience–  Because we have been working with breast implants for over 20 years we are familiar with the techniques involved with implant removal, capsule removal, breast lift, implant replacement, and other procedures which may be required.
  • Familiarity with implant types and manufacturers–  We have removed and replaced a large number of different implants over the years made by a variety of manufacturers, including saline, silicone, smooth, textured, round, shaped, polyurethane coated, combination silicone/saline, and others.  An appreciation for the differences in these implants helps a surgeon better understand what may be required for correction.
  • Familiarity with current manufacturers and their warranties–  We will do our best to see what can be done to minimize your out of pocket costs.
  • Surgeon board certified by The American Board of Plastic Surgery
  • Fully accredited surgical facilities– We utilize the Lawrence Surgery Center and Lawrence Memorial Hospital to perform our operations.