Breast Implant Exchange By Jim Lowe, MD on January 18, 2017


Do I really need to exchange my breast implants?

Implant removal or exchange is recommended for all ruptures. Dr. Lowe recommends gel implant exchange primarily for extra-capsular rupture.  Saline and gel implants usually rupture at 10 years, ruptured saline implants should be exchanged within several months, but ruptured gel implant exchange may be delayed in many cases.  Most gel implant ruptures are intra-capsular and can be watched.  However, extra-capsular gel rupture or aging implants over 20 years old should be exchanged when possible.  Most patients exchange implants due to capsular contracture that causes deformity or pain.  Some patients remove gel breast implants that are ruptured because they are simply afraid. 

Will my health insurance cover my implant exchange?

Implant exchange is not usually covered insurance plans unless the implants were placed due to a medical condition such as breast cancer.  Cosmetic implant exchange, with or without a breast lift, or other cosmetic work would require an out-of-pocket expense.  Patients are encouraged to call their provider regarding coverage.  Always forward or bring past medical records or documentation for review. Dr. Lowe determines eligibility based on cancer history, type of implant, dater of surgery, MRI analysis, and clinical history.  If Dr. Lowe feels the surgery is medically indicated he will submit the operation to your insurance provider.    

Should I replace with Gel or Saline implants?

One of the biggest concerns for patients considering implant exchanges is choosing saline vs. gel breast implants.  The cosmetic choice is simple in most cases based on the physical exam but there are often other issues to consider.  Is the patient scared of gel implants?  Scared patients should get saline implants and not worry.  Is the patient planning to follow the FDA gel implant guidelines and does the patient have the resources to pay for future screening?  Simply said, gel breast implants look and feel better (a lot better) particularly when combined with a breast lift.  Gel implants stiffen more, rupture is silent, cost more, incisions are bigger, patient age is restricted, and safety concerns exist.  Saline implants do not look and feel as good as gels. Saline implants sag quicker, deflate more often, cost less, incisions are smaller, and safety is rarely a concern.

How do I choose size when exchanging breast implants?

One of the most important decisions in breast implant exchange with or without breast lift is choosing an implant size.  Although your surgeon will make recommendations, the patient needs to make the final decision regarding size. A variety of techniques are available to assist patients with choosing implant size: computer analysis, manufacture protocols, sizing bras, surgeon experience, and photographs.  Dr. Lowe thinks that all patients should review pre and post-op photos with size descriptions to get it just right. Patients should simply go to to pick out their favorite patient (about your age, height, and shape) photos and bring examples to their consultation. Remember, it is usually better to go a bit smaller with breast lifts because large implants or breast tissue result in a less effective breast lift.

Do I need a breast lift?

Many young patients undergoing primary breast augmentation do not need a breast lift.  However, patients who have had major weight changes, breast feed, or over 40 years of age may be candidates for a breast lift (mastopexy).  Almost every patient getting breast implants exchange will require breast lift. At the time of the original breast augmentation patients usually have tight skin envelope. Years after breast augmentation the breast do not sag due to a strong capsule that holds the implants up on the chest wall. When the implant capsule is removed the new implant lacks support because the skin has been stretch over time.  Implant exchange without a lift will almost always result in some implant decent and breast sagging. 

Simply stated, implant exchange is rarely as simple as the primary breast augmentation. 

In most cases, the need for breast lift is obvious, but in other cases it may not be clear. Patients with droopy breast who are happy with their native breast size may opt to remove the breast implant and lift the breast.  Patients with significant droopiness (ptosis) may require two separate surgical procedures. The need for breast lift sometimes is not clear until months after a breast implant exchange.  Patients should have a frank discussion with the board certified plastic surgeon to help them make the right decision.

Will I need surgery again in the future?

Breast implants and breast lifts do not last forever. Breast lifts usually do not require revision until the next implant exchange, but revision rates increase based on implant size and patient anatomy. Saline and gel breast implants have reported life span of ten years. Interestingly, ten years is also the length of manufacture warranties and FDA recommended exchange period. Both implant types have a 2% rupture risk per side per year. When saline implants rupture they deflate. When gel implants rupture patients are usually unaware. The manufacture places a silicone capsule around all implants to hold in either saline or gel.  All patients form a biologic capsule around implants. This capsule (good or bad) as it forms actually helps prevent implant decent.  Inter-capsular rupture refers to gel implant rupture within the human capsule, and extra-capsular rupture refers to rupture out-side the human capsule. 

Why do breast implant exchange cost more than primary operation?

The cost for revision is limited for patients who experience complications or planned surgery within the first year when returning to the original surgeon.  However, future breast implant exchange is never as easy or as cheap as primary surgery.  After implants have been in for several years the breast tissue shrinks, capsule forms, and skin stretches.  Patients can rarely remove or exchange implants without further significant surgical work which directly impacts cost.  The implant capsule usually needs to be removed at exchange and a lift or a revision lift may be required as well. Implant removal with breast lift alone is possible if there is adequate native breast tissue.

Should I wait and think about my options?

Breast implant exchange with or without breast lift is an important decision.  The surgical procedure carries significant risks and benefits. It is important prior to surgery for patients to educate themselves on the pros and cons of breast implant exchange. Although patients who undergo breast implant exchange are typically very happy, this elective operation is not for everybody.  The risks of surgery are infection, bleeding, implant loss, and scarring.  Patients require a period of recovery and implant support and maintenance.  Patient should choose a board certified plastic surgeon that they feel comfortable with, who takes time, reviews risks, puts safety first, and trust.  One of the most important aspects of the surgery is patient care and follow-up.  When possible, patients should talk about their plans with physicians, family members, and significant others. Patients should have realistic expectations regarding the surgery, recovery, long term care, potential scarring, and results. Breast implant exchange with or without breast lift (mastopexy) is often the right thing for the right person.

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James B. Lowe, MD, FACS

Lowe Plastic Surgery

Dr. Lowe is a triple board-certified surgeon with over 20 years of experience providing comprehensive cosmetic and reconstructive care. He is affiliated with several prestigious organizations:

  • American Society of Plastic Surgeons 
  • American Society for Aesthetic Plastic Surgery
  • American Board of Plastic Surgery
  • Fellow, American Association of Plastic Surgeons
  • Fellow, American College of Surgeons 
  • American Society for Surgery of the Hand 

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