Implant Exchange & Removal

The reasons for this vary. Sometimes personal preferences have changed. In other situations, the breast, skin and tissue have developed further through pregnancy, weight changes, or the natural ageing process. Changes to the implant itself, its position, or the surrounding capsule can also make a further operation necessary. This is not only a question of whether an implant is removed or replaced. What matters equally is what the breast should look like afterwards. At Clinic Selnau in Zürich, we therefore consider the implant, existing breast tissue, skin quality and breast shape together. Only from this does it emerge whether an implant exchange, a straightforward removal, or a combination with a breast lift / mastopexy or fat transfer makes sense.

Our Approach

A breast with existing implants has a different starting point than a breast that has not previously been operated on. The tissue has adapted to the implant. Skin and breast tissue can have stretched, the inframammary fold can have changed, and the body forms a natural tissue capsule around every implant. Previous scars and the existing implant pocket also influence the possibilities for a further operation.

For this reason, planning does not begin with the question of a new implant. We first consider what is already there, and what result you would like today. Do you want to continue wearing implants? Should the breast become smaller or larger? Would you like to do without implants entirely? Is there enough of your own tissue available? Has the breast descended? Should lost volume be partially replaced with fat transfer? The individual treatment plan emerges from these questions.

Reasons for an Implant Exchange or Removal

An implant exchange or removal may be considered for different reasons:

• A wish for a different breast size
• A wish for a different breast shape
• A wish for smaller or larger implants
• A wish to live without breast implants in the future
• Changes to the breast following pregnancy or breastfeeding
• Changes following weight gain or loss
• Descent of breast tissue or the implant
• Visible or palpable implant edges
• Implant displacement or rotation
• Asymmetries
• Changes to the implant capsule
• Capsular contracture
• Implant defect or rupture
• Dissatisfaction with the result of a previous breast augmentation

Not every change automatically requires an implant exchange. For this reason, it is first assessed which structure is actually responsible for the existing concern.

Planning & Analysis

Careful analysis is especially important for breasts that have already been operated on. During consultation, we assess breast shape, skin quality, existing breast tissue, nipple position, and existing scars. The position of the implants, the existing implant pocket, and any signs of capsule changes are also considered.

Where information about the existing implants is available, implant type, size, position, and the timing of the previous operation are included in planning. Depending on the starting point, further imaging may be useful or necessary. We then discuss not only whether the existing implant should be removed, but above all, what breast shape is being aimed for afterwards. This matters because the same implant removal can lead to very different starting situations, depending on existing skin and breast tissue.

Implant Exchange

In an implant exchange, the existing breast implant is removed and replaced with a new one. The previous size can generally be kept, or deliberately changed. Some women wish, after a number of years, for a smaller implant and a more understated breast shape. Others want more volume, or a different projection.

The operation, however, is not necessarily limited to exchanging one implant for another. The existing implant pocket and the surrounding capsule are also assessed. Depending on the findings, adjustments may be necessary to support the position, shape and stability of the new implant. Where breast tissue has descended, a breast lift / mastopexy can additionally make sense. An implant exchange is therefore not a standardised swap procedure. It is newly planned according to the changed anatomy of the breast.

Implant Removal

Not every patient wishes to replace a removed implant with a new one. A straightforward implant removal without replacement is generally possible. How the breast looks afterwards depends significantly on how large the previous implant was, how long it was worn, and how much the skin and breast tissue changed as a result, or over time.

The originally existing breast volume also plays an important role. After removal of smaller implants, existing tissue can, in suitable situations, retract sufficiently. After larger implants, or with significantly stretched skin, excess skin and tissue can remain. For this reason, it is discussed before surgery whether a pure implant removal is likely to be sufficient, or whether additional reshaping of the breast makes sense.

Implant Removal with Breast Lift / Mastopexy

Where skin and breast tissue have stretched significantly due to the implant or over the years, a breast lift / mastopexy can make sense following removal. The implant is removed and the remaining breast is rebuilt from the patient's own tissue.

Excess skin is reduced, existing breast tissue is reshaped, and nipple position is adjusted accordingly. Particularly after larger implants, this step can be decisive for achieving a more compact breast shape again. A lift, however, is not automatically necessary after every implant removal. How much skin and tissue can retract after removal depends on age, skin quality, implant size, existing breast tissue, and individual anatomy. It is not the removal of the implant alone that determines the later breast shape. What matters is how the remaining own tissue can be reorganised. You can find more about the possibilities for reshaping under Breast Lift / Mastopexy.

Implant Removal with Fat Transfer

Where own breast volume is missing following an implant removal, fat transfer can be used in suitable situations. Fat tissue is harvested from suitable areas of the body through liposuction, processed, and placed into the breast in a targeted way.

Fat transfer can help address certain volume deficits, soften contours, or harmonise transitions. It cannot, however, arbitrarily replace a previously large implant. The amount of fat that can meaningfully be transplanted in one session is limited. In addition, not all of the transferred fat integrates permanently. Depending on the desired volume, several treatments may therefore be necessary. Fat transfer is particularly suited to situations where moderate volume support is desired following implant removal, and sufficient suitable donor fat is available. You can find more about this technique under Breast Augmentation with Fat Transfer, within Breast Augmentation.

Implant Removal, Lift & Fat Transfer

The different techniques can also be combined with one another. In an implant removal with simultaneous mastopexy, the breast is first reshaped from existing own tissue. Fat transfer can be used in addition to support selected areas or address volume deficits. This results in a completely implant-free treatment concept.

How much volume can be achieved this way, however, depends on the existing breast and the available amount of suitable fat tissue. The aim is not to reproduce the previous implant volume at all costs. Rather, the breast is newly planned using the existing anatomical structures of the body.

Changing Implant Size

An implant exchange also offers the opportunity to reconsider the previous breast size. When switching to a larger implant, skin, tissue and the existing implant pocket need to be sufficiently stable to support the additional volume. When switching to a significantly smaller implant, excess skin can remain.

In this case, a simultaneous breast lift / mastopexy can be necessary to adapt the breast to the reduced volume. The choice of a new implant is therefore not guided by desired size alone. Breast width, existing tissue, skin quality, and the existing implant pocket together determine which volume can meaningfully be carried long-term. You can find more about implant selection, projection and the different techniques under Breast Augmentation.

The Capsule

The body forms a natural connective tissue capsule around every breast implant. This capsule is, at first, a normal response of the body to the implant. It does not automatically need to be fully removed during an implant exchange or removal. Whether, and to what extent, the capsule is treated depends on the individual findings.

For certain changes, partial or complete removal can make sense or be necessary. In other situations, the capsule can be left in place or only specifically adjusted. The decision is made based on the existing anatomy, the implant, the capsule, and the surgical goal. Complete capsule removal is therefore not automatically part of every implant removal.

Capsular Contracture

In capsular contracture, the normally soft tissue capsule around the implant changes and can thicken or contract. Depending on severity, this can make the breast firmer, cause deformation, or lead to discomfort.

Treatment is guided by the individual findings. Depending on the situation, implant exchange, changes to the implant pocket, and partial or complete capsule removal may be considered. A straightforward implant removal, too, can be an option. Where a change in breast shape or a volume deficit results afterwards, a breast lift / mastopexy and fat transfer can again form part of the treatment concept.

Implant Rupture or Defect

Where an implant defect is suspected, it must first be clarified what type of implant is present, and what change has actually occurred. Depending on the situation, imaging may be required for further assessment. If an implant defect is confirmed, a joint decision is made as to whether the implant should be replaced or fully removed.

Here, too, we consider not only the implant itself. The existing capsule, breast tissue, and the desired future breast shape are included in surgical planning.

Exchange or Removal?

The most important decision is not always the choice of a new implant. For some women, an implant-based breast augmentation remains the right solution. Others, after years with implants, deliberately want less volume, or to do without implants entirely. Both paths can make sense. What matters is how the breast looks today, and what result you would like today.

An implant exchange can redefine shape and volume. An implant removal can be combined with a breast lift / mastopexy. Fat transfer can partially replace lost volume or supplement contours. And sometimes a straightforward implant removal alone is sufficient. It is not about reproducing the previous result. It is about newly planning the breast for today's anatomy and today's preferences.

Healing & Results

The healing phase depends significantly on which procedure is performed. A pure implant exchange differs from an implant removal with simultaneous mastopexy or additional fat transfer. Swelling, a feeling of tightness, and temporary changes in breast shape are normal at first.

Following an implant removal, existing tissue needs to adapt to the changed situation. Particularly after larger implants, the breast can initially appear emptier or unfamiliar immediately after removal. Where a lift is performed at the same time, the new breast shape develops with healing and as swelling subsides. With additional fat transfer, the initial volume also changes, as not all of the transplanted fat integrates permanently.

The final result should therefore not be assessed immediately after surgery.

Long-Term Changes

The breast continues to change after an implant exchange or removal as well. Skin ageing, pregnancies, weight fluctuations, and natural tissue quality can influence shape and position long-term. With a new implant, the general long-term considerations of an implant-based breast augmentation also remain relevant.

Following a straightforward removal, further development depends primarily on your own breast tissue and skin quality. Where fat transfer was additionally used, the fat that has integrated long-term behaves like the body's own fat tissue, and can also change with significant weight fluctuations. Treatment is therefore not planned only for the immediate postoperative shape. The long-term development of the breast is also part of the decision.

It is not about reproducing the previous result. It is about reassessing the breast as a whole, and choosing the treatment that fits your anatomy and your preferences today.

Consultation

An implant exchange or removal begins with taking stock. During your consultation at Clinic Selnau in Zürich, we assess the current breast shape, skin quality, existing breast tissue, implant position, and existing scars. Where possible, we take into account information about the existing implants and previous operations. Depending on the starting point, further examinations may be useful.

We then discuss what change you would like today. Should the implant be replaced? Would you like less or more volume? Should the implant be removed entirely? Should the breast be lifted at the same time? Or would you like to replace part of the volume with fat transfer? On this basis, an individual treatment concept is developed. Depending on the starting point, this can include an implant exchange, a straightforward implant removal, a breast lift / mastopexy, a breast augmentation with fat transfer, or a combination of these techniques.

We discuss openly the changes to be expected, possible scars, the healing process, and the limitations and risks of each treatment. The aim is not simply to exchange or remove an implant. It is to reassess the breast as a whole, and to choose the treatment that fits your anatomy and your preferences today.