What's Involved in Replacing Old Implants with Bigger, New Ones?

Question

What are the procedures involving the removal of old implants with capsule contracture and getting bigger implants? Can it be done in one session? I'm a size C and would like to go to D. Under the muscle. Thank you.

Vivek Bansal, MD · Answer

This is possible, but you first need to see your Board Certified Plastic Surgeon, be evaluated, then consider the risks of the change, and whether the risks can be justified. Bigger means, more risks, and risk of infection, asymmetry, and more.

Steven H. Williams, MD · Answer

Thank you for your question.

	Replacing existing breast implants with larger sizes is occasionally requested in our San Francisco Bay Area practice and the surgery is similar to the original procedure. Replacement implant size can be increased, decreased, or remain the same depending on the goals of the individual. Saline implants may be exchanged for either silicone or saline implants and silicone implants may be exchanged for either saline or silicone implants. Implants placed above the muscle may be replaced above or below the muscle (generally below). If present, capsular contracture (hardening of the tissue around the implant) can be corrected during the same procedure. Additionally the recovery period for breast implant exchange is generally faster and easier on patients than the original surgery.

	For additional information on breast implant exchange please visit the office of a board-certified plastic surgeon.

	I hope this helps.

Steven Svehlak, MD · Answer

Hi YG,

	A capsulectomy (removal of capsular tissue) and capsulotomy (release of capsular tissue) is done under general anesthesia.  Old implants are removed and new implants can be replaced during the same surgery. 

	Going to a larger implant is likely ok, as long as you have adequate tissue for coverage of a larger implant.  Usually, your old incision site can be used for the procedure, as long as it wasn't an axillary or transumbilical approach.  

	Dr. Svehlak

Daniel Yamini, MD, FACS · Answer

Dear YG
Exchanging implants usually is very straightforward.  What can be extremely challenging is dealing with a high grade capsular contracture.  Managing this problem depends on the cause, the degree, and the number of times you have had a contracture.  There are several old and new ways to manage this and each has it's pros and cons.  Make sure you discuss a capsulotomy vs a capsulectomy, smooth vs textured implants, size of the pocket, and the possible use of an artificial dermal matrix to decide what treatment is best.  Best of luck.

Jeffrey D. Hoefflin, MD · Answer

Removing your current implants and replacing them with larger implants is a relatively straightforward process. It involves using your previous breast incision, removing the older implants, opening select portions of your capsule (the scar tissue within your best), and placing a larger implant. The recovery period can often be significantly faster with much less pain. However, if you have hard capsules, the operation is much different. The later involves excisng all of your capsules (scar tissue) and then replacing the implants, in particular, under the muscle if they aren't already placed within a submuscular pocket. Total removal of your capsules can often be associated with some discomfort and depending upon your surgeon, may involve the use of drains.

Tom J. Pousti, MD · Answer

Generally speaking, the procedure is relatively simple. It involves incising capsule tissue to allow for placement of a larger implant. If encapsulation is present, some scar tissue excision may be necessary.

	On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a board certified physician is always the best way to get the most accurate information.

Alan M. Engler, MD, FACS (retired) · Answer

In general - and, as always, there is no way to say 100% without being able to see you - that sounds like a reasonably straight-forward procedure.

	The first step is to remove the anterior (front) of the scar tissue (the capsule).  When implants are above the muscle you can typically remove all the scar tissue safely, but when they're behind (under) the muscle, it is more common to leave the back half of the capsule in place since removing it can get too close to the tissues of the ribcage.  If the scar is particularly thick it may be possible to remove it but that is done less commonly.

	Once that tissue is out, increasing your implant by about a cup size (in the range of 250 cc or, depending on your overall dimensions of chest size, ribcage, how tall you are, etc) should be possible.  You should discuss the specifics of what size you want but also understand that it may not be possible to go as large as you'd like.

	Finally, though, for significant and recurrent capsules, you should consider - even if not now - the need or benefit ultimately of adding acellular dermal matrix (ADM) such as Alloderm or Strattice.  These materials have proven to be very helpful in cases recalcitrant capsule formation, and it's worth at least having that discussion with your plastic surgeon.

	I hope that this helps, and good luck,

	Dr. E

Robert M. Grenley, MD (retired) · Answer

If a patient does not have a capsular contracture or leaking silicone gel implants, replacing implants is fairly simple, involving making the pocket a little larger to accomodate a larger implant. If a patient has a capsular contracture, as you do, then a complete capsulectomy (scar tissue removal, no removal of breast tissue) is perfomed, as the risk of recurrent capsular contracture is less if a new implant is placed into a new, fresh pocket. If the implants are under your muscle, they would remain under your muscle. The surgery described is usually less painful than the initial breast augmentation, though most surgeons would place drains in for a few days postoperatively.

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