Implant exchange under local anesthesia? (Photo)

My office in NYC performs this “awake exchange” often, just under local anesthesia. Patients can choose to increase or decrease their size, or go more or less cohesive. It’s an excellent procedure for someone who has implants and is happy with the position, but wants a change in size or feel. Our prices are posted online.

Whether your implants are subfacial or truely subglandular, there was precious little soft tissue covering your implants to begin with. As time went on, the forces of expansion on your tissues from the implants have thinned them further; this is why rippling showed up sometime after surgery. The appearance of your breasts now are tight and spherical, with the actual implant silhouette nearly visible through your skin. If you do nothing, your rippling will actually worsen with time as you age (unless you gain weight or have genetically controlled hormonal changes that lead to breast growth). Having a relatively simple surgery to remove and replace your implants with larger ones would be simple and could be done easily under local anesthesia by any experienced breast surgeon, and you would have virtually no postoperative pain. However, regardless of implant selection, be it an optimally filled device with the highest cohesive gel available (Natrelle Inspira with their 'cohesive' gel), you would end up rippling the same or likely worse in a short time. I've been in the business long enough to learn a lot from my patients. I no longer make presumptions nor have any preconceived notions about what a patient might like, not like, or not care about. If you want larger implants, and you know that rippling comes with the territory, then I know that is virtually the only thing that will make you satisfied and I would move forward with your wishes. The only caveat is that I would first have a detailed discussion with you about your future and what the inevitable surgeries might entail. With you knowing that, then I would proceed.

While it sounds easy and a simple swap, in my experience, I do not recommend any breast implant surgery under local.

The pockets may have to be released, any bleeding to control with the cautery (hot knife) is very painful and usually cannot be numbed properly in an awake patient. If you get uncomfortable and the operation can’t be finished, you cannot simply be put you to sleep without an anesthesiologist present. So that would mean another surgery at a different time.

Further discussion with your/a plastic surgeon is recommended for the exchange under anesthesia.

I am sure you can find someone or go back to your original surgeon. However, I would suggest not going bigger since you have rippling now. You will have more with larger implants.