Breast implant exchange and revision · New York and New Jersey
Breast Implant Exchange
Breast implant exchange replaces the implants you have now. It is done to treat a problem such as capsular contracture, to change the size, or to move the implant to a better position. Dr. Steven Ovadia is a board certified plastic surgeon with offices in New York City and New Jersey.
Overview
What breast implant exchange is
In an implant exchange, the implants are removed and new ones are placed, usually through the scars you already have. What else is done depends on the reason for surgery: the scar tissue around the implant may be removed, the pocket may be made larger or smaller, or the implant may be moved to a new pocket.
Breast implants are not lifetime devices, but they do not come with an expiration date either. Implants that are not causing a problem do not need to be exchanged because of their age alone. Most patients come in because something has changed, or because they want something different.
Why people have it
Capsular contracture
The scar tissue around an implant has tightened. The breast feels firm, sits higher, looks different from the other side, or hurts.
Capsular contractureA different size
You would like to be larger or smaller than you are now. Bodies and preferences change over the years, and the implant can change with them.
Changing sizeMovement with the chest muscle
An implant under the muscle moves or changes shape when you tighten your chest. This is called animation deformity.
Changing the pocketA rupture or a leak
A saline implant has deflated, or imaging has shown a tear in the shell of a silicone gel implant.
An implant that has shifted
An implant sits too high, too low, or too far to the side, or rippling can be seen or felt through the skin.
No longer wanting implants
Some patients decide they would rather not have implants. The implants can be removed, with or without fat grafting to keep some of the volume.
Removal with fat graftingImplants placed for breast reconstruction after a mastectomy can be exchanged for the same reasons, and so can implants placed in gender-affirming breast augmentation.
Capsular contracture
When the breast becomes firm or tight
Capsular contracture is one of the most common reasons for another operation after breast implants. It can happen in one breast or both, soon after surgery or many years later. It is not always known why it happens.
A normal capsule
Thin and soft
The body forms a thin layer of scar tissue around every implant. This is expected. The implant stays soft and can settle into the lower part of the breast.
Capsular contracture
Thick and tight
In some patients the capsule thickens and tightens around the implant. The implant is squeezed into a rounder, firmer shape and is often pulled higher on the chest.
How it is graded
Soft
The breast is soft and looks natural. This is how most breasts with implants stay.
A little firm
The breast is a little firm but looks normal.
Firm, and it shows
The breast is firm and looks abnormal. It may sit higher or look rounder than the other side.
Hard and painful
The breast is hard, painful, and looks abnormal.
This is the Baker scale. Grades III and IV are considered severe, and they are the grades for which surgery is usually discussed.
How it is treated
Removing the capsule
Capsulectomy
The tightened scar tissue is removed, in whole or in part. How much is removed depends on how thick the capsule is and where it sits.
Releasing the capsule
Capsulotomy
In some cases the capsule is left in place and opened with cuts that let it expand, so that the implant has room again.
A new implant
Implant exchange
The old implant is replaced with a new one. Dr. Ovadia uses only smooth implants.
A new pocket
Changing the plane
The new implant can be placed in a new plane, for example moved from in front of the chest muscle to behind it, or the reverse.
These are usually combined. Dr. Ovadia examines you and explains which he recommends and why. Capsular contracture can come back after it is treated, and no operation and no implant can guarantee that it will not.
Changing size
Going larger or going smaller
What looked right at one point in life may not be what you want now. Implants are measured by volume, in cubic centimeters (cc), and Dr. Ovadia starts from the size you have. If you know it, or have your implant card, bring it to your consultation.
Going larger
Upsizing
The pocket is opened to fit a wider or fuller implant.
- The width of your chest and the amount of tissue you have still set the range that fits
- A larger implant is heavier, and over time it stretches the skin and tissue that hold it
- With thin tissue, the edges of a larger implant can be easier to see or feel
Going smaller
Downsizing
A smaller implant is placed, and the pocket is made smaller with stitches on the inside so that the implant stays in position.
- Skin that was stretched by a larger implant does not always tighten on its own
- A breast lift at the same operation removes the extra skin and raises the nipple
- Some patients go smaller in steps, or choose to have the implants removed
Other things that can change
Saline to silicone gel, or the reverse
An exchange is also a chance to change the type of implant. Silicone gel feels closer to breast tissue. A saline implant is filled once it is in place, and a leak is noticed quickly.
A different profile
Profile is how far an implant projects forward for its width. Two implants of the same volume can look different: one wider and flatter, one narrower and fuller.
Together with a lift
An implant adds volume. It does not raise a breast that has dropped with time, pregnancy, or weight change. A breast lift can be done at the same operation as the exchange.
More about implant types, sizes, and profiles is on the breast augmentation page.
Animation deformity
When the implant moves with the chest muscle
Many implants are placed under the chest muscle. For some patients, tightening that muscle pushes the implant up or out to the side, and the breast changes shape for as long as the muscle is working. This is called animation deformity.
A small amount of movement is common and does not need treatment. When it is easy to see, uncomfortable, or gets in the way of exercise, the plane can be changed: the implant is moved from behind the muscle to in front of it.
Under the muscle
Where the implant is now
The upper part of the implant sits behind the chest muscle. When the muscle tightens, it presses on the implant and pulls on the skin over it.
- The implant moves up or out to the side when you flex
- The breast can flatten or show a crease
- Often most noticeable with exercise
In front of the muscle
After changing the plane
The implant is moved to a new pocket in front of the muscle, and the muscle is returned to its place on the chest wall.
- The muscle no longer presses on the implant
- The chest muscle works the way it did before implants
- Needs enough of your own tissue to cover the implant
The muscle gave the upper part of the implant extra cover. In front of the muscle, the implant is covered by your own tissue alone, so when that tissue is thin, rippling or the edge of the implant can be easier to see. Fat grafting can add cover where it is needed. Dr. Ovadia examines you and tells you whether changing the plane is a good option for you.
Removal with fat grafting
Replacing implants with your own fat
Some patients no longer want implants but do not want to lose all of the volume. Fat grafting, also called fat transfer, moves fat from another part of your body into the breasts at the same operation in which the implants are removed.
What to expect
Smaller and softer than an implant
Fat feels like your own tissue, because it is. In most cases it adds less volume than the implant did, so expect a smaller breast than you have now.
Not all of the fat stays
The body absorbs part of the fat over the first few months. The fat that remains after that is living tissue. It lasts, and it changes with your weight like the rest of your body.
Sometimes more than one session
There is a limit to how much fat a breast can take at one time. Patients who want more volume can have a second session of fat grafting later.
You need fat to give
The fat has to come from somewhere. Very lean patients may not have enough for the volume they hope for. Dr. Ovadia examines you and tells you what is realistic.
A lift may be part of the plan
Skin that was stretched by an implant can look loose once the implant is gone. A breast lift can be done at the same operation or later.
Fat and breast imaging
Grafted fat can form small firm lumps or oil cysts, which are harmless and can show up on a mammogram. Tell the imaging center that you have had fat grafting to the breast.
Implants can also be removed without replacing them at all. The breasts are then smaller, and they can look flatter or looser than they did before implants. Dr. Ovadia goes over what your breasts are likely to look like, and whether a lift or fat grafting would help.
Recovery
What to expect after surgery
It depends on what was done
A simple exchange in the same pocket is usually an easier recovery than the first operation was. Removing the capsule, changing the pocket, or adding a lift means more healing.
Swelling is normal and expected
The breasts are swollen at first, and new implants can sit high and feel firm. Over the following weeks and months the swelling goes down and the implants settle into position.
The surgical bra is important
You wear a surgical bra after surgery. The compression helps prevent and minimize swelling and supports the breasts while they heal.
Drains
A drain may be placed, most often when the capsule has been removed. If you have drains, you are shown how to care for them, and they are removed in the office.
After fat grafting
The areas where fat was taken are bruised and swollen, and you wear a compression garment over them. Dr. Ovadia goes over what to wear on the chest while the fat settles in.
Walking starts early
Short walks begin right after surgery. Lifting, reaching overhead, and exercise come back in steps, as Dr. Ovadia advises.
Call the office right away if one breast becomes much more swollen, firm, or painful than the other, or if you notice spreading redness, warmth, or a fever. These are best taken care of early.
A general timeline
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Cost and insurance
Cost and insurance coverage
An implant exchange done for cosmetic reasons, such as a change in size, is not covered by insurance. The cost depends on the implants and on what is done at surgery, and we go over it with you after your consultation.
Surgery on implants may be covered by insurance when there is a medical reason for it and it is a covered benefit of your policy. Federal law requires most health plans that cover mastectomy to cover all stages of breast reconstruction.
Common criteria for insurance coverage
Removing or replacing breast implants
- Implants placed for breast reconstruction after a mastectomy
- Severe capsular contracture. Plans often look for a breast that is hard and painful, with photographs
- A ruptured silicone gel implant shown on imaging
- An implant that is infected or coming through the skin
When the first implants were placed for cosmetic reasons, insurance is unlikely to cover new implants or fat grafting, even when it covers removing the implants for a medical problem. Every plan sets its own criteria. Coverage is not guaranteed.
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
He performs implant exchange and revision for cosmetic, gender-affirming, and breast reconstruction patients, including patients whose implants were placed by another surgeon. His published research includes a study of the risk factors for capsular contracture after breast implant surgery. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about breast implant exchange
Do breast implants need to be replaced every 10 years?
No. Breast implants are not lifetime devices, and the longer they are in place the more likely it is that they will need to be removed or replaced. But there is no set date for replacing them. Implants that are not causing a problem do not need to be exchanged because of their age alone.
What is capsular contracture?
The body forms a thin layer of scar tissue, called a capsule, around every implant. In some patients the capsule tightens. The breast can feel firm, sit higher, look different from the other side, or hurt. Capsular contracture that is firm and visible or painful is usually treated with surgery.
How is capsular contracture treated?
With surgery. The tightened capsule is removed or released, and the implant is replaced with a new one, moved to a new pocket, or taken out. Dr. Ovadia examines you and explains which he recommends and why.
Can capsular contracture come back after surgery?
Yes, it can. Most patients do well after surgery, but no operation and no implant can guarantee that a capsule will not tighten again.
What is animation deformity?
When an implant sits under the chest muscle, tightening the muscle can push the implant up or to the side and change the shape of the breast. For many patients the movement is small. When it is bothersome, the implant can be moved to a new pocket in front of the muscle, where the muscle no longer presses on it.
Can I go bigger or smaller when my implants are exchanged?
Yes. Changing size is one of the most common reasons for an exchange. Going larger depends on the width of your chest and the tissue you have to cover the implant. Going smaller may leave extra skin, and a breast lift at the same operation can take care of that.
Can my implants be removed and replaced with fat?
For many patients, yes. The implants are removed, fat is taken with liposuction from another part of your body, and it is placed into the breasts. Expect a smaller breast than you have with implants. Part of the fat is absorbed in the first few months, and some patients choose a second session for more volume.
Will I have new scars?
Usually not. Whenever possible, Dr. Ovadia uses the scar you already have. A breast lift, if it is part of the plan, adds scars around the areola and on the lower breast. Fat grafting uses a few very small incisions.
I have textured implants. What should I know?
Textured implants have been linked to BIA-ALCL, a rare lymphoma that can develop around an implant. New swelling, a lump, or pain around an implant should be checked. If you have textured implants and would like to discuss having them removed, you are welcome to schedule an appointment. Dr. Ovadia uses only smooth implants.
Is breast implant exchange covered by insurance?
An exchange done for cosmetic reasons, such as a change in size, is not covered by insurance. Surgery on implants placed for breast reconstruction after a mastectomy may be covered. Some plans cover removing implants for a medical problem, such as severe capsular contracture or a ruptured silicone gel implant, but are unlikely to cover new implants or fat grafting when the first ones were cosmetic. Each plan sets its own criteria, and coverage is not guaranteed. If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
My implants were placed by another surgeon. Can Dr. Ovadia exchange them?
Yes. It helps to bring whatever you have about your implants: the implant card you were given, or the records from your first operation. They show the maker, the size, and where the implants were placed. If you do not have them, Dr. Ovadia can still plan your surgery.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine you, go over what you want to change, and explain what he recommends. If you have your implant card or the records from your first operation, bring them with you.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com