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Implant exchange and capsular contracture – when a breast implant causes problems
Breast implants last a long time, but not necessarily a lifetime. If the capsule hardens, an implant is damaged or it no longer suits the body, an exchange can be advisable. Here you can learn how to recognize this and how an exchange proceeds.
A breast implant is a medical device – high-quality, but not everlasting. Many women live with it for decades without any problems. For others, something changes over time: the breast becomes firmer, the shape shifts, an older implant has started to leak. Or life has changed – after pregnancies, weight fluctuations or simply over the years, the size no longer fits. Then the question of an exchange arises.
When an exchange can be advisable
- Capsular contracture: The connective tissue around the implant has hardened and contracted (see below).
- Defective or aged implant: Over time, the material of older implants can fatigue or rupture. Earlier models with saline filling also often lose volume.
- Change in position: The implant has slipped or rotated – with anatomically shaped implants, this is visibly noticeable.
- Inflammation: An infection in the implant pocket can make removal necessary.
- Certain implant types: For some textured implants, the approval was not renewed due to a rare lymphoma risk (BIA-ALCL). Anyone with such implants should seek advice – but without symptoms, an exchange is not mandatory.
- Wish for change: larger, smaller, lighter or in combination with a lift.
Capsular contracture: what lies behind it
The body surrounds every implant with a thin sheath of connective tissue. This is normal and desirable. In some women, however, this capsule becomes thick, hard and shrinks. Why this happens has not yet been conclusively clarified; among the factors discussed are a subclinical inflammation caused by skin bacteria and bruising after surgery.
Typical signs are increasing hardening, a feeling of tension or pressure, pain, a changed shape or a new asymmetry between the two sides.
The four Baker grades
| Grade | Finding | What is usually advisable |
|---|---|---|
| Baker I | soft, no palpable or visible change | no treatment, check-up |
| Baker II | slightly firm to the touch, externally inconspicuous | observe, anti-inflammatory treatment if necessary |
| Baker III | clearly firm, shape visibly changed | treatment recommended |
| Baker IV | hard, deformed, often painful | surgical treatment |
In pronounced capsular contracture, the hardened capsule is surgically removed and the implant is replaced with a new one. The formerly common practice of “squeezing open” the capsule from the outside is no longer recommended today.
Prevention – what you can contribute yourself
- consistently follow the instructions after surgery, in particular wearing the support bra
- if possible, do not smoke before and after the procedure
- have bruising and signs of inflammation checked early
- attend regular follow-up examinations
How an implant exchange proceeds
An exchange is more complex than the first implantation, because the old capsule is usually removed as well. The procedure is, however, similar to that of a breast augmentation.
- Consultation and findings We discuss your complaints and wishes. Documents from the first operation and the implant card are very helpful – please bring them with you.
- Imaging Depending on the question, this includes ultrasound and, if necessary, a mammogram or MRI.
- Planning We decide whether the capsule is removed completely or partially, which new implant is suitable and whether the position (above or below the muscle) should be changed. A lift or forgoing a new implant are also options.
- Surgery under general anesthesia, usually via the existing scar. Removed parts of the capsule can be examined histologically.
- Aftercare as after a breast augmentation – support bra, rest, check-ups.
An implant exchange is a good opportunity to reassess everything: size, shape, position – and whether you want an implant again at all.
After the exchange
Expect a few days of tightness and swelling. You usually wear the support bra for about six weeks. Light activities are usually possible again after one to two weeks; intensive sports and heavy lifting only after about six to eight weeks. The final shape develops over a few months.
Costs and health insurance
An exchange usually costs about as much as a breast augmentation; you will receive the exact amount after the examination. If there is a medical reason, German statutory health insurers usually only contribute to the removal – not to the new implant. In the case of an implant defect, it is worth asking the manufacturer, and anyone who has taken out follow-up cost insurance should check it.
Risks
Like any operation, an exchange carries risks: secondary bleeding, infections, wound healing problems, changes in nipple sensitivity, asymmetries and conspicuous scars. Capsular contracture can also develop again after an exchange. I inform you about all points in detail before the procedure.
Breast surgery: the process step by stepPreparation, day of surgery and healing – with illustrations
Frequently asked questions
Do I have to have my implants exchanged after ten years?
No, there is no fixed replacement date. Regular check-ups are important. An exchange is indicated if findings or complaints suggest it – or if you yourself would like to change something.
Will the exchange leave new scars?
In most cases, surgery is performed via the existing scar. If a lift is performed at the same time, additional incisions are added – we discuss this precisely beforehand.
Can I simply have the implants removed?
Yes. Without an implant, however, the breast often looks emptier and saggier than before the first operation. A simultaneous lift or an autologous fat treatment can mitigate this.
I no longer have my implant card. Is that a problem?
It makes planning more difficult, but does not prevent the procedure. It is often possible to find out from the clinic at the time which implant was used.
How do I recognize capsular contracture?
Signs are an increasingly firm or painful breast and a changed shape. Certainty is provided by an examination, supplemented by ultrasound if necessary.