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What is breast implant exchange?
Implant exchange is the removal of an existing implant and its replacement with a new one in a patient who has previously had augmentation or a lift with implants. Sometimes only the implant changes; sometimes the capsule around it is removed, the implant is moved to a different plane, or a sagging breast is lifted in the same operation.
The body forms a thin sheath of scar tissue (a capsule) around every implant, which is normal. Problems begin when the capsule thickens and tightens, the implant shifts, its shell wears or wishes about size change. A trouble-free implant does not have to be replaced because of its age, but it does need regular follow-up. Our breast surgery page gives the wider context.
Who is a candidate? Reasons for exchange
Any healthy patient with a specific complaint about, or wish for, their implants can be considered. The main reasons are:
- Size change: a wish for larger or smaller implants, or proportions altered by weight, pregnancy or age.
- Rupture: usually silent in silicone implants and detected on ultrasound or MRI; saline implants deflate visibly within days.
- Capsular contracture: the capsule tightens and squeezes the implant; the Baker grades describe increasing firmness, distortion and pain.
- Rippling: implant edges visible through thin tissue.
- Malposition: the implant dropping too low (bottoming out), the implants meeting in the midline (symmastia), a double-bubble deformity or a rotated anatomical implant.
- Ageing implants: shell wear in older-generation implants, or breast tissue sagging off an implant that has stayed in place.
- BIA-ALCL awareness: a rare lymphoma linked mainly with certain textured-surface implants. Late swelling or fluid on one side must be investigated; preventive removal is not routinely recommended without symptoms.
Techniques and options
Exchange only
If the capsule is soft, the breast sits well and the only wish is a change of size or model, the implant is swapped through the previous incision.
Exchange with a lift
When the implant has stayed put but the breast tissue has sagged off it, changing the implant alone is not enough. A breast lift in the same session tightens the skin envelope and raises the nipple; the scar pattern depends on the degree of sagging.
Capsulectomy and en bloc removal
With capsular contracture, rupture or calcification, the capsule is removed partially or completely. In en bloc removal the implant is taken out unopened, inside its intact capsule, which is the standard approach when BIA-ALCL is suspected. Capsulectomy lengthens the operation and may need a drain.
Fat transfer
The patient's own fat, harvested by liposuction, can thicken thin tissue over an implant, disguise edges and rippling, or provide modest volume after implant removal. Part of the fat is reabsorbed.
Removal without replacement
Some patients no longer want implants. The implant and, where needed, the capsule are removed, and a simultaneous lift or fat transfer is planned according to the remaining tissue and loose skin.
Implant types
Most implants used today are cohesive silicone gel, round or anatomical, with smooth, micro-textured or textured surfaces and a range of base widths and projections. The new implant is chosen from the old implant's dimensions, the state of the pocket and the intended look; a move between the subglandular and submuscular planes is planned at the same time.
First consultation and planning
For international patients, revision planning starts with an online photo assessment and the details of the earlier surgery: the implant card (brand, volume, surface, serial number), the operation report if available and any previous imaging.
A breast ultrasound is always performed before surgery to assess silicone rupture, capsule thickness and fluid collections. Where ultrasound is inconclusive, silent rupture is suspected or the implants are an older generation, a breast MRI is requested. Patients over forty also have a mammogram. Late fluid on one side is sampled for analysis.
At the in-person examination the firmness of the capsule is graded and implant position, nipple level, tissue thickness and asymmetry are measured. By the end, the suitable options, scar pattern and new implant size are clear.
Before surgery
- Smoking and nicotine: stop at least 4 weeks beforehand; skin circulation is more delicate in revision surgery.
- Blood thinners and aspirin: stopped 7–10 days before surgery in agreement with the prescribing doctor; bleeding control matters especially with capsulectomy.
- Supplements: vitamin E, omega-3, ginkgo, garlic and similar products are paused.
- Alcohol: none in the week before surgery.
- Fasting: no solid food for 8 hours and no clear fluids for 2 hours before the operation.
- Surgical bra: a front-opening, wire-free bra; an extra support band may be planned if the implant has dropped.
- Documents and imaging: implant card, previous reports and ultrasound or MRI results are handed in before the day of surgery.
On the morning of surgery, blood tests, an ECG and the anaesthetic review are completed, and the incisions and new fold level are drawn with you standing.
The operation day
Surgery takes place in a fully equipped hospital under general anaesthesia. A straightforward exchange takes about 1–1.5 hours; capsulectomy, a change of plane or a lift extends this to 2–3 hours. The removed implant and capsule are inspected, and when BIA-ALCL is suspected they are sent for pathology together with any fluid.
The new implant is placed in a pocket that is reshaped if necessary; in a dropped implant the pocket is narrowed with internal sutures. Incisions are closed with dissolving sutures. After capsulectomy a drain is usually left overnight. You stay one night in hospital; discomfort is similar to the first operation and is controlled with regular painkillers.
Recovery and aftercare
- Surgical bra: day and night for 4–6 weeks; an upper band may be used if the implant was moved upwards.
- Drains and dressings: any drain is removed within 1–2 days; tapes are renewed at the first check.
- Sleeping: on your back, slightly propped up, for 2–3 weeks.
- Showering: usually after 48 hours with waterproof dressings; baths and the sea wait 4 weeks.
- Exercise: walking from day one; raising the arms and lifting wait 3–4 weeks, upper-body training 6 weeks.
- Scar care: silicone gel or tape once the wounds have closed, and sun protection for a year.
- Long-term follow-up: new implants are not lifetime devices either; an ultrasound or MRI every few years is advised even without symptoms.
Swelling settles within 2–3 weeks and breast shape within about 3 months.
Risks and how they are minimised
Revision surgery works in a previously operated field with scar tissue, so it demands more planning than a first operation:
- Recurrent capsular contracture: reduced by total capsulectomy, irrigating the pocket with antibiotic solution, no-touch implant insertion and, where indicated, a change of plane.
- Bleeding and haematoma: prevented by meticulous bleeding control, drains and stopping blood thinners.
- Infection: sterile technique, prophylactic antibiotics and close follow-up.
- Recurrent malposition: prevented by pocket sutures, an implant base that fits the chest and a supportive bra.
- Sensory change and asymmetry: limited by tissue planning and realistic goals; minor differences are normal.
- Disappointment with volume or shape: after removal without replacement the breast can be smaller and looser; this is discussed openly and balanced with a lift or fat transfer.
For international patients
A stay of 5–7 days in Istanbul is recommended for an exchange, and 7 days when capsulectomy and a lift are added. Ultrasound or MRI can be done at home before you travel and the results shared. Surgery is scheduled for the day after arrival, you spend one night in hospital and have two check-ups after discharge, the last of which clears you to fly.
Back home, follow-up continues over WhatsApp with photographs and video calls when needed. Airport transfers, accommodation close to the hospital and an English-speaking patient coordinator are arranged by our team, and an interpreter can be requested for other languages. Details are on our international patients page.
How the price is determined
Turkish regulations prohibit advertising the prices of medical services, so no prices appear on this website. A personalised written quote follows imaging and examination. The main factors are:
- The scope of the procedure: exchange only, capsulectomy, change of plane, lift or fat transfer
- The type and dimensions of the new implant
- Operating time, anaesthesia, drains and length of hospital stay
- Pathology examination and pre-operative imaging
- Package services such as accommodation, transfers and an interpreter
The quote states what is included: follow-up visits, the bra, medication and the conditions for any revision.
Why Dr. Göktuğ Esmer
Dr. Göktuğ Esmer is a board-certified plastic, reconstructive and aesthetic surgeon and a member of ISAPS. In revision surgery his first priority is to establish the real cause of the complaint through imaging and examination, and to say clearly when changing the implant alone will not solve it.
The pros and cons of every option are discussed with you, and the decision is yours. Pre- and post-operative examinations are carried out by Dr. Esmer personally, and follow-up for international patients is handled by the surgeon himself.
Recovery Timeline
The timeline below shows a typical course; healing speed varies between patients.
Before / After
Results shared with patient consent. See more on Instagram: @doctorg.official
Frequently Asked Questions – Breast Implant Exchange and Revision Surgery in Turkey
How often should implants be replaced?
There is no fixed number of years. A trouble-free implant that looks intact on imaging does not need replacing because of its age, but implants are not lifetime devices, so regular checks are essential.
How would I know if my implant has ruptured?
Silicone rupture is often silent; there may be a change in shape, firmness or pain. Ultrasound or MRI confirms it. Saline implants deflate visibly within days.
What is capsular contracture, and can it come back?
Thickening and tightening of the sheath around the implant. Capsulectomy, pocket irrigation, a new implant and, where needed, a change of plane reduce the risk of recurrence but cannot remove it entirely.
Will the surgery go through the same incision?
Usually yes; the previous fold or areolar scar is used. If a lift is added, further scars are needed according to the degree of sagging.
What will my breasts look like if I remove the implants without replacing them?
Depending on tissue volume and skin elasticity they may look smaller and somewhat loose. A lift or fat transfer can improve this, and the likely appearance is described honestly beforehand.
Can I go up in size?
Yes, if tissue thickness and chest width allow. Oversized implants increase rippling and bottoming out, so size is based on measurements rather than volume alone.
Should I have my implants removed because of BIA-ALCL?
Preventive removal is not routinely recommended without symptoms. Swelling or fluid on one side developing years later must always be investigated; if you are concerned, we go through it together.
Can fat transfer replace an implant?
Only to a limited degree. It thickens thin tissue, disguises rippling and can give modest volume after implant removal, but a full cup-size increase should not be expected.
Sources
The general information on this page is supported by the organisations and publications below.
- Risks and Complications of Breast Implants (U.S. Food and Drug Administration)
- Things to Consider Before Getting Breast Implants (U.S. Food and Drug Administration)
- Do I need to change my breast implants every 10 years? (American Society of Plastic Surgeons)
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