Breast implant removal or revision: reasons and options

Many people live with breast implants for years without problems. Even so, implants are not designed to last for ever, and the breasts around them can change over time. At some point, further surgery may be needed or wanted, whether to replace an implant, take it out altogether or correct a problem. This guide explains the common reasons for removal or revision, what the surgical options are, what is known about BIA-ALCL and breast implant illness, and what to ask before deciding.

Implants are not lifetime devices

The U.S. Food and Drug Administration (FDA) states that breast implants are not considered lifetime devices. How long an individual implant lasts varies and cannot be predicted, and the longer someone has implants, the more likely complications become. The NHS similarly explains that implants are not permanent and will probably need replacing at some point, either because of a problem with the implant or because the breasts have changed around it.

This does not mean implants have to be changed on a fixed timetable. It means it is sensible to know your implant details, keep up with check-ups and get any changes looked at. The FDA suggests keeping a record of the manufacturer and model of your implants, which your surgeon or operation notes can provide. In the UK, the Breast and Cosmetic Implant Registry has recorded implant operations since 2016 so that people can be traced if a safety concern arises; the MHRA notes that you can ask your surgeon or clinic to add earlier details.

Common reasons for removal or revision

The FDA and NHS describe several problems that can lead to another operation:

• Capsular contracture: the body naturally forms a layer of scar tissue, called a capsule, around an implant. Sometimes this tightens, making the breast feel firm or hard and sometimes painful. More severe contracture may need surgery.
• Rupture: a tear or hole in the implant shell. A saline implant deflates, while a silicone gel rupture often causes no symptoms. The NHS advises that a ruptured implant should be removed.
• Position and shape: an implant can move out of place or rotate, the breasts can look uneven, and visible folds or rippling can develop, especially where the tissue covering the implant is thin.
• Pain, infection or changes in sensation around the breast or nipple.
• Changes over time: the NHS notes that the breasts themselves can change around the implants, which may lead to further surgery.

Because most silicone ruptures are silent, the FDA explains that an MRI scan is the most effective way to detect them, with ultrasound an acceptable alternative for people without symptoms. When symptoms do occur, they can include changes in breast shape, lumps, pain or numbness.

Surgical options

According to the FDA, further operations can involve removing an implant with or without replacing it, removing the scar capsule, repositioning an implant, revising scars or draining a collection of blood. The right combination depends on the reason for surgery, your tissue and your wishes.

Replacing the implant

An implant may be exchanged for a new one, sometimes of a different size or type, with or without work on the capsule or the position of the pocket. The FDA notes that no reoperation can promise a satisfactory cosmetic result, so it is worth discussing realistic expectations in detail.

Removing the implant without replacement

Some people choose to have implants taken out and not replaced. The FDA explains that after removal some people notice dimpling, puckering, sagging or a hollowed look, and that this can be more marked after large implants placed in front of the chest muscle. The MHRA notes that shape changes after removal may need further surgery to correct.

What happens to the capsule

The surgeon may remove only the implant and leave the capsule, which involves less dissection, or remove part or all of the capsule. Total removal, sometimes called a total or en bloc capsulectomy, is more complex. The MHRA explains that it can cause serious problems, such as a collapsed lung, that it is not routinely available on the NHS and that it is not known whether removing the capsule lowers any future risk. The FDA advises that the choice should be made together with your surgeon.

BIA-ALCL: what it is and what to look for

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare cancer of the immune system, not a breast cancer. It usually develops in the fluid or scar tissue around an implant. Both the FDA and the MHRA describe the overall risk as low. Most cases have been linked to textured implants, but the MHRA advises assuming any implant could carry some risk until the evidence is clearer. The cause is not yet known, and nothing is known to prevent it.

Most cases appear years after implant surgery. The MHRA describes the most common sign as a fairly quick, painless swelling of the breast caused by fluid collecting around the implant. Less often, there is a lump near the implant or the capsule becomes tight, hard or painful. If you notice these changes, seek medical advice so they can be assessed with an examination, imaging and, if needed, tests on the fluid or tissue.

When BIA-ALCL is confirmed, treatment involves removing the implant and the surrounding capsule, and some people need further treatment. The MHRA notes that most cases in the UK are found early and cured by this surgery. For people without symptoms, the FDA and the MHRA do not recommend routine removal, and the MHRA explains that there is no screening test and routine scans are not needed.

In the UK, the MHRA advises that if your implants have been trouble-free for years and you notice new changes, you can see your GP and ask for referral to an NHS breast clinic, even if the implants were placed privately or abroad. If the implant was placed within the last year, contact the surgeon or clinic that did the operation.

Breast implant illness

The NHS notes that some women report tiredness, anxiety and joint pain after implant surgery, which is sometimes called breast implant illness. The FDA lists similar reported symptoms, including fatigue, memory problems, rash, “brain fog” and joint pain, and states that these symptoms and their causes are poorly understood. It also notes that some people report their symptoms improved after their implants were removed without replacement.

If you have symptoms like these, it is reasonable to raise them with your doctor and surgeon. The FDA encourages people to report such symptoms, and your surgeon can discuss whether removal is an option for you.

Recovery and questions to ask

Recovery depends on what is done. Removing an implant alone is usually a smaller operation than removing the whole capsule or reshaping the breast, and your surgeon will advise you on time off work, driving and exercise. General aftercare advice from MedlinePlus after cosmetic breast surgery includes short walks soon after the operation, avoiding heavy lifting and strenuous exercise for several weeks, wearing a soft supportive bra as advised and keeping wounds clean and dry.

Questions you may want to ask include:

• What do you think is causing my symptoms, and which tests do I need?
• What are the options: replacement, removal alone, or removal with capsule surgery?
• What will my breasts be likely to look like afterwards?
• What are the specific risks of the operation you recommend?
• What follow-up will I have, and who do I contact with concerns?

The NHS advises contacting the clinic promptly after breast implant surgery if you have unexpected pain, a burning sensation, unusual swelling or changes in skin colour. MedlinePlus also advises calling your surgeon about a fever of 38°C or higher, yellow or green discharge from a wound, or sudden swelling of a breast. With or without implants, the NHS advises staying breast aware and continuing breast screening, telling the staff about any implants.

Next steps

If you have concerns about your breast implants, a review with a plastic surgeon can help clarify what is happening and which options make sense for you. You can read more about our plastic and aesthetic surgery specialists, or answer a few questions to be matched with a doctor: Find my physician.