The operation is always performed under general anaesthetic and depending on the reason for the exchange it can either be done as a day surgery or a short in-patient procedure.
In cases where the implant merely needs to be replaced, without significant changes to the breast size or shape, an old scar in the breast fold can be re-opened to replace the implant.
If there is capsular contracture often part or even the entire capsule must be removed to allow the tissues to drape nicely over the new implant. This can also usually be done over an old scar in the breast fold, however it may need to be lengthened slightly.
When the new implant is smaller than the existing one, it is usually necessary to surgically tighten the breast as well, like it is done in a mastopexy.
The implants we use are exclusively made from silicone and manufactured by reputable, medically certified companies. Implants are available in a wide range of sizes and typically come in two different shapes, namely round and anatomical (or “tear drop”). Your surgeon will advise you as to the ideal shape and size to accommodate your desires and expectations based on your existing breast shape and size. However the final decision on the implant used will be left to you.
The implant can either be placed in a pocket between the chest muscle and the breast tissue, or behind the pectoral muscle. Each position has advantages and disadvantages that may or may not apply to each individual patient. Your surgeon will advise you which the most suitable implant position is for you.
The skin incisions are usually closed with self-absorbing sutures.
You will be encouraged to wear a fitted bra day and night for 4-6 weeks after surgery.
The wounds will be covered with water-proof dressings allowing you to get the area wet in the shower.
The dressings can usually be left intact until your first follow-up appointment with your surgeon.
You will be able to resume most every-day activities within the first few days after surgery. We recommend refraining from sport or any strenuous upper body activities for at least 6 weeks after surgery.
Regular follow-up appointments with your surgeon will be scheduled at 2 weeks, 6 weeks, 3 months and 1 year after surgery.
As with every surgical procedure implant replacement is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
General complications of all surgical procedures include:
Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)
The most common surgical complications after implant replacement include:
- postoperative bleeding, hematoma
- implant displacement or rotation
- unsightly or asymmetric scars
- delayed wound healing or wound breakdown
- decreased or altered sensation of the nipple/areola
- Implant failure/rupture
- seroma (fluid collection around the implant)
- capsular contracture
- visible or palpable implant
Implant replacement with or without removal of any existing capsule does not prevent capsular contracture from reoccurring. In fact, new capsule formation tends to progress faster after around the replaced implant and can frequently even become symptomatic as soon as three to four years postoperatively.
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special tests before surgery?
Usually not. The surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
Do silicone implants cause cancer?
Silicone has been used in many different areas of medicine for over 40 years. Multiple long-term studies have been able to confirm that medical grade silicone inside the body can be considered harmless. The risk of any individual developing breast cancer is identical before and after breast augmentation with implants. Therefore the same recommendations for breast cancer screening can and should be applied after surgery.
There have been a small number of case reports where a very rare form of lymphoma (Anaplastic Large Cell Lymphoma, or ALCL) have occurred in woman with silicone breast implants. According to current scientific knowledge the absolute risk of developing ALCL after breast augmentation with silicone implants is estimated to be between 1 in 5000000 and 1 in 3 million. The Swiss Society of Plastic Surgery (SGPRAC) has published the following recommendations in 2015:
You can read the official publication online under the following link:
Is silicone poisonous or dangerous?
No. Silicone is neither poisonous nor dangerous. Silicone implants contain medical grade silicone which is a cohesive gel. Even in the event of an implant rupture the silicone does not spread around the body but remains within the tissue pocket where the implant lies.
How common are implant ruptures?
Implant ruptures are very rare (current scientific studies report an incidence of below 10% over a 10 year period). The most common causes are manufacturing defects or advanced capsular contracture. Implant ruptures after extensive physical activity or trauma are exceedingly rare.
An implant rupture itself is not dangerous and certainly not a medical emergency. It does however cause the breast to lose its shape and the implant should be replaced.
What happens if the implant gets infected?
An infected implant will need to be surgically removed followed by a course of antibiotics. Once the infection has subsided and the tissues have recovered (approximately 6-8 weeks later) a new implant can be inserted in a second procedure.
Do you use PIP implants?
No. PIP implants have been withdrawn from the market. We only use medically certified implants from reputable manufacturers.
How long can breast implants stay in?
Implants do not have an expiry date. The lifespan of the newer generations of breast implants can easily extend 30 years. How long a breast implant can stay in place is usually not determined by the implant itself, but more by changes in the tissues around it. Capsular contracture or changes in the breast shape and size after pregnancy or aging are the most common reasons to replace the implant.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed after about a week. Lifting heavy objects and activities that strain the upper body and chest muscles should be refrained from for at least 6 weeks. Especially if you have small children it is important for you to plan and ensure enough support for their care other household chores during your recovery period.
Will I get a sick certificate for the time I am off work?
If the procedure is covered by your health insurance (e.g. advanced capsular contracture) a sick certificate can be issued. However sick certificates cannot be issued for cosmetic procedures. You will need to take leave for the entire period that you are absent from work.
Will my health insurance cover the costs for the surgery?
In cases of advanced symptomatic capsular contracture or implant rupture your health insurance may cover some the costs for the procedure (the cost of the new implant is usually not covered). Written confirmation of approval to cover the costs by your insurer will need to be obtained prior to the procedure.
Implant replacements for cosmetic reasons will not be covered by health insurance.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. In case of capsular contracture your health insurance will usually cover the cost for removal of the capsule, but you will be required to pay for any new implant yourself. Corrections of aesthetic complications (e.g. unsatisfactory shape, size, implant rotation or malposition etc. ) are not covered.