Breast Implant Replacement and Removal in Ukraine

Breast implant replacement and removal is a repeat procedure for a patient who already has implants. The logic is different from a first augmentation: you are not choosing a size from scratch but solving a specific problem, and the surgeon is working not with untouched tissue but with a scar capsule, altered breast tissue and skin that has already been stretched.

The most common reason is capsular contracture: the connective tissue capsule around the implant thickens and squeezes it, the breast becomes firm, changes shape and rides up, and pain appears. The second most common is implant rupture or leakage. Next come implant displacement and rotation, noticeable asymmetry, double bubble and symmastia: defects that occur when the implant moves beyond a correctly formed pocket or when the pockets merge in the midline.

A separate group of reasons has nothing to do with complications. After pregnancy, breastfeeding and weight loss the breast tissue shrinks while the skin remains stretched, so the breast sags and the implant drops along with the tissues. Other patients simply want to change the volume or shape: over ten to fifteen years both the body and your idea of the result you want change.

There is no such thing as a routine replacement every ten years. This is a common myth: intact implants that do not bother you and show no signs of damage on imaging do not need to be replaced. The indication is a specific finding (rupture, grade III or IV contracture, displacement, persistent deformity or symptoms), not the date of the previous operation in your medical record. Manufacturers recommend periodic checks on the condition of implants, and this means monitoring, not a reason to have surgery by the calendar. At the same time, implants are not lifelong devices: over the years the risk of rupture and capsular contracture increases, and according to manufacturers' data roughly 20–30% of patients have a repeat operation within ten years of implantation. In other words, replacement is determined by the condition of the implant and tissues, not by a date in your record, but the likelihood of another operation in future remains, and it makes sense to factor it into your plans, including financial ones, from the outset.

Surgery is not performed with active infection, uncontrolled heart, vascular or lung disease, blood clotting disorders, or untreated cancer. It is postponed if your weight is unstable, if you are planning a pregnancy in the near future, and while breastfeeding. Unrealistic expectations are also approached with caution: if you expect your breasts to look as they did before the first operation, this conversation needs to happen before surgery, not after. MediUkraine is a treatment search and coordination service, not a clinic: we select the surgeon and medical centre, and the decision on surgery is made by the doctor after an in-person examination.

Any repeat operation comes down to three decisions: what to do with the old implant, what to do with the capsule around it, and what to do with the shape of the breast afterwards. They are not made separately: the amount of work on the capsule determines how much room is left for the new implant, and the condition of the skin determines whether replacement alone is enough or a lift is needed. That is why the plan is put together as a whole, not as a list of independent stages.

The capsule is a connective tissue layer that the body forms around any foreign object; in itself it is not a disease but a normal reaction. It becomes a problem when it thickens and squeezes the implant. On the Baker scale, grade I means the breast is soft and looks natural; grade II, the firmness can be felt; grade III, the shape has changed and is visible; grade IV, there is pain as well. Surgery is usually needed for grades III and IV, while grades I and II are more often monitored.

Capsulotomy means cutting into the capsule without removing it: the capsule is opened to enlarge the pocket and relieve the squeezing. It is chosen when the capsule is soft and thin without calcification, and the implant simply needs to be replaced with a new one and the pocket slightly resized. Partial capsulectomy is excision of only the altered part of the capsule, most often the front wall, while the back wall, which lies tightly against the ribs and chest fascia, is preserved. It is a compromise between thoroughness and tissue trauma, and it is the option used most often in revision practice.

Total capsulectomy means removing the entire capsule, both the front and back walls. It is done when the capsule is thick and calcified, when contracture recurs, when free silicone has been present for a long time, and when the implant is moved from beneath the muscle to a different plane. En bloc capsulectomy means removing the capsule in one piece together with the implant, without opening it. Technically this is the more demanding option: the capsule is thin and lies tightly against the ribs and pleura, so in some patients it cannot be removed completely in one piece without risking damage to the chest wall.

En bloc should be understood correctly: it is a technique used when indicated, not a universal requirement. It is justified for confirmed or suspected BIA-ALCL, for a ruptured silicone implant with gel outside the shell, and for a thick, calcified capsule. When the capsule is thin, soft and unchanged, en bloc gives the patient no additional benefit but lengthens the operation and increases blood loss and the risk of damage to the pleura. A surgeon who offers en bloc to everyone and a surgeon who refuses it when there are real indications are equally wrong.

A separate note on BIA-ALCL, breast implant-associated anaplastic large cell lymphoma. It is a rare disease of the lymphatic system that develops not in the breast tissue but in the capsule around the implant, and the risk varies depending on which implant you have. For smooth surfaces only isolated cases have been described. For textured surfaces the risk is estimated at roughly 1:2,200 to 1:86,000, depending on the manufacturer and type of texture; these estimates come from the FDA and the PROFILE registry, and this is why a patient with textured implants should know the symptoms and not skip check-ups. Removing intact implants as a precaution solely because of this diagnosis is not recommended. The typical sign is a late seroma: sudden enlargement and swelling of the breast a year or more after surgery, and less often a lump in the capsule. Such a seroma does not go away on its own and is not treated with antibiotics: the fluid is aspirated under ultrasound guidance and sent for cytology with immunohistochemistry for CD30 and ALK. When detected early, complete removal of the capsule together with the implant is sufficient in most cases. This diagnosis must not be glossed over: a late seroma always needs investigation, not waiting.

Changing the implant plane is a separate decision in revision surgery. An implant that sat beneath the breast tissue is often moved beneath the pectoralis major muscle or into a dual-plane position: muscle coverage masks the edges of the implant, reduces visible rippling and lowers the rate of recurrent contracture. The reverse move also happens: with marked animation deformity, when the breast visibly moves as the muscle tenses, the implant is returned to the plane above the muscle, sometimes with coverage by acellular dermal matrix or mesh. The new pocket is formed precisely to the size of the new implant, and the old one is stitched closed if needed so that the implant does not slip into the old space.

For a repeat procedure, access is most often through the existing scar, which adds no new marks. An inframammary incision in the fold beneath the breast gives the surgeon a direct, wide view of the capsule and chest wall, so it is the one chosen for capsulectomy; a periareolar approach is suitable when a lift around the areola is planned at the same time. Repeat operations are rarely done through the armpit: it is difficult to control the back wall of the capsule from there. If the old scar is poorly placed or coarse, it is excised and a new one is formed.

When sagging accompanies replacement, a simultaneous mastopexy is needed: a new implant on its own does not lift the nipple. The extent of the lift depends on how far the nipple-areola complex has dropped relative to the inframammary fold, from periareolar to vertical and anchor patterns. Combining replacement with a lift increases the length of the procedure and of the scars, but gives you one operation and one recovery period instead of two. With a large excess of skin, some surgeons deliberately split the work into two stages a few months apart, as this lowers the risk of problems with the blood supply to the areola.

Removing implants without replacement almost always requires a lift. This needs to be said plainly: for years the implant stretched the skin and pressed on the breast tissue, so after it is removed the breast does not return to how it looked before surgery. What remains is empty, sagging skin, often with a lowered nipple and a flattened upper pole. The larger the implant, the longer it was in place and the more your weight has changed, the more noticeable the effect. That is why removal is planned together with a mastopexy and, if needed, fat grafting with your own fat is added to restore volume in the upper part of the breast. If you want to just remove the implants first and see, the surgeon must show you photos of real results without a lift rather than simply reassure you.

You spend the first hours after the operation in a ward under observation: blood pressure, pulse and the condition of the dressing and drains, if any were placed, are monitored. The hospital stay is usually 1–2 days; after an extensive capsulectomy or a simultaneous lift it is longer, at the surgeon's discretion.

Pain in the first two to three days is noticeable and is controlled with painkillers on a schedule. Swelling and bruising peak on the second or third day and then gradually subside: things ease noticeably by the end of the second week, while residual swelling lasts longer. Drains, if present, are removed on days two to five, once the amount of fluid decreases.

The compression garment is put on straight after the procedure and worn around the clock for the first four weeks, then only during the day for the same length of time again; the surgeon gives you the exact timeframe. You will need to sleep on your back with the head of the bed raised for about a month. Stitches are removed on days 10–14, or dissolvable stitches are used.

Most patients return to desk work after 10–14 days. Everyday activity without raising your arms above shoulder height is allowed from the second week, light cardio after about a month, and strength exercises for the chest, shoulders and back no earlier than eight weeks. Saunas, swimming pools and sunbeds are ruled out for two months.

The shape of the breasts in the first weeks is misleading: the implants sit higher than they will later, the tissues are tight and the lower pole has not yet formed. The implants settle into position over 3–6 months, and after a simultaneous lift the final result is assessed no earlier than six months later, sometimes after a year.

Scars follow their own course, separately from the shape: at first they are red and firm, by the third or fourth month they fade, and they fully mature over 12–18 months. Scar care (silicone sheets or gels, sun protection) starts once healing is complete and as prescribed by the doctor. Follow-up appointments are usually on day 7 and at one, three and six months; for patients from abroad MediUkraine arranges them remotely, and the first check-up is scheduled before you leave.