Exchange or definitive removal? How to decide between replacing your implants and having them removed

The question is decided earlier than it seems, and with a single distinction: is the problem the implant, or is it what is around it? If it is the implant —it is ruptured, it has shifted, it no longer matches the size you want—, an exchange solves it. If the problem is the tissue, the capsule or your relationship with carrying implants, swapping it for another like it leaves the problem where it was.

This page is the comparison between the two, not the catalogue of each. What exactly an exchange is and how long an implant lasts is on the page about how long implants really last.

🚨 What this page is about, and what it is not. Here a simple removal is compared with a simple exchange: the cases in which the breast has not dropped, has not got worse and there is nothing aesthetic to correct. If there is —and it is the commonest situation after years with implants—, neither option is done on its own: it is combined with a breast lift, with or without an implant. That changes the surgery, the price and the recovery, and it is on how the breast looks when the implants come out.

The distinction that orders everything

Before comparing prices, timings or scars, one question is worth answering.

What is it that has failed?

• The implant has failed. Rupture, loss of volume, displacement, rippling that can be felt. Here there is a component that no longer does its job and replacing it is the direct solution.
• The relationship between the implant and your body has failed. The breast has changed with weight, pregnancies or the years, and the implant that fitted then does not fit now. A new implant can readjust the size, but it does not on its own correct the position or the skin.
• The capsule has failed. Symptomatic contracture, hardening, pain, deformity. The implant may be perfectly fine and the problem be outside it.
• What you want has changed. You no longer feel like carrying implants. It is reason enough and it needs no medical justification.

What each one solves

The figure that weighs most: the contracture can come back

It is the part of the conversation that is usually missing, and it is the one that makes many patients choose removal.

In a series of 75 women treated surgically for capsular contracture after an augmentation:

• 17 (22.7%) developed a recurrent contracture;
• 2 (2.7%) had a second recurrence;
• patients with ruptured silicone gel implants had a significantly greater risk of recurrence (p = 0.01);
• the problem was corrected with a single operation in 77.3% and with two in 97.3%.

🔑 And the counter-intuitive finding: in that series there was no significant difference between putting the intact implant back and replacing it with a new one — 12.5% against 18.2% recurrence. That is, the idea that “a new implant prevents contracture” is not supported by that study.

⚠️ There are far better results published, such as a single-centre series of 51 patients describing a recurrence of 1.96% by combining total capsulectomy with a new implant. It is level of evidence V, from a single centre and attributed to a particular commercial implant model that this page does not name. Both figures are published and the distance between them is the honest measure of what is known: recurrence is real and how often it happens depends a great deal on the technique, on the case and on who is publishing.

What age does and does not decide

“At what age is it worth thinking about having them out for good?” is a frequent question and the answer is not a number.

What does change with the years is the arithmetic: every implant has a lifespan and every exchange is one more operation. At 40, considering an exchange means probably taking on another one later. At 60, it may mean that this is the last. Each patient does that sum, and it is legitimate in both directions.

What does not change is the medical indication. There is no age at which implants have to come out and none beyond which surgery is impossible. What is assessed is general health, not the date of birth.

⚠️ And one piece of context: in the most recent twenty-year series, the mean age at explantation was 43 and the mean time with the implant 12 years.

If the reason is general symptoms

Here one has to be particularly careful, because it is where promising is easiest.

The most recent meta-analysis on explantation and capsulectomy in patients with symptoms attributed to the implant concludes that, in the systemic symptoms group, most did not achieve complete improvement and the degree of improvement was moderate. The authors themselves warn of considerable heterogeneity between studies and ask for the results to be interpreted with caution.

That same piece of work offers two qualifications worth knowing:

• how often these pictures occur was not related to how long the implant had been in place, or to capsular contracture, or to rupture;
• being under 50 was an associated factor in their appearance.

🚨 Practical translation: if what brings you to the consultation is general symptoms, the conversation starts by ruling out other causes, not by choosing between exchange and removal. And if after that you decide to have the implants removed, it is a reasonable decision taken in the knowledge that improvement is variable and not guaranteed. The page on BIA-ALCL and implant illness sets it out in full.

What each one costs

Between €5,900 and €7,900, as a guide and subject to assessment, with a written quotation after the consultation. What moves a case within that range:

• The exchange includes the new implant, which is separate from the operation itself. Removal does not.
• Removal can end up costing more if a breast lift, lipofilling or both are added: that means two more procedures in theatre.
• A total capsulectomy lengthens the operation in either of the two options.
• The manufacturer’s warranty may cover the replacement implant if the reason is a rupture. It covers the implant, not the surgery. Here we normally work with Motiva, Mentor, Silimed and Polytech. ⚠️ Two limits worth knowing before counting on it: it depends on the brand still existing —the programmes lapse when a company disappears— and if you had surgery in another country, the exchange is often not covered in a different one.

Risks

Those of any properly conducted breast operation —seroma, haematoma, infection, healing problems, altered sensation— and two that belong to this decision in particular:

• In an exchange: that the reason that led to surgery appears again, notably contracture.
• In removal: that the aesthetic result is not what was expected. The FDA warns of this expressly for large implants placed in front of the muscle.

The specific figures depend on the technique and on the case, and they are explained in consultation.

Frequently asked questions

Exchange or removal: how do I decide which suits me?

By first answering what has failed. If it is the implant, an exchange solves it. If it is the capsule, the position of the breast or your relationship with carrying implants, a new implant does not change that. And if it is general symptoms, the first thing is to rule out other causes.

Can the contracture come back after an exchange?

Yes. In the most cited series, it recurred in 22.7% of the patients treated for contracture, and those whose silicone implant was ruptured had a significantly greater risk. There are series with far lower figures, but with a lower level of evidence. It is a real risk and it has to be reckoned with when choosing.

Do both implants have to be changed even if only one has ruptured?

It is the usual course, for two practical reasons: symmetry —a new implant and a fifteen-year-old one do not age the same— and avoiding a second operation in the short term. It is not an absolute medical obligation and it is decided case by case.

Is an exchange simpler or cheaper than the first augmentation?

Not necessarily. It can be when the implant comes out without difficulty and the capsule is thin. It stops being so when a thick or calcified capsule has to be removed, when the position of the pocket has to be corrected or when a lift is added. An exchange is more like revision surgery than a first augmentation.

Can I use the exchange to change size or lift the breast?

Yes, and it is one of the frequent reasons for doing it. Changing the volume is straightforward; lifting the breast at the same time is a more complex operation, decided by the position of the nipple and the excess skin. It is set out in full in the page on lifting the breast over implants already in place.

At what age is it worth having them out for good?

There is no such age. What changes with the years is how many more implant and surgery cycles it makes sense to take on, and each patient does that sum. In the published series the mean age at explantation is around 43, but it is an average, not a criterion.

If I have them removed, can I have them put back later on?

It can be considered. In the twenty-year series, of 77 patients explanted only two went back to an implant. The sensible thing is to let some months pass and see how the breast ends up before deciding anything.

Will the manufacturer’s warranty pay for the new implant if the old one ruptured?

It depends on each manufacturer’s programme and its time limit. In general they cover the replacement implant, not the costs of the surgery, and they require documentation of the original implant. Here we normally work with Motiva, Mentor, Silimed and Polytech. Two warnings: the warranty depends on the brand still existing, and surgery done in another country often does not have the exchange covered in a different one. It has to be checked before surgery, not afterwards.

Sources

• Swanson E. Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation. Plastic and Reconstructive Surgery – Global Open. 2016;4(10):e1096. PMID 27826488 — 75 women treated for capsular contracture. Recurrence in 17 (22.7%) and a second recurrence in 2 (2.7%); a significantly greater risk with ruptured gel implants (p = 0.01); and no significant difference between putting the intact implant back (12.5%) and replacing it with a new one (18.2%). Corrected with one operation in 77.3% and with two in 97.3%. Checked on 05-09-2026.
• Serra PL, Mariani M, Fabbri M, et al. Capsular Contracture After Breast Augmentation: Our Approach to Prevent Reoccurrence with Combined Total Capsulectomy and Implant Replacement. Aesthetic Plastic Surgery. 2025;49(7):1988-1999. PMID 39681688 — 51 patients with grade III-IV contracture; recurrence of 1.96% with total capsulectomy and a new implant. Level of evidence V, a single centre and a result attributed to a particular commercial model, which this page does not name. It is cited as a contrast to the published range, not as a figure to expect. Checked on 05-09-2026.
• Cuenca-Pardo J, Ramos-Gallardo GO, Lira-Álvarez M, et al. Breast implant explantation and capsulectomy in symptomatic patients. Is there any improvement with the procedure? Systematic review and meta-analysis. JPRAS Open. 2026;50:152-164. PMID 42099752 — Most patients with systemic symptoms did not achieve complete improvement and the degree was moderate. How often these pictures occurred was not related to how long the implant had been in place, to contracture or to rupture, and being under 50 was a significant factor. Considerable heterogeneity declared by the authors. Checked on 05-09-2026.
• Eisenberg TS, Pilla J, Chapa G. A 20-Year Experience with Round Smooth Saline Breast Implant Explantation: Reasons, Trends, and Management. Aesthetic Plastic Surgery. 2026;50(3):1073-1081. PMID 41023230 — A mean age at explantation of 43 and a mean of 12 years with the implant; of 77 patients explanted, only two went back to an implant. Level of evidence III. Checked on 05-09-2026.
• Risks and Complications of Breast Implants. U.S. Food and Drug Administration, updated 14 December 2023. fda.gov — A warning about the aesthetic result after removal without replacement, with a greater risk with large subglandular implants. Checked on 05-09-2026.

Book your consultation

If you are torn between changing them and taking them out, what settles the question is not a list of advantages: it is knowing what has failed in your case. That is seen by examining and, where needed, with an imaging test — and from that comes the recommendation, including the recommendation not to operate yet.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503