In short
- The surgeon goes in through the scar you already have. An exchange does not add a new scar in most cases.
- 🔑 What is decided in theatre is the capsule, not the implant: the implant has already been chosen beforehand.
- An exchange changes the container, not the contents: the tissue, the skin and the pocket are the same.
- ⚠️ Changing the implant does not on its own prevent contracture. In the reference series, recurrence was 18.2% when the implant was replaced and 12.5% when the same one was put back, with no significant difference.
- Recovery is that of breast surgery with an implant: desk work at 2-3 days, driving at 2 weeks, the gym gradually at one month.
- The post-operative bra for a month, and sometimes it has to be extended.
- 🚨 Smoking is stopped a month before and a month after. It is the clinic’s rule for all its surgery.
An exchange is done through the same scar, and more is decided in theatre than it appears. The old implant is removed, the capsule that has formed around it is assessed —which is what determines a good part of the result—, the pocket is adjusted if need be and the new one is placed.
And the second half of this page is the one almost nobody writes: how long it takes to drive, to go back to work and to set foot in a gym, with the regimen used here.
This page sets out the “how” of the option decided in exchange or removal.
🚨 What this page is about: a SIMPLE exchange, in which the implant is changed and nothing else is done. If on top of that the breast has dropped or there is something aesthetic to correct, an exchange alone does not fix it: a breast lift has to be added, with or without an implant. That is another operation, with another timescale and another price.
What is done, step by step
1. The way in is chosen
In many exchanges the existing scar is reopened and no new incision is needed. But that is not always the best option, and this is worth knowing beforehand: when there is something more to correct, a new scar can give an advantage the old one cannot.
- Periareolar, if the areola is also to be made smaller.
- Inframammary, if the fold has to be anchored or lowered.
🔑 So the question in consultation is not “will you go in through the same scar?” but “what else has to be corrected?”. The approach comes out of the answer, not the other way round.
2. The old implant is removed
It is taken out and examined: whether it is intact, whether there is silicone bleeding through the shell, whether it is ruptured. That information changes what is done next.
3. What to do with the capsule is decided
It is the decision that weighs most on the result, and it has no single answer. It can be left, opened to release tension, removed partly or removed whole. Which one applies depends on whether there is contracture, on its grade, on whether the implant was ruptured and on the thickness of the capsule itself.
It is set out in full on the page about the capsule and en bloc explantation, including where the boundary lies between when en bloc removal is indicated and when it is not.
4. The pocket is adjusted
If the implant had shifted, if the fold has dropped or if the new implant has a different base, the space has to be remade: closing on one side, opening on the other. In some cases meshes are used to hold it, although the evidence available is still from short series.
5. The new implant is placed
And there is no last-minute decision here: the implant is chosen beforehand, in consultation, by measuring. What types there are and how they differ is on the page on types of implant.
What an exchange does not fix on its own
It is worth saying here because it is where the most false expectation is created.
The implant is the only new thing. The skin covering it, the gland that remains and the pocket are the same as before, with all the years they have. A breast that has dropped over the implant is not lifted by putting in a new one: for that a lift is needed, which is on its own page.
⚠️ And on contracture, the figure that goes against intuition. In a series of 75 women treated for capsular contracture, overall recurrence was 22.7%, and there was no significant difference between putting the intact implant back (12.5%) and replacing it with a new one (18.2%). That is: changing the implant, on its own, is not what prevents recurrence. What was associated with more risk was the gel implant being ruptured.
🔑 What can change things is treating the capsule. A series of 51 patients with grade III or IV contracture treated with total capsulectomy plus a new implant describes a recurrence of 1.96% — a very striking result, from a single centre and with a small sample, as the authors themselves point out. It marks a direction; it does not settle the question.
What recovery is like
This is the clinic’s regimen for breast surgery with an implant, which is the one that applies to an exchange. ⚠️ It is not a fixed calendar: the surgeon individualises it according to how each case progresses and to the circumstances.
| ICPM protocol | |
|---|---|
| Walking | From the day of the operation itself |
| Arms and weight | No raising your arms above the horizontal and no carrying more than 2 kg for the first 2 weeks |
| Driving | From 2 weeks onwards |
| Office work | At 2-3 days, if there is no excessive discomfort |
| Work with light physical activity | At around 3 weeks |
| Work with heavy physical activity | 1 month |
| Gym and exercise | Resumed gradually at one month |
| Post-operative bra | 1 month, adapted to how things progress. Sometimes it has to be extended |
| Stitches | At 2 weeks |
| Shower | Once the dressing is removed, if one is used |
| Sun on the area operated on | At one year, and with factor 50. On areas not operated on, from the first week |
| Check-ups | 2-3 days · 2 weeks · 1 month · 3 months · 6 months · 1 year |
⚠️ A note about the stitches. All the stitches are internal: what is taken out at two weeks are the external ends of the intradermal sutures, not a stitch in the skin.
🔑 The restriction on the arms is the one that most constrains daily life, and it is the one most underestimated when planning. Two weeks without raising your arms above the horizontal or carrying more than two kilos affects hanging out the washing, picking up a child and most jobs that are not office work.
Smoking
🚨 A month before and a month after. It is the clinic’s rule for all its surgery, not just this one, and it is the modifiable measure that weighs most on the risk of healing problems.
Risks
They are those of breast surgery with an implant, with two qualifications specific to a second operation:
- Capsular contracture, which can come back even if the implant is changed.
- Seroma and haematoma.
- Infection, which in surgery with an implant may force it to be removed.
- Healing problems, on a scar that has already healed once.
- Malposition of the implant or asymmetry, more likely the more the pocket has to be remade.
- Altered nipple sensation, usually temporary.
- The need for a further operation, which in revision surgery is more likely than in a first operation.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
What is exchange surgery like?
The surgeon goes in through the previous scar, removes the implant and examines it, decides what to do with the capsule, adjusts the pocket if need be and places the new implant, which has already been chosen beforehand in consultation.
Does it leave a new scar?
Often not: the existing one is reopened. But it is not always in your interest to do it that way. If the areola also has to be made smaller, a periareolar incision allows that; if the fold has to be anchored or lowered, the inframammary one does. In those cases the new scar is not a cost, it is what makes the correction possible.
What is recovery like? Do I need time off work again?
The clinic’s regimen is walking from the day itself, office work at 2-3 days if there is no excessive discomfort, 3 weeks for work with light physical activity and 1 month for heavy work. Driving at 2 weeks and the gym gradually at one month. What constrains you most is the first two weeks without raising your arms above the horizontal or carrying more than 2 kg.
How long do I wear the post-operative bra?
One month, adapted to how things progress, and sometimes it has to be extended.
When are the stitches taken out?
At two weeks. All the stitches are internal: what is taken out are the external ends of the intradermal sutures.
When can I sunbathe?
On the area operated on, at one year and with factor 50. On areas not operated on, from the first week.
What check-ups will I have?
At 2-3 days, at 2 weeks, at one month, at 3 months, at 6 months and at a year.
Can the contracture come back after an exchange?
It can. In the reference series, recurrence after treating a contracture was 22.7%, and changing the implant made no significant difference compared with putting the same one back. What was associated with more risk was the gel implant being ruptured. Treating the capsule does appear to change the outlook, although the evidence for that comes from small single-centre series.
How long does the operation take and how many nights in hospital?
A simple exchange, around 1 hour. If a capsulectomy is added, between 1.5 and 2 hours. It can be dealt with as day surgery or with one night in hospital, depending on the case and on how the afternoon goes.
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 22.7%, 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%). 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 or IV contracture and 102 implants; of those explanted, 77 intact, 15 with silicone bleeding and 10 ruptured. Recurrence of 1.96% with total capsulectomy plus a new implant. ⚠️ A single centre and a small sample, a limitation the authors themselves declare. Checked on 05-09-2026.
- Zucal I, Cresta E, De Pellegrin L, Weinzierl A, Harder Y. The Role of Synthetic Meshes in Revision Surgery After Breast Augmentation: A Personal Experience. Journal of Clinical Medicine. 2025;14(17):5978. PMID 40943738 — Series of eight patients with symptomatic contracture, implant migration or animation deformity. No infection and no seroma over a follow-up of 6 to 42 months. ⚠️ A very small, heterogeneous group: the authors ask for larger studies to validate the findings. It is cited as what it is, an initial experience. Checked on 06-09-2026.
- Risks and Complications of Breast Implants. U.S. Food and Drug Administration, updated 14 December 2023. fda.gov — Breast implants are not lifetime devices and the risk of complications increases with the time they have been in place: it is the frame within which any exchange is considered. Checked on 05-09-2026.
- ICPM’s protocols and criteria. Dictated by Dr Enrique Salmerón, 06-09-2026 (
dms/PAUTAS-DE-LA-CASA.md, §1 and §2). The source of the whole recovery table and of the smoking rule. It is the clinic’s own criterion, not literature, and it is cited as such.
Book your consultation
If you have already decided on an exchange and want to know what it involves in your case —what will be done with the capsule, whether the pocket has to be adjusted and how many days you are going to need—, that is what is pinned down at an assessment with your reports and your implant card in front of us.
Clinical confirmation by the surgeon
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