Breast implant replacement and removal
what you need to know

When implants are replaced or removed, what smooth, micro-textured and macro-textured implants are, and what BIA-ALCL is.

It is widely believed that implants “have to be replaced every 10 years”. This is not accurate. There is no fixed time limit, but implants are not lifelong devices, and over time the likelihood of complications increases.

Why implants are replaced or removed

• capsular contracture — hardening and deformation of the tissue around the implant;
• rupture of the implant;
• change of position, rotation or descent;
• changes after pregnancy, breastfeeding or in weight;
• a wish for a different size or shape;
• a wish to have them removed altogether.

Follow-up

The rupture of a silicone implant can be “silent”, with no symptoms. The American FDA recommends that, for silicone gel implants, an imaging test (ultrasound or MRI) is done about 5–6 years after the operation, and then every 2–3 years. In practice, a breast ultrasound is most often used, and MRI when there is a suspicion. Keep your implant card: manufacturer, model and serial number.

Types of surface

• Smooth surface.
• Micro-textured (finely rough).
• Macro-textured (coarser).

Texture was designed to hold the implant more stably in its pocket and to reduce rotation, especially with anatomical shapes. It is macro-textured implants that are linked to the most serious risk, described below.

BIA-ALCL: anaplastic large cell lymphoma

BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) is a rare type of lymphoma (a cancer of immune cells) that develops in the capsule and in the fluid around the implant. It is not a cancer of the breast gland.

• It is linked almost entirely to macro-textured implants; with smooth implants the risk is extremely small and disputed.
• The frequency is low — by various estimates between 1 in 3,000 and 1 in 30,000 women, depending on the type of implant and the country.
• Typical signs: sudden swelling of one breast months or years after the operation (late seroma — fluid around the implant), a lump, pain, a change in shape. It usually appears after 7–10 years or more.
• The diagnosis is made with an ultrasound scan, sampling of the fluid and a special examination of the cells.
• Treatment is removal of the implant together with the whole capsule. When the disease is confined to the capsule, it is usually treated successfully.
• In 2019 the FDA asked the manufacturer to withdraw certain macro-textured implants (Allergan Biocell) from the market.

The FDA does not recommend preventive removal of implants in women without symptoms. In 2022–2023 the FDA also reported very rare cases of squamous cell carcinoma and other lymphomas in the capsule — with both smooth and textured implants. The advice is the same: with any new symptom — an examination.

Removing the implant

• It can be done with or without insertion of a new implant.
• The capsule can be left, partly removed or removed entirely (capsulectomy). The choice depends on its condition, on the type of implant and on the reason for the operation. With BIA-ALCL, all of it is removed.
• After removal the breast often looks smaller and more sagging. If there is excess skin, a lift is discussed — at the same time or later.
• Some patients report general symptoms that they link to their implants (so-called “breast implant illness”). A causal link has not been proven. Removal is acceptable on request, but improvement cannot be guaranteed.

What to do if you need a replacement

• Bring the documents for your implant.
• Discuss the type, size and surface of the new implant — smooth or micro-textured ones are now more often preferred.
• Expect a longer discussion than for the first operation — the conditions have changed.

When to see a doctor

• swelling of one breast after it has been normal for years;
• a new lump, pain, redness;
• a change in shape or hardening.