Should You Replace Your Implant During Revision Surgery?

This is something I get asked all the time: if you're having a breast revision, do you need to replace the implant? The answer depends on several factors.

Early positional issues: If the implant has been in place for four or five months and it's just dropped too low on one side, it's totally reasonable to keep the same implant, as long as it looks okay in the operating room, and fix the crease with mesh or other support.

Hematoma right after surgery: If we take you back to the operating room the same day or the next day for a hematoma, it's totally reasonable to keep the same implant. There's nothing wrong with it. We clean the hematoma out and close everything up.

Never, ever should you allow a surgeon to reuse the same implant if you have a capsular contracture. Many patients with contractures have biofilms, and that's not something you can always detect at the time of surgery. It is extremely difficult to clear a biofilm from an implant, and in my opinion, it's just not the right thing to do.

If you're having contracture surgery, you should have a new implant placed.

If you have an incision that's opened up with a visible implant, or if there's a suspected infection (like an infected seroma or cellulitis of the breast), those are situations where I always recommend swapping the implant out. Whether it's cosmetic or reconstructive, you're assuming there may be bacteria on the device, and that's really hard to get rid of.

Depending on how old the implant is, we're probably going to recommend swapping it out. Implants weaken with time, and we want to make sure we're not putting a damaged device back in when we have the perfect opportunity (we're already in there) to place a new one.

Implants are expensive, and we always try to minimize costs for our patients. But you want to make sure your surgeon is making good medical decisions, not just doing something that's financially beneficial but not a good idea for you.

One final thing: implants are indicated as a single-use device. Reusing them in a revision is technically an off-label use. We do it from time to time when appropriate, but it's worth knowing.

Also worth noting: for capsular contracture cases, implants are typically covered by the manufacturer's warranty, so there's really no reason to reuse the same one.