Implant change

One of the most common long-term complications with implants is so-called capsular fibrosis. This medical diagnosis hides a usually gradual process at the edge of the implant, in the transition to the connective tissue. Capsular fibrosis can be caused, for example, by a leakage of the implant, mastitis, i.e. an inflammation in the breast, as well as a possible temporary immune deficiency. After every breast operation with an implant, the body forms a wafer-thin biological capsule of connective tissue. Fibrosis can be initiated by the patient’s own body due to the reasons described above as examples.

This process, which can take place over months and years, results in a biological shielding of the implant through the formation of a hardened capsule. This capsule can become thicker, harder and stronger in substance due to external influences, depending on how long the process progresses. To put it simply, the body tries to prevent the exchange of ingredients or foreign substances that have developed in the vicinity of the implant.

The diagnosis of capsular fibrosis is first and foremost made clinically by you, the patient, noticing the changes described above yourself. To support the diagnosis, an ultrasound examination of the breast is first and generally recommended. This can determine how thick the capsule is, whether the implant has received any damage, for example a leak, and whether free fluid has formed around the implant. An internationally recognised scheme that classifies capsular fibrosis into four levels (BIRADS 1-4) is used to consolidate the diagnosis. If there is any uncertainty about the diagnosis, a mammogram or magnetic resonance imaging may also be recommended.

According to today’s standards, the only therapy/cure for capsular fibrosis is a new operation. Previously used, so-called simple solutions, such as the so-called capsule blasting, are not only obsolete, but also mean considerable danger for the patient. In this manoeuvre, which is usually performed under short anaesthesia, the capsule is simply destroyed mechanically from the outside. Unfortunately, this in turn promotes the distribution of micro-small foreign bodies and silicone parts in the body. Despite this knowledge, this method was used again and again until well into the nineties of the last millennium and it was also generally accepted.

According to the current state of medicine, the only medically and ethically correct decision is to perform a reoperation. On the one hand, a subsequent breast lift could be integrated in order to be able to do without a new implant. On the other hand, there is also the possibility of changing the implant; this can also be done in combination with a possible breast lift. Of course, the implant change can be carried out with a larger or different implant.

The logical consequence of the diagnosis described above is that an implant change is always an operation with higher medical expenditure and sometimes a somewhat longer post-operative course. If possible, the entire capsule should be removed during the operation. Since this is often inseparably connected to the surrounding tissue, this results in a significantly longer operation time and, as a result, increased damage to the connective tissue connected to the capsule. However, only a completely removed capsule can prevent a recurrence in the near future. 

In my practice clinic, we have been performing implant replacement routinely or the implant removal described above for almost 20 years. Our own figures on the frequency of capsular fibrosis in patients are based on international statistics; they do not differ significantly. The advantages of implants with a micropolyurethane coating (MPS) described in the medical literature are reflected in our figures, as is the significantly poorer performance of low quality implants. Since we have never used implants that do not meet the highest standards, we only know about them from our removal operations on our patients. At this point I would like to remind you that the greatest possible care should be taken when choosing implants to ensure their quality. I will be happy to give you more information about this during your consultation. Unfortunately, our experience has shown that implant manufacturers do not focus exclusively on the well-being of patients. Therefore, please trust in my experienced and our comprehensive expertise when choosing your implants. For me as a medical professional, dealing with integrity with the diverse offerings of the silicone industry is essential. I offer my patients absolutely flawless and recommendable implants and put patient safety first. It is extremely important to us that you are guided only by comprehensible scientific facts and that we do not compromise on the quality of your implants. Of course, this high quality has its price, but for us it is always about the highest possible standard of health for you! We act according to this motto – and so should you!

An implant exchange in our clinic begins with a detailed preliminary discussion, a physical clinical examination and the collection of objective data; e.g. ultrasound or magnetic resonance tomography. For all elective procedures, i.e. also for an implant change, our patients receive a laboratory blood test.

In addition, we offer all patients an ECG examination in preparation for the operation. This increased medical effort serves the safety of our patients in order to overlook a disease or a possible heart defect that may not have been clinically noticeable up to now.

On the day of the operation you will come to our clinic at the appointed time and will be welcomed there once again by our anaesthetist, our nursing team and by me. Here the operation will be briefly discussed again; possibly a drawing of the planned incisions will be made. Afterwards, another consultation with our anaesthetist will take place. Since you come to us sober, the operation can be performed relatively soon. After the successful operation you will be in one of our recovery rooms. Here you will receive medical and nursing care from our caring team.

Since fluid draining silicone drains are always placed during an implant change, also to prevent later capsular fibrosis, we wait until no more fluids are being pumped before the drains are removed. This is usually done during the first post-operative day. The drains are then removed during a dressing change and you will receive your compression girdle or a compression bra. You can usually be collected by a relative around midday or go home by taxi. We will be happy to organise this for you. Please refrain from driving yourself after such a demanding operation.

The further postoperative course hardly differs from the normal breast augmentation. Here, too, the routine dressing checks are carried out and after 14 days the suture material is removed. We recommend that you wear a stabilising compression bra for at least six weeks.

Wearing the compression bra ensures increased immobilisation in the surgical area, which enables the wound to heal more quickly. Your sporting activity should also be adapted to this and we ask you to avoid increased exertion for the first six weeks after the operation.