Out and in. One session.
Breast implant removal and replacement — often called implant exchange — is one of the most commonly performed surgeries at NCSS. Implants placed 10, 15, or 20 years ago behave differently than they did on placement day. Bodies change. Preferences change. And modern implants offer options that weren't available when many patients had their original augmentation. The exchange operation addresses all of those in a single session: the old implants come out, and new ones go in.
This page is specifically about the removal-and-replacement pathway — distinct from two related pages on this site. If you are considering removing your implants without replacement (whether for symptoms attributed to your implants, for the decision to be done with implants, or for BIA-ALCL concerns with textured implants), our dedicated Breast Implant Removal & En Bloc Capsulectomy page covers that pathway. If your revision doesn't involve implant exchange at all (pocket repair, capsulorrhaphy for malposition, other refinements), our Breast Revision page covers those broader modifications.
At NCSS, this operation is performed by eight of our affiliated surgeons (every surgeon on the roster except Dr. Bednar, whose entire focus is autologous fat transfer to breast), with Dr. Toohey leading the exchange practice given the volume of these cases in his three decades of breast work.
Who this procedure is designed for.
Implant exchange addresses a wide range of indications — from rupture and capsular contracture to size change, style change, and aging with implants.
Implant rupture (silicone or saline)
Silicone rupture is often silent and detected on MRI or ultrasound (the FDA recommends screening starting at year 5 and every 2–3 years thereafter for silicone). Saline rupture is visible as deflation. Either indicates exchange — and it's usually the moment patients also decide whether they want the same size, a different size, or a different implant type.
Capsular contracture (Baker III or IV)
The scar capsule surrounding the implant has tightened, producing firmness, distortion, or discomfort. Capsulectomy (removal of the scar capsule) is combined with the new implant placement. Choosing exchange rather than removal-only is a legitimate answer to this problem.
Size change — larger
Patients who want more volume than their original augmentation delivered. Often straightforward, though pocket adjustment may be needed for substantial size jumps.
Size change — smaller (downsize)
Increasingly common as patients move toward more natural sizes. Downsizing typically requires mastopexy at the same time to address the skin envelope that the smaller implant will no longer fill.
Profile change
Modern implants come in a range of profiles (moderate, moderate-plus, high, ultra-high). Patients who chose one profile years ago sometimes want a different projection now.
Style change (textured to smooth, round to teardrop, saline to silicone)
Patients with older textured implants (particularly Allergan Biocell, recalled in 2019 following the BIA-ALCL association) often want them exchanged for smooth-shell implants. Style-related exchanges are common in the post-recall landscape.
Aging with implants
Breasts continue to age around implants. Sometimes the implant itself is fine, but the tissue has changed enough that a new implant — often paired with mastopexy — is what suits the current body better than the old implant does.
Approaching the suggested exchange window
Manufacturers commonly cite 10–15 years as a typical implant lifespan, though many implants remain intact well beyond that. Some patients pursue proactive exchange near this window even without symptoms; others wait for a specific indication. Neither approach is wrong.
Combined with mastopexy
A very common combination. Any exchange scenario where the breast tissue has descended or the skin envelope has stretched benefits from mastopexy at the same time. Consultation determines whether adding a lift is the right choice for your specific starting point.
Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before surgery day.
Three stages, one procedure.
The technical decisions in implant exchange are consequential and made together with your surgeon during consultation. The most common elements:
Incision through prior scar (when possible)
Whenever the prior incision is accessible and the exchange plan allows, we use the existing scar rather than creating a new one. Revision through prior scars often heals better than the original scar did.
Capsule management — capsulectomy vs. capsulotomy
The scar capsule around the existing implant can be left alone (rarely appropriate for revision), released with a capsulotomy (scoring the capsule), or removed with a capsulectomy (partial or total). For most exchange scenarios, at minimum a capsulotomy is performed to allow the new implant to sit properly. For capsular contracture, capsulectomy is standard.
Pocket management
The implant pocket may need to be opened (for a larger implant), closed with capsulorrhaphy sutures (for a smaller implant or malposition correction), or switched entirely from subglandular to submuscular plane. Modern practice often favors subfascial or submuscular positioning; if your original implant is subglandular, we discuss whether plane change makes sense.
New implant selection
Full range of modern implants available: silicone (most common), saline (still selected by some patients), smooth or textured shell (smooth strongly preferred post-2019 recall), round or shaped (teardrop), and the full range of size and profile options.
Combined mastopexy when needed
Very frequent addition. When breast tissue has descended, when downsizing leaves excess skin, or when the nipple position needs adjustment, mastopexy is performed in the same session.
Combined fat transfer
For asymmetry correction or refinement of the upper pole, autologous fat transfer can be added to the exchange.
Capsule pathology
When capsulectomy is performed, the tissue can be sent to pathology if there are clinical questions or patient request.
Every Breast Implant Removal & Replacement at NCSS is performed under physician anesthesia — no CRNAs, no exceptions — in our AAAHC-accredited operating rooms.
Two sites. One recovery.
Recovery from implant exchange is similar to primary augmentation for straightforward cases — and more involved when combined with mastopexy or extensive capsulectomy.
Discharged the day of surgery with your dedicated nurse. Surgical bra worn continuously. Multimodal pain protocol.
Restricted arm movement. Most patients return to desk work at day 5–7. Combined exchange-with-mastopexy or extensive capsulectomy cases may need slightly longer.
Progressive return to normal activity. Surgical bra continues. Sutures typically removed at 10–14 days. Drains (used occasionally for extensive capsulectomy) come out when output diminishes below threshold.
Return to full exercise once your surgeon confirms complete healing. Add 1–2 weeks for combined mastopexy cases.
Final result becomes apparent as swelling fully resolves and the new implants settle into their pocket. Scars from revision often heal well, particularly when placed through prior incision sites.
Modern implants typically last 10–20 years before considered for exchange. The specific device warranty and manufacturer replacement policy of your new implants applies from placement day.
Every Breast Implant Removal & Replacement patient at NCSS is covered by our Rest-Assure program: physician anesthesia on the day of surgery, one nurse from arrival through discharge, and post-operative direct access to your surgeon — not an answering service.
Eight surgeons. Exchange is common work here.
Every affiliated surgeon at NCSS except Dr. Bednar (whose entire focus is autologous fat transfer to breast) performs implant exchange.
Dr. Toohey
Exchange Leader · Practice FocusAll-UC training; three decades of breast work; substantial exchange practice volume across all common indications.
View surgeon →Dr. Nichter
Full Breast ContinuumTriple-boarded; four decades in Newport Beach; exchange as part of full breast practice; long experience across implant eras.
View surgeon →Dr. Horowitz
Full Breast ContinuumEmory + UVA under Milton Edgerton; published breast surgery work; substantial exchange practice.
View surgeon →Dr. Bernett
Female Surgeon · Full ContinuumUC Irvine trained; female surgeon offering the full continuum of exchange scenarios; fluent Spanish and Italian.
View surgeon →Dr. Hendricks
Whisper Rule · Refined WorkTriple-boarded; 30 years in Newport Beach; exchange as part of comprehensive body and breast practice.
View surgeon →Dr. Andre
New GenerationCleveland Clinic + UC Davis + Loyola + Pacific Center; modern approach to exchange as part of full practice.
View surgeon →Dr. Castaldo
Female Surgeon · New GenerationUMASS trained; award-winning research background; exchange as part of comprehensive breast practice.
View surgeon →Dr. Leong
Female Surgeon · Selective NCSS UseBrown-trained female plastic surgeon; exchange as part of comprehensive breast practice.
View surgeon →The right starting point is a conversation.
Every consultation at NCSS begins with time — time to understand your goals, your health history, and which of our affiliated surgeons is the right fit for your specific situation.
Call (949) 644-8182Monday–Thursday, 8am–3pm · Friday by appointment only.
Related procedures.
Breast Implant Removal & En Bloc Capsulectomy
The removal-only pathway — when you want your implants out without replacement. Covers BII, BIA-ALCL, and the decision to be done with implants.
Learn more →Vertical Mastopexy
Breast lift — the most common addition to implant exchange when the skin envelope has stretched or downsizing has left excess tissue.
Learn more →Breast Revision
Broader revision category — pocket repair, malposition correction, and other refinements that don't involve implant exchange.
Learn more →