Ten years ago, nearly everyone in my consultation chair wanted bigger. Now? Half of them want the reverse.
The pattern is consistent. A decade or more with the same implants. A late-night thread, a video, a friend who has felt off lately. And then the question, which I think deserves a real answer rather than a brochure. Should these come out?
Let me give you the version I give in the room, with nothing dressed up.
The Honest Truth About Breast Implant Illness
First thing I tell women. If you have carried your implants for years and felt fine the whole time, the odds are you will keep feeling fine. This is rare.
I have done thousands of augmentations. Out of all of them, maybe ten or twelve women have come back asking me to take the implants out because they felt the implants were the problem. When we removed them, most felt better.
I will not oversell that result, though. Plenty of the time, honestly, we cannot separate the implant from everything else going on. Aches. Fatigue. The fog that arrives in your forties no matter what is or is not sitting in your chest. When you have implants, they make a convenient suspect. The research is still catching up, so I am not going to hand you a certainty the science has not earned.
And I am not in the business of talking you out of removal either. My only job is making sure you decide with the whole picture, not the cropped one you found online at midnight.
Textured Implants Are a Different Conversation
This one I weigh differently. Textured implants, the kind with a rougher shell, have been associated in some patients with a specific type of lymphoma. Low risk, roughly one in a few thousand, and tied to that textured surface rather than to smooth implants.
So if you are carrying textured implants and feel perfectly fine, swapping them for smooth is still a reasonable move. My philosophy here is not complicated. When a problem can be sidestepped, I would rather sidestep it than wait around to find out. A breast augmentation revision is exactly the operation that does it.
What Removal Actually Does to Your Shape
Now the part nobody loves hearing. Pull out an implant of any real size and you will drop a cup size or more, and yes, things sag. That implant was propping up volume your skin stretched to hold over the years. Remove the prop and the skin does not spring back to where it started.
Which is why removal by itself is rarely the whole story. To look good afterward, most women need a breast lift in the same operation, raising and tightening everything into place.
Want a little fullness up top still? We have moves for that. I will not add fat to the breast during the removal itself, because the empty pocket needs to close off first. Come back a few months later feeling too flat, and fat grafting can put a little body back without committing you to another implant.
Going Smaller Instead of Going Without
A lot of women land right here, and I love this option.
We take out the big old implant, perform a lift, and drop in a small one, sometimes just 150 or 200 cc, purely to hold a bit of cleavage and shape. A small implant behaves more predictably than fat. Reliable size. It does not shift every time the scale goes up or down on you.
| Path | What You Gain | What You Trade |
|---|---|---|
| Remove only | Implant gone, simplest plan | More sag, a cup size or more lost |
| Remove plus lift | Tighter, lifted shape | A lift scar, longer operation |
| Remove, lift, downsize | Lifted shape with a little fullness on top | A small implant stays in |
| Remove, lift, fat later | Soft, natural touch of volume | Staged over a few months |
Are the Newer Implants Safer?
The Motiva implants I place now run a rupture rate under half a percent and a capsular contracture rate also around half a percent. Set that beside the ten to fifteen percent we used to see with older devices and you understand why I stopped telling patients they have to swap every ten years.
These could go a very long time. I often add an internal bra, a mesh that holds everything in place so the result holds too. Patients here in El Paso and across the border read about the same options on our breast lift page.
Get the Imaging First
Often, yes. A new firmness, a shooting or stabbing sensation, or just plain uncertainty about whether the implant is intact, any of those earns an ultrasound so we can look at the shell and rule out a rupture. If we need more detail, we step up to an MRI.
Sometimes that little stab is nothing more than the implant tickling a nerve. Harmless. I would still rather confirm it than guess at it.
The Credential Behind the Caution
I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Mayo Clinic plastic surgery fellowship alum, and a Castle Connolly Top Doctor thirteen years running. Removal and exchange asks more of a surgeon than a first-time augmentation does, because the tissue has been operated on once already. That is the whole reason I insist on examining you, reading your imaging, and being honest about how your shape will shift before either of us commits to anything.
Ready to Talk?
If you are weighing whether to remove, exchange, or downsize, come let me take a look and we will build the plan around what you actually want.
For the patient-facing version of this conversation, see the companion post on agulloplasticsurgery.com. For the El Paso treatment menu, see the version on swplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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