The importance of getting your breast implants exchanged... from someone who has gotten it done

A date was looming... the 10-year anniversary of my bilateral mastectomies and reconstruction.

My plastic surgeon already broached the subject of exchanging my implants a couple of times, reminding me that silicone implants generally last 10 years. I wasn't sure I wanted to do the surgery. New scars? No thanks. Overall, my reconstruction was an excellent experience. I had a fantastic plastic surgeon. My scars were barely visible, and I recovered beautifully. However, I wasn't keen on going back under the knife and my implants seemed fine.

What if this time the scars were worse? Or thicker? At my 10-year visit, we discussed the surgery again and this time I let him know I was moving to Alaska. After some casual banter about 24-hour darkness and grizzly bears, he reminded me that Alaska might not be the best place to deal with a rupture. The medical care in Juneau is simply not the same as in Chicago. There aren't as many specialists, and it's not as easy to schedule surgery. If something major goes wrong, folks in Juneau have medevac insurance.

I went home and decided to weigh the pros and cons. I'm also a professor, so I tend to do my research before making any major decisions. Reading articles and making lists feels good to me. Most of the articles agreed that implants should be exchanged somewhere between 10-15 years and that one out of five women needed their implants exchanged at the 10-year mark. So with that, I started the list-making process.

The pros

1. New breasts that would fit my body better. During my initial reconstruction, my expanders unfortunately leaked, and my surgeon had to put in smaller implants than we originally planned.
2. I was experiencing some rippling, so we could get rid of that by altering the size of my implants. Also, I had bariatric surgery just as COVID-19 was hitting the United States. My surgery was wildly successful, and I lost 125 pounds. This also caused the rippling to increase and the shape of my chest to change. One article specifically mentioned rippling around the breasts and said it means the implant itself is wrinkled. This isn't harmful per se, but since folks generally want their implants to help them achieve a smooth look, rippling is not ideal.
3. I would never have to deal with a rupture if I proactively exchanged.

The cons

1. Surgery.
2. Pain.
3. Downtime.
4. "The Exchange Rate"... it was expensive! My insurance rolled over with the new job, and I have a very high deductible.
5. I was planning a pretty epic tattoo – a scar cover-up – that would have to be postponed one year if I exchanged because tattoo artists can't tattoo over fresh scars. I have been planning this cover-up for the last couple of years, so postponing would be a bit of a bummer. For me, the tattoos have a lot to do with body image and self-confidence, and I was not looking forward to fresh scars again.

The pros definitely outweighed the cons. It was time to schedule with my plastic surgeon. I made an appointment for January 26 and began making plans with work, etc. Then, I contracted COVID-19 on January 4 and almost couldn't have surgery. It was a rough case of COVID, and I was still testing positive 19 days later when I showed up for surgical testing. I was feeling fine, but COVID can show up in your system for weeks or months afterward. The hospital needed to discuss this with my surgeon – and for a day or so, I thought my surgery was going to be canceled. Fortunately, my surgeon also recently had COVID, and he felt it was safe to proceed. He spoke to the folks at the hospital and made the argument that I was asymptomatic and almost three weeks out from my first positive test.

Day of the surgery

I was not looking forward to going back to the hospital. It was a disconcertingly vulnerable feeling, almost like back to pre-mastectomy when I felt like I had ticking time bombs inside of me. Walking back in there, the smell of the hospital, the conversations with my surgeon... brought it all back again. I remembered the fear and the vulnerability of the first go-around. I remembered unwrapping the gauze and seeing my post-mastectomy body for the first time. It all rushed back when I entered the hospital. However, there was a huge positive this time! Unlike my first experience with reconstruction, the exchange was scheduled as outpatient surgery. This surprised me! Ten years ago, I had to spend time in the hospital, and I had drains to contend with and more. Not this time! I was told I would go home a few hours after my surgery and there would be no drains. I was thrilled! The drains were my least favorite part of my previous surgery.

Additionally, now that we knew I am allergic to steri-strips – the doctor was able to glue my incisions together. This was significantly better for my comfort level. I was so itchy last time, and I broke out in a huge rash, so I was thankful for the glue option. My favorite part of surgery is the countdown as you are falling asleep – I don't know why, but I'm never scared. I'm ready... goodnight.

Waking up post-surgery

When I woke up in the hospital, they gave me juice and some crackers. My blood pressure was a little low, so it took some time before my wife was allowed to come see me. By the time she made it back to postop, it was almost time for me to be discharged. I wasn't in much pain. They sent me home with oxycodone, but I never needed it. I relied on Tylenol for the first week out of surgery and then I was fine. I'll admit, I have a high pain tolerance, but I really dislike pain meds. They make me nauseous, and I try to avoid them at all costs.

At some point, while I was unconscious, my surgical team fit me with a compression bra. They told me this bra is supposed to be worn 24/7 for about a month. One bonus of breast reconstruction is not having to wear a bra, so I hadn't worn one in about 10 years! I wasn't thrilled with having to wear one day and night. I would describe the general feeling in your chest as "heavy".

My doctor gave me instructions to avoid vigorous activity and working out for about a month, but he did say that I could go back to work after a few days to a week, depending on how I was feeling.

The first week

I definitely needed the wedge pillow for the first week or so. It's the same pillow I used during my mastectomies and initial reconstruction surgeries. Basically, the pillow keeps you more upright in bed. I lined it with pillows so it's more comfortable, but it allowed me to sleep at an angle. Sleeping flat would be uncomfortable after reconstruction, and I was advised against sleeping on my side. Although, after a few days, I was able to slowly start to roll onto my side.

The surgeon's office also counseled me to be careful with arm movements – no movements above my head, for example. I needed help washing my hair for the first day or so, and my wonderful wife was happy to oblige. They also said no lifting anything over 10 pounds for about a month. I guess that meant I was off of grocery duty!

Overall, I'd say the pain from the exchange surgery was lighter than from the initial reconstruction. I recovered faster, and the experience was easier.

Fully recovered

Now that I have recovered, I am really happy I exchanged. There is peace of mind knowing I have at least 10-15 years before I have to think about this again. Also, my scars are already quickly fading – my surgeon did an excellent job. The slightly larger size is better and barely noticeable, but it did take care of the rippling in my skin. I went to a spa as soon as I was clear and I felt so confident in a bathing suit! There was no rippling in my skin so you couldn't even tell I had breast implants. I feel like I look incredibly natural. This kind of body positivity and confidence in how you feel and look matters.

Writing about postsurgical body changes – and body image – has, by far, been the hardest thing to put into words and share with others. It's incredibly vulnerable to put this out into the world, but it's so important to let people know that there is life on the other side of mastectomies and reconstruction. You can feel confident in your body and feel good in your skin again. It's personal and so individual. I have listened to my friends talk about their difficulties with body image... but for me, reconstruction helped put the pieces back together again.

Now, I am looking forward to my scar cover-up tattoo!

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.