Patient information on breast implant replacement

The preliminary examination – What do you need to have done?

Prior to your surgery, you will first have a preliminary examination with our plastic surgeon. Here you will discuss your expectations with the surgeon. The surgeon will assess what will best suit your body type, and you will receive a thorough review of your options – and the risks that always come with surgery. Finally, the surgeon will ask about your health to ensure you are suitable for the procedure.

Based on your expectations and the surgeon’s recommendations, you’ll plan your surgery and the size and profile of the implant. Just note that, by law, you can only give your consent to the surgery and undergo surgery after you’ve had 7 days to think about it after the preliminary examination.

We recommend that you leave your children at home for the preliminary examinations with the plastic surgeon. We have often found that customers find it difficult to concentrate when their children are present. At AK Nygart, we take pride in providing as thorough professional and personal guidance as possible.

Remember that there can be a maximum of 2 people for a pre-examination at a time. If there are several of you who want a preliminary examination and would like to bring a relative, you must therefore book appointments independently of each other.

How long do implant replacements last?

When we talk about how long the results of your replacement surgery will last, there are two things you need to be aware of.

The implant
Different manufacturers have different guarantees. Regardless, all experience shows that as the years go by, implants become more fragile, which reduces their stability and increases the risk of them suddenly breaking. It’s a clear recommendation to have your implants replaced before they break, but no one can predict exactly when that is. We recommend that you have your breast implant checked after 10-12 years, possibly with an ultrasound scan. You are also always welcome to visit us for a check-up.

Your own ageing
Even if you achieve a satisfactory result from the surgery, your body and tissue will continue to age. This means that the shape of your new breasts will change over time. How quickly this happens depends on your hereditary predisposition, how you live, whether you smoke, the overall weight of your breasts and the placement of the implant. Note that your breast tissue will become particularly lax after pregnancy and breastfeeding, and this will also affect the appearance of your breasts.
If you are overweight, there is an increased risk of anaesthetic complications. If your BMI (Body Mass Index) is above 30, we cannot offer you breast augmentation surgery. Calculate your BMI here.

If the end result does not meet your and the surgeon’s expectations, it is up to the surgeon to decide whether re-operation can improve the result.

What type of implant should I choose?

At AK Nygart, we primarily use silicone implants from Motiva, Mentor and Silimed. Silicone implants come in different shapes and softness: Round (slightly firmer) implants, anatomical (teardrop-shaped) implants and Ergonomix, (extra soft and round) implants. In collaboration with our plastic surgeons, you will find the manufacturer and size that suits you best.

Motiva implants with chip (Q-ID)

Motiva implants contain a small chip. Should your implant card be lost, you will carry the identification of the implant in the small chip. You will be able to have MRI scans even if you have this. During an MRI scan, there may be a slight heat change of approximately 1.5-1.8 degrees around the chip. This temperature change will not affect the lifespan of the implant.

See more product information about the implants.

Security package

At AK Nygart, a security package for the first year is included in the price. This covers all surgical costs in the unlikely event of problems with the implants during the first year.

Since capsular contracture rarely occurs during the first year after surgery, but typically in the following years, most people choose to purchase the extended coverage package, which covers for 7 years after surgery. With this extended coverage package, you will also be covered if other problems with the implants arise, such as bottoming out, rotation, rupture, etc.

You can find the prices by clicking here. 

How do I prepare for implant replacement surgery?

• 3 days before the surgery, you must stop taking medicines containing acetylsalicylic acid (Magnyl, Aspirin, etc.). However, you should not stop taking cardiac magnesium or other blood-thinning medication (Clopidogrel, Marevan, etc.) without consulting your GP or cardiologist. If Clopidogrel can be paused, it is for 5 days before surgery.
• Herbal remedies that can affect the blood’s ability to clot, e.g. Q10, fish oil, valerian, ginseng, ginkgo, garlic powder/ginger or vitamin E should be stopped 1 week before.
• Arthritis medication (Ibuprofen, Naproxen, Diclofenac etc.): Pause for 3 days, if necessary in consultation with your GP or rheumatologist.
• If you are on weight-reducing medication such as Wegovy, take a 3-week break before surgery.
• Avoid getting tattoos, piercings or major dental work such as fillings 1 month before surgery and 1 month after surgery. This is because tattoos, piercings and dental work can cause bacteria to build up in the bloodstream, which can settle around the implant.
• In addition, you will need to purchase Paracetamol 500 mg + Ibuprofen 200 mg for one week’s supply.
• Arrange with a carer to pick you up 2 hours after surgery and look after you for the next 24 hours.
• It’s a good idea to shop and cook for a week so that you only have to concentrate on recovering from the surgery.
• On the day of surgery, take a shower and wash your body and hair thoroughly with soap. Do not use body lotion or cream on the area to be operated on.
• Dress in loose, comfortable clothing, preferably a zip-up blouse and flat shoes.
• Remove jewellery and any piercings and leave them at home.
• Quit smoking/ E-cigarettes 6 weeks before and 4 weeks after surgery: To reduce the risk of poor wound healing, lung problems and surgical site infections, you should stop smoking at least 6 weeks before your surgery. If you plan to start smoking again, we recommend waiting until at least 4 weeks after surgery to optimise the healing process. Smoking cessation medication (nicotine patches, nicotine gum, etc) can be used. Read more here.
• Taking a break from alcohol: If you drink less than 7 units/week as a woman and less than 14 units/week as a man, you have a low risk of becoming ill from alcohol during surgery. If you drink more than this, you should reduce your consumption, and if you drink more than 4 units per day, you should stop drinking alcohol completely 4 weeks before your surgery. This will minimise the risk of complications (infections, poor wound healing, lung problems etc.)
• The Danish Society of Breast Surgery recommends mammography for women over the age of 35 or for women with a family history of breast cancer. The mammogram must be no more than 1 year old.

How will I be anaesthetised?

If you are completely healthy, you will meet the anaesthetist on the day of surgery. The anaesthetist will inform you about the anaesthesia and ask you about past and present illnesses, medication, allergies and previous surgeries.

It is important that you fast as the surgery is performed under general anaesthesia. This means that you are allowed to drink small amounts of water or juice until 2 hours before surgery, but you are not allowed to eat in the last 6 hours before surgery.

Some customers are nervous about going under anaesthesia, but our skilled anaesthetists and nurses are professionally and personally equipped to make your experience as safe as possible. Read more about anaesthesia here.

How does the surgery take place?

The replacement can often be done via your old scar if it is located under the breast or at the nipple. If your current implants are inserted through an incision in the armpit, we will need to create a new scar either in the crease or around the nipple.

In some cases, the surgeon may assess whether a drain will need to be placed during surgery.

The operating time for this surgery is highly variable and depends on the complexity of the procedure.

After the surgery, you will be observed in the recovery room for a few hours. We’ll make sure you’re awake and alert and that you’ve had all your questions answered before you go home. Make sure a relative can pick you up and stay with you for the first 24 hours after surgery.

Before you leave the clinic, the plastic surgeon will go through the procedure with you. You will be given a number for the surgeon’s on-call telephone so that you can always get in touch with him/her if you have any urgent questions.

The surgeon will contact you in the evening by phone and the nurse the day after surgery.

You will be given a check-up time on the day of surgery and it is important that you follow the recommendations given to you by the recovery nurse. You will also receive information about when you can shower and what type of dressing you have been given and when it needs to be changed.

You should not be left alone for the first 24 hours after anaesthesia and it’s best to be picked up by a relative who can help for the first few days after surgery.

Are there any risks associated with implant replacement?

When a qualified plastic surgeon performs breast implant replacement, complications are few. However, there is always a risk associated with any type of surgery.

Haemorrhage

In rare cases, bleeding may occur in the days after surgery, also known as haematoma (less than 1%). This may require re-operation to remove the haematoma. If bleeding occurs, the breast will grow and start oozing fresh blood. If you’ve come home with a drain, a sudden haemorrhage will result in a lot of fresh red blood in the drain. If this happens, it will usually be right after surgery while you are still with us. If bleeding occurs after discharge, you should contact us immediately. If treated in a timely manner, post-operative bleeding will not affect the final cosmetic result.

Infection 

Infection can occur after any surgery, but it is very rare after implant replacement. Preventive antibiotics are given during surgery to reduce the risk of infection. If infection does occur, if it is a superficial infection in the scar, it can usually be treated with antibiotics. If an abscess develops around the prosthesis, which is extremely rare, we will have to remove the implant and wait 4 months before we can insert a new one. The symptoms of infection are increasing redness, warmth, tenderness, possibly throbbing pain, swelling and fever. Typically, an infection will appear in the first few days after surgery. Should you experience any symptoms of infection, it is important that you contact us immediately. Infection rarely affects the final cosmetic result. Should the above happen, you will of course not have to pay for the additional surgery.

Pain and discomfort

For most people, this procedure is associated with less pain than primary augmentation. It is important that you take your painkillers. The pain usually subsides quite quickly.

Sensory disturbance

The nipples can become more or less sensitive and in rare cases numb. The risk of losing sensation completely is up to 1.0%.

Stretch marks

Depending on your skin quality and the size of the prostheses, there may be a small risk of stretch marks after surgery. Some women may also develop stretch marks during pregnancy, when the breast grows.

Swelling

Swelling and deformity are normal after such a procedure. The swelling will slowly decrease and the breast will slowly “settle” and approach the final result.

Seroma

In very rare cases, thin yellowish lymph fluid can accumulate in the surgical area and it may be necessary to suction out the fluid with a thin cannula. Seroma formation is not dangerous and will not affect the final result.

Capsular contracture 5 -10% depending on which calculations you look at. Capsular contracture is when the capsule that always forms around the implant suddenly starts to tighten around the implant. This causes the breast to become hard and, in some cases, deformed and painful. This can happen on one or both breasts. The cause is still somewhat unclear, but the consensus is that it is caused by biofilm, which is a bacterial culture found in the breast pocket that does not cause inflammation, but for unexplained reasons can cause capsule formation. If you’ve had a capsule once, you’re more likely to get it again.

Rupture

Should the implant break, it will of course need to be replaced. If it happens within the first year, the surgery itself is free (Tryg 1). If you have taken out Tryg 7, the surgery is free for 7 years in the event of rupture (Tryg 5). After that, you will have to pay for the surgery yourself if the implants break.

Leakage

AK Nygart is part of a research project that looks at leakage (seepage) from silicone implants depending on the cutting strength (Cohesivity) of the implant. For the project, we looked at Mentor’s round implants. There are Cohesive 1 + 2, while anatomical implants are labelled Cohesive 3. The higher the Cohesivity, the less leakage and probably less capsule formation. This means that Coh 2 and 3 can probably last longer, up to about 25 years, while Coh 1 implants are recommended to be replaced after about 10-15 years to avoid possible seepage with subsequent capsule formation.

Rotation

When using anatomical (teardrop-shaped) implants, the risk of rotation is less than 1%. When using very “strutting” round smooth implants (Motiva), rotation can rarely occur, where the implant lies with the bottom upwards.

Double fold

Sometimes it may be necessary to lower the lower boundary of the breast to make room for the implant. This can cause an indentation in the skin at the top of the breast, similar to the old fold under the breast. This is called a double fold. The risk of this is small and the plastic surgeon will try to take this into account if you have a breast that is predisposed to a double fold.

If a double fold does occur, it can be very difficult to correct and in the worst case scenario, it can be permanent.

Implant edge and rippling

Especially in very slim women with a small original breast and very little subcutaneous fat, there is a risk that the implant edge can be felt and sometimes even seen under the breast and to the side. In the same slender women, wrinkles or folds in the skin above the implant can sometimes be seen. This is called rippling. The risk of this is less now that we have cut-resistant implants than when liquid silicone or saline implants were used. Rippling and a noticeable implant edge are most often seen in thin women who opt for large implants.

Asymmetry 

Most women have some asymmetry of the breasts prior to surgery. While we do our best to achieve symmetry after surgery, there is no guarantee that the breasts will be exactly the same. Therefore, you should expect a varying degree of asymmetry in terms of shape, size and nipple placement depending on the starting point of your breast.

Breast implant related lymphoma (ALCL) 

In very rare cases, cancers can develop in the scar tissue around the breast implant. This includes breast implant-related lymphoma (ALCL), a cancer that has only been seen in what are known as textured implants, i.e. implants with a rough surface. Among these types, implants from a company we don’t use are clearly the highest risk. Of the textured implants, we use Mentor or Silimed instead. ALCL has been seen in women with Mentor implants, but it is extremely rare: the incidence of ALCL in women with Mentor implants has been found in one study to be approximately 1 in 66,000. With Silimed True Texture implants, there are currently no cases of ALCL, even though it is a textured implant. Motiva is referred to as a smooth implant, and no cases of ALCL have been detected. ALCL is characterised by either persistent swelling of one breast, typically several years after surgery. ALCL can also be characterised by the formation of nodules in the capsular membrane around the implant or swollen lymph nodes. If you experience these symptoms, you should visit a plastic surgery clinic, such as the one where you had your surgery, or your own doctor. However, it should be emphasised that in the vast majority of cases, such symptoms will be caused by benign conditions.

Breastfeeding/pregnancy 

Breast implant replacement can affect breastfeeding, especially if the procedure is performed via the nipple. Breastfeeding is only rarely affected if the procedure is performed from the fold under the breast or via the armpit.

If you have breast implants, there is no guarantee how your breast will look after pregnancy and breastfeeding. Many will have a beautiful breast, perhaps even more natural than before pregnancy, while others may have much larger breasts during pregnancy, resulting in loose skin as the breast shrinks. Corrective surgery may be necessary.

Scars 

You can expect your scar to be red and swollen for the first 6-12 months after surgery. Over time, it will gradually lighten and become less visible, but you will always have scars. While we do everything we can to minimise scarring, everyone heals differently. Some will have almost invisible scars, while others will have more obvious scars. In rare cases, it may be necessary to perform a scar correction to improve the cosmetic result. Therefore, unfortunately, we cannot guarantee the appearance of your particular scar.

REGARDING SILICONE BREASTS AND BLOOD CLOTS 

At AK Nygart, we put safety first. There are certain things that increase the risk of blood clots, especially in the legs and lungs during surgery. Therefore, some customers are recommended prevention with a drug called Fragmin, Klexane or Innohep.

If you need Fragmin, Klexane or Innohep, it will be given as an injection in the thigh or abdomen by a nurse in the recovery room.

In extremely rare cases (special risk patients), you will receive an electronic prescription for blood thinners.

The first dose is given on the day of surgery, where a nurse in the recovery room will show you how it’s done.

When do I have a follow-up appointment?

On the day of surgery, you will be informed by the recovery nurse about the check-up process with the nurse and surgeon.

We recommend that you leave your children at home for the subsequent check-ups. It’s important that you can concentrate on the important information being given, and our experience from post-op check-ups shows that children find it very upsetting to see mum or dad having their bandages changed.

If you are unsure or have any questions in the meantime, you are always welcome to call us and possibly make an appointment at the clinic.

What about future breast exams?

Most women with breast implants can be screened during mammography screening, but there may be technical obstacles. Therefore, you should always make the staff aware that you have silicone breasts.
If the breast implants are placed behind the pectoral muscles, mammography screening can usually, but not always, be performed without problems.
In women where the implants are placed in front of the pectoral muscles and in women with heavy capsule formation around the implants, mammography screening is often less suitable or not possible at all. This is because X-rays cannot penetrate the implants.

If there are symptoms of changes in the breast, a so-called clinical mammography is always performed, which includes several X-rays (mammography) supplemented by an ultrasound examination and cell and tissue samples.

The Danish Society of Breast Surgery recommends that women over the age of 35 who want silicone breasts have a mammogram/ultrasound scan before surgery.

The Danish Health Authority writes: 

“Breast implants can cause problems with mammograms, so if you choose to have an implant, it is important that you inform the staff that you have a breast implant. If the implant is behind the pectoral muscle, the examination can often be carried out anyway as staff try to push the implant so that it does not hide the breast tissue. There may be a very small risk that the implant capsule may rupture during the examination, but this is extremely rare.  

Women who have breast implants in front of the pectoral muscles cannot usually be examined with mammography. If there are symptoms or suspicion of disease in the breasts, a so-called clinical mammography, which includes several X-rays supplemented by an ultrasound examination, may be performed on medical indication. However, the implants may still prevent part of the breast tissue from being seen and assessed.” 

BII – BREAST IMPLANT ILLNESS 

Symptoms of BII include muscle and joint pain, fever, fatigue, “brain fog”, headache, anxiety, dry eyes and mouth, etc. Several possible causes of BII have been proposed, but none have been scientifically established. Therefore, patients with BII usually want to have the implant removed with the capsular tissue intact.

There are no diagnostic tests specific to this condition. We still don’t know exactly what it is, but now we know a lot more about what it isn’t, based on recently produced scientific studies. According to the results of these studies, BII is not an inflammatory disease, not related to heavy metal exposure and not associated with silicone gel (as BII can occur with saline implants.) BII also occurs with both smooth and textured implants.

Most women who have symptoms they believe are related to their breast implants experience improvements after the implant is removed. No one knows why, and there is no way to predict who will not improve after implant removal.

According to recent studies, it doesn’t matter how they are removed. In other words, patients’ symptoms improve whether the implants are removed with or without the surrounding capsular tissue. 

IS THERE A BOOKING RESTRICTION BEFORE THE SURGERY?  

According to the Danish Health Authority, at least 7 days must elapse after the written and oral information has been given before the treatment can take place. 

Your consultation is valid for one year. The validity is subject to the condition that no major health changes have since occurred, e.g. major weight fluctuations or new medication, which can be an obstacle to the plan that has been made together with the surgeon. If such changes have occurred, or if more than a year has passed since your initial consultation, and you wish to have the surgery, you must come in for a renewed consultation.

OTHER 

In case of cancellation, future consultations and check-ups must be cancelled at least 24 hours before the agreed time. In case of no-show without cancellation, a fee of DKK 600 will be charged. 

We only forward information regarding your treatment at AK Nygart to your own doctor after we have obtained consent from our patients. 

On our website you will find all cosmetic reports made by the Danish Health Authority. 

The reports are also available on the National Board of Health’s own website. 

Questions about my surgery 

You are always welcome to contact the clinic if you have any questions about the surgery, filling in the loan application, the procedure at AK Nygart, etc. You can either write to info@aknygart.dk or call 70 27 57 57. 

What does breast implant replacement cost? 

You can find the prices by clicking here. 

If you want to finance your upcoming surgery, click on the link. 

Patient information on breast implant replacement– version 11-04-2024