Breast implant replacement and breast lift in Switzerland: lifting the breasts, renewing the implants

Over the years, augmented breasts change. The implants age, the capsule around them may harden, and an implant's shell may rupture. But the breasts themselves also change: pregnancies, breastfeeding, weight changes, menopause and the simple passage of time make the gland descend and stretch the skin. Breasts then appear that seem to slide in front of an implant that has stayed high, an areola that points downwards, a breast that hangs over a well-positioned implant. Replacing the implants alone does not correct this descent; removing them without replacement would leave empty breasts. For women who want to keep volume, the answer is often to combine implant replacement with a breast lift. This page explains what this combination aims to correct, how the surgeon reconciles an implant that fills and a lift that tightens, when it is better to operate in one or two stages, how to choose the new implant, and the risks, results and provision in Switzerland.

Under general anaesthesia, the surgeon removes the old implants, treats the capsule according to its condition, adapts the pocket or creates a new one, then places new implants, often smaller or of a different shape. At the same time, they perform a lift that raises the areola, removes excess skin and repositions the gland over the implant. The procedure generally takes three to four and a half hours, with one night at the clinic. The result is lifted breasts of harmonious volume, with lift scars around the areola and often a vertical one. The new implants will in turn require surveillance. If the replacement responds to a complication, the insurer may be approached; the lift, however, is almost always at the patient's expense. Budget guidelines are on the page on breast implant replacement with lift prices in Switzerland.

The combination brings together two procedures. Implant replacement swaps the existing implants for new ones, sometimes of a different volume or shape or placed in a different plane, treating the capsule along the way. The lift, or mastopexy, raises the areola, removes excess skin and repositions the gland. Together, they restore breasts in which gland and implant are aligned again, with volume preserved.

This procedure differs from a simple implant replacement, which changes neither the skin nor the position of the areola, presented on our page on breast implant replacement, and from explantation with a lift, which removes the implants without replacing them, described on our page on implant removal with a breast lift.

Many women who had a breast augmentation in the 1990s and 2000s are now considering a revision. Their implants have aged, their breasts have changed with pregnancies and age, and techniques have evolved. Surgeons have developed growing experience of these combined revisions, with suitable pocket, capsule and lift techniques. This experience is an asset for patients, provided they choose a surgeon who performs these procedures regularly.

Many women wait a long time before consulting, telling themselves that their implants are fine as long as they do not hurt. Yet a rupture can be silent, capsular contracture can set in gradually, and descent of the gland can worsen over the years, making the necessary lift more extensive. Consulting early allows you to take stock, plan a revision in good conditions and sometimes choose a simpler procedure.

An implant, especially when placed behind the muscle, often stays at roughly the same height over the years, held by the muscle and the capsule. The gland, however, descends with time, pregnancies and gravity. The breast may then seem to hang in front of an implant that has stayed high: a firm roundness is visible at the top — the implant — and a breast that falls below, with an areola pointing towards the floor. Surgeons sometimes call this the waterfall appearance. A simple implant replacement does not correct this mismatch; the gland and areola must be raised, which is the role of the lift.

In augmented breasts, the gland and implant form a whole. When the implant is placed under the gland, the gland rests directly on the implant and follows it more readily. When the implant is placed behind the muscle, the muscle holds it high, while the gland, in front of the muscle, is free to descend over time. This difference explains why the waterfall appearance is more common with submuscular implants, and why the revision strategy depends so much on the original plane.

Skin that has covered an implant for many years is often stretched, sometimes thinned and marked by stretch marks. It has lost part of its ability to retract. The lift removes the excess skin, but the quality of the remaining skin determines how well the result holds. The surgeon takes this into account when choosing the volume of the new implant and the type of lift.

The continuous pressure of an implant gradually thins the gland and fat covering it, especially when the implant is large or placed under the gland. During replacement, this thin gland moulds less well to the implant and sometimes allows its edges to be seen. The surgeon may then choose a smaller implant, a plane behind the muscle or fat transfer to improve coverage.

In the first few years after placement, the breasts generally remain stable. Then, gradually, the gland descends, the skin stretches, and the implant itself may move. Pregnancies, breastfeeding, menopause and weight changes accelerate these changes. After ten or fifteen years, many women notice a mismatch between the implant and the gland, which prompts a consultation.

In other cases, it is the implant itself that has dropped below the fold, pulling the breast down, notably with large implants placed under the gland or in women with thin tissues. The areola then ends up too high relative to the volume of the breast, which looks empty at the top and heavy at the bottom. Correction involves raising the implant by closing the bottom of the pocket, putting the fold back at the right height, often with a smaller implant, and adjusting the skin with a lift if it is stretched.

Before proposing a plan, the surgeon seeks to understand precisely what has descended. They look at the breasts from the front and in profile, standing, arms by your sides and then raised, and compare the position of the areola, the fold and the implant.

The degree of sagging is measured by the position of the areola relative to the fold under the breast. An areola above the fold corresponds to mild ptosis or pseudoptosis; an areola at the level of the fold, to moderate ptosis; an areola below the fold and pointing downwards, to significant ptosis. With an implant in place, the surgeon also takes into account the position of the implant, which can mask or accentuate this measurement. This assessment guides the type of lift and the distance the areola must be raised. Our page on breast ptosis describes these degrees in detail.

In pseudoptosis, the areola stays at roughly the right height, but the lower part of the gland has lengthened and hangs below the fold. The breasts look heavy at the bottom. Correction focuses mainly on the lower part of the breast, with a lift that removes excess skin and gland at the bottom, sometimes combined with repositioning the fold. The areola does not need to be raised much.

When the gland slides in front of the implant, the areola often ends up pointing towards the floor, which gives an aged appearance even if the volume remains significant. The lift raises it and reorients it forwards, at the top of the breast. This is one of the most visible changes of the procedure.

Standing in front of a mirror, gently lift your breast until the areola sits at the desired height. If the breast then looks harmonious, with an implant well centred under the gland, a lift is probably the main correction needed. If, when lifting, you feel the implant staying low or moving to the side, it is probably the pocket that will need correcting. This test does not replace an examination, but it helps you understand the situation.

When the breasts have descended, replacing the implants without a lift gives a disappointing result: the new implant raises neither the gland nor the areola. Doing a lift without touching the implants risks placing a lifted gland over an old implant, sometimes poorly positioned or surrounded by a hardened capsule. Combining the two procedures allows all the elements to be treated at once: capsule, pocket, implant, gland, skin and areola. It is longer and more complex than a single procedure, but it is often the only way to achieve a harmonious shape.

The success of a revision relies on a precise analysis of what has changed: has the gland slid, has the implant descended, has the pocket enlarged, has the capsule hardened, has the skin stretched? Each cause calls for a different correction. A plan that does not treat the real cause risks a disappointing result or rapid recurrence. That is why prior examination and imaging are so important.

When the implant has dropped below the natural fold, or conversely when the gland slides below an implant that has stayed high, two contours can appear under the breast: this is called a double bubble. Correction involves putting the fold and implant back at the right height, through a capsulorrhaphy or a new pocket, and raising the gland with a lift if necessary. The choice depends on the mechanism involved.

Over time, implants may move apart towards the armpits, especially when lying down, or conversely move closer together in the centre until they touch. During the revision, the surgeon tightens the pocket on the side concerned with internal stitches, or creates a new pocket, to recentre the implants. The lift completes the correction by repositioning the areolas at the top of each breast.

The combination poses a technical challenge well known to surgeons: the implant pushes the tissues outwards, while the lift removes skin and tightens the envelope. If too much skin is removed around a large implant, the scars are put under tension, may open or widen, and the areola may be compromised. If too little is removed, the breasts remain low. Finding the right balance requires adjusting both the implant volume and the amount of skin removed, and explains why this procedure is considered one of the most delicate in cosmetic breast surgery.

Any revision with a lift is a compromise between several sometimes contradictory objectives: keeping volume, achieving high breasts, limiting scars, reducing the risk of a touch-up and shortening recovery. It is rarely possible to maximise all these objectives at once. A large volume complicates the lift and increases the risk of renewed descent; minimal scars limit the correction possible; a single procedure is more practical but sometimes less safe. Discussing your priorities openly with the surgeon allows you to find the balance best suited to your situation and values.

At the consultation, it is useful to describe precisely what bothers you and what you want, in words and possibly with images. Also say what you do not want: overly extensive scars, breasts that are too small, two procedures. The surgeon can then propose a coherent plan, explaining what is achievable and at what cost in terms of scars, recovery and risks.

Many women choose implants smaller than their previous ones during this procedure. The reasons are many: lighter breasts, more in keeping with their age; less weight on tissues that are already stretched; reduced tension on the lift scars; and a lower risk of the breasts descending again quickly. A smaller implant combined with a lift often gives higher, more harmonious breasts than a large implant alone.

The choice of volume does not rest solely on the patient's wishes. The surgeon measures the width of the breast base, tissue thickness, skin quality and the excess skin to be removed by the lift. They explain how each volume will interact with the lift: too large a volume puts the scars under tension and encourages renewed descent, while too small a volume may leave the breast empty at the top. The right volume is the one that fills the remodelled envelope without stretching it excessively.

For many women, reducing the volume of their implants is a delicate decision, linked to the image they have had of themselves for years. Yet a smaller implant combined with a lift often gives higher, firmer, younger-looking breasts than a large implant on descended breasts. Trials at the practice and photographs of results help you project yourself. Patients often end up satisfied with a volume they initially considered too small.

At the practice, sizers placed in a bra give an idea of the volume. For a revision with a lift, the exercise is harder, as you need to imagine the lifted breasts. It is useful to wear a well-fitting bra that already lifts the breasts, to get closer to the future shape. Photographs of patients who have had the same procedure complete this projection.

Some women, on the contrary, want to increase the volume during the replacement. This is possible, but with caution: a larger implant on tissues that are already thin and stretched accentuates the tendency of the breasts to descend and increases tension on the lift scars. The surgeon explains the limits of this choice and may propose a compromise, for example a slightly larger volume combined with fat transfer to improve coverage.

The choice of volume is often the most delicate question. Keeping the same volume is reassuring, but may not suit tissues that have changed. Reducing the volume lightens the breasts and makes the lift easier, but requires time to adjust. Increasing the volume is possible, but carries a greater risk of renewed descent and complications. The surgeon helps find a volume that reconciles your wishes and what the tissues can take, explaining clearly the consequences of each choice.

The volume chosen today will accompany the breasts for many years. Over time, the gland will continue to thin, the skin to slacken and the weight of the implant to bear on the tissues. A volume that seems ideal at forty-five may seem excessive at sixty. That is why surgeons often encourage thinking long term, favouring a volume that will remain harmonious and comfortable over the years rather than the maximum volume straight away. This reasoning also helps space out the next revision and preserve tissue quality for any future procedure, whether a new replacement or permanent removal of the implants.

Replacement is also an opportunity to choose a better-suited implant. An anatomical implant can replace a round one for a more natural upper breast, or vice versa. An implant with a smooth or microtextured surface can replace a heavily textured one, often for safety reasons. A different projection may better suit the new shape of the breasts after the lift. These choices are discussed according to body shape and wishes.

The width of the breast base limits the width of the new implant. An implant wider than the base spills over towards the armpit or the breastbone. When the old implant was too wide, replacement is an opportunity to choose a better-proportioned implant, tightening the pockets at the sides if necessary.

Modern implants are filled with cohesive gel, which keeps its shape and limits rippling. Some are more filled than others, which further reduces visible folds on thin tissues. The surgeon chooses a model whose fill and cohesiveness suit the thickness of your tissues.

For a given base, a more projected implant provides more forward volume, useful for filling a stretched skin envelope. But too much projection can give a less natural look and stretch the tissues. The surgeon chooses the projection according to the base, the skin remaining after the lift and the desired look.

Replacement is often an opportunity to replace textured implants with smooth or microtextured models, because of the link between certain heavily textured surfaces and the rare implant-associated lymphoma. This choice is discussed with the surgeon, taking into account the stability of the implant, especially for anatomical models, which may rotate if they are smooth.

Anatomical, teardrop-shaped implants must stay correctly oriented to give a good shape. Over time, they may rotate in their pocket, especially if it has enlarged, and distort the breast. In a revision with a lift, the surgeon may replace them with a round implant, less sensitive to rotation, or with a new anatomical implant placed in a tightened pocket. The choice depends on the desired shape and the condition of the tissues.

When an implant was placed under the gland, in front of the muscle, and its edges have become visible or capsular contracture has formed, the surgeon may move it behind the muscle, into a new pocket. This change of plane improves coverage of the upper implant. Conversely, an implant behind the muscle that distorts on contraction in a sportswoman can sometimes be moved in front of the muscle. These changes lengthen the procedure and recovery, but often correct the problem permanently.

When the capsule is thin and supple, the implant was well positioned and the main problem is descent of the gland, the surgeon can keep the same pocket. They remove the old implant, clean the pocket, possibly adjust it with a few stitches, and place the new implant. This is the simplest situation and shortens the procedure.

The dual plane involves placing the implant behind the muscle in its upper part, while releasing the lower muscle so that the gland can rest directly on the lower part of the implant. In a revision with a lift, this technique can improve cohesion between gland and implant and reduce the waterfall appearance. The surgeon adapts the degree of muscle release to the situation.

In some women, particularly sportswomen, an implant behind the muscle distorts during contractions and rides up over time, accentuating the apparent descent of the gland. Placing the new implant in front of the muscle, under the gland, can solve both problems, provided the tissues are thick enough to cover it. Fat transfer can complete the coverage. This change is accompanied by reattaching the muscle to the chest wall.

When an implant placed in front of the muscle has revealed its edges, rippling or capsular contracture, moving it behind the muscle improves coverage of the upper breast. The surgeon then creates a new pocket under the muscle, removes or leaves the old capsule depending on its condition, and adapts the lift to this new configuration. Recovery is a little more painful in the first few days.

Rather than putting the new implant back in the old pocket, the surgeon may create a new one, in a slightly different plane, for example between the capsule and the muscle. This technique, sometimes called a neo-pocket, allows a fresh start in healthy tissue, avoids a damaged capsule and gives better control of the implant's position. It is particularly useful in the event of capsular contracture or a poorly positioned implant.

The choice between keeping the old pocket and creating a new one rests on several elements observed on imaging and during the procedure. A thin, supple capsule, a well-positioned implant and no capsular contracture argue for keeping the pocket, possibly adjusted with a few stitches. A thickened or calcified capsule, capsular contracture, a descended or displaced implant, or rippling linked to insufficient coverage argue for a new pocket, often in another plane. The surgeon explains before the procedure which option they favour, while making clear that they may adapt it according to what they find during the operation. This flexibility is part of good practice in revision surgery, where every breast has particular features linked to its history.

A healthy, thick capsule can be used as reinforcement: the surgeon folds it, sutures it or uses it as a wall to support the new implant and close a pocket that is too large. This use of the capsule, rather than its routine removal, can improve the stability of the implant. The choice depends on the condition of the capsule and the problem to be corrected.

The stability of the new implant depends on the size of the pocket, the quality of the surrounding tissues, the volume of the implant and its surface. A well-fitted pocket, a moderate-volume implant and suitable fixation stitches reduce the risk of displacement. The surgeon explains the measures they take so that the correction holds over time.

Over time, the pocket containing the implant may enlarge, allowing the implant to drop, shift to the side or move closer to the other breast. The surgeon can tighten this pocket with internal stitches on the capsule, a technique called capsulorrhaphy, to hold the new implant in the right place. They can thus raise a descended fold or recentre an implant that has drifted towards the armpit.

During replacement, the capsule can be left if it is thin and supple, opened to soften it, or partially or totally removed if it is thickened, calcified or contracted. The choice depends on its condition, the type of previous implant, the problem to be corrected and the risks of dissection. The capsule removed is generally analysed. These options are detailed on our page on breast implant replacement.

When only one breast has capsular contracture, the surgeon generally treats both sides during the revision, to achieve symmetry of volume, shape and consistency. The work on the capsule is more extensive on the affected side. The lift is adapted to each breast.

When the capsule is removed, it is sent for analysis, as is any fluid present around the implant. In the vast majority of cases, the analysis confirms benign tissue. The result is given to you at a check-up.

If your current implants have a textured surface, the surgeon will inform you about the rare lymphoma associated with these surfaces. In the absence of symptoms, preventive removal is not routinely recommended, but replacement is often an opportunity to switch to a smooth or microtextured surface. If there is fluid around the implant, a specific analysis is performed and en bloc removal may be indicated.

In some difficult revisions, particularly when the tissues are very thin or the pocket tends to stretch, surgeons use a reinforcing matrix, a biological or synthetic material placed in the pocket to support the implant. Its use remains reserved for particular situations and increases the cost. If you are offered one, ask what benefit is expected, what the risks are and whether there are alternatives.

When a reinforcing matrix is used, it is placed like a sling under the lower part or at the side of the implant, fixed to the neighbouring tissues. It acts as an internal support and can thicken the coverage. It lengthens the procedure slightly, increases the cost and carries its own risks, such as fluid accumulation or infection. It is reserved for revisions where other techniques are not enough.

As with augmentation combined with a lift at a first procedure, implant replacement with a lift can be done in one or two stages. In one stage, everything is done in a single procedure. In two stages, the surgeon first treats the implant and capsule, then performs the lift a few months later, once the new implant has stabilised, or vice versa. The choice depends on the complexity of the situation, the condition of the tissues and the risks.

When a lift, which cuts some of the vessels of the skin and gland, is combined with dissection around the implant, the blood supply to the areola can be weakened. The risk of areola compromise is higher than with a simple lift. The surgeon chooses a gland pedicle that best preserves blood supply, limits dissection and may opt for two stages in the highest-risk situations, notably in a former smoker.

Studies show that combining an implant and a lift carries a higher touch-up rate than either procedure alone, and that this rate is even higher in a revision. Touch-ups mainly concern the position of the areola, the shape of the lower breast, the scars and the position of the implant. It is important to know this before the procedure, to discuss it with the surgeon and to know their policy on touch-ups.

Several reasons explain the higher touch-up rate of this combination. The tissues have already been operated on and react less predictably. The implant exerts a constant force on the skin and the lift scars. The gland, often thinned, moulds less well. Finally, the balance between volume and skin is difficult to adjust perfectly in one go. Touch-ups are generally limited: correction of a scar, adjustment of the position of an areola, a small removal of skin in the lower part. They are often performed under local anaesthesia, after the result has stabilised.

Several choices reduce this risk: a moderate implant volume suited to the envelope; a lift adjusted gradually during the procedure; a gland fixed and supported by internal stitches; a well-sized pocket; a two-stage strategy when the situation is complex; and, on the patient's side, stopping smoking, wearing the support garments as instructed and keeping a stable weight. None of these measures eliminates the risk completely, but together they clearly improve predictability.

Over the years, surgeons who regularly perform these revisions have drawn several lessons. A more moderate volume generally gives more lasting results than a large one. A lift adjusted during the procedure, over the final implant, limits unpleasant surprises. A well-sized pocket and a gland fixed over the implant reduce the risk of renewed descent. Finally, being able to propose two stages in complex situations improves safety, particularly for the blood supply to the areola. These principles now guide most revision strategies.

Before the procedure, ask the surgeon how they handle touch-ups: minimum waiting time, type of anaesthesia, any cost, what is included in the initial fee. Some surgeons include a small touch-up within a given period, others charge for it. This information should appear in the quote or in a written document, to avoid any surprises.

The lift chosen depends on how far the areola must be raised and the excess skin. A scar around the areola is enough for mild ptosis, but it is put under tension by the implant and may widen. A vertical scar is added for moderate to marked ptosis. A horizontal scar in the fold is needed for significant excess skin. Our page on the breast lift describes these techniques in detail.

A lift performed on breasts without an implant reshapes only the gland and skin. On breasts containing an implant, the surgeon must deal with a volume that pushes outwards and cannot be moulded. They cannot remove as much gland, as it serves as coverage for the implant, and they must keep enough skin to wrap the volume without excessive tension. That is why lift techniques are adapted: more measured skin removal, preservation of gland thickness in front of the implant, and particular attention to the blood supply to the areola.

With an implant in place, it is difficult to predict exactly how much skin to remove before the procedure. Many surgeons draw a cautious pattern, first place the new implant, then bring the skin together with temporary staples or stitches to judge the shape, with the patient sat up on the table. Only once satisfied with the position of the areola and the tension do they remove the skin permanently. This gradual approach limits the risk of a lift that is too tight.

So that the gland does not slide in front of the implant again, the surgeon can fix it with internal stitches to the deep tissues or the capsule at the right height. They also bring together the gland pillars below the areola to create a cone that supports the shape. These invisible internal steps count for a great deal in how well the result holds.

The areolas have often enlarged under the effect of the implant and time. The lift allows them to be brought back to a harmonious diameter. With an implant, tension on the scar surrounding the areola is greater; the surgeon uses suturing techniques that distribute this tension, such as an internal purse-string stitch, to limit later widening.

The distance between the areola and the fold determines the balance of the shape. When it is too long, the breast looks saggy; too short, it looks flattened. The vertical lift shortens this distance by removing excess skin and gland at the bottom. The surgeon adjusts this length to the volume of the new implant.

When an inverted-T lift is needed, the horizontal scar is placed in the new fold. If the fold has been raised, the scar must be too, otherwise it would end up visible below the breast. The surgeon thus coordinates closure of the pocket, the position of the fold and the scar line.

Tension is the enemy of scars. To reduce it, the surgeon brings the deep tissues together with internal stitches, so that the skin does not bear the weight of the implant and gland alone. They also choose an implant volume that does not force the envelope. A less tense scar is finer and widens less.

Most often, the surgeon uses the lift incisions to remove the old implant, treat the capsule and place the new one, avoiding additional scars. The old placement scar, if it is in the fold, is generally incorporated into the new one. An old scar in the armpit stays in place without being reused.

Generally, the surgeon begins by removing the old implants and treating the capsule, then prepares the pocket, places a sizer or the final implant, and draws or adjusts the lift according to the volume obtained. They sit the patient up on the table to check the position of the areola and the shape before removing the skin permanently. Some surgeons temporarily fix the skin with staples to judge the result before cutting. This gradual approach limits the risk of removing too much skin.

A revision takes place in tissues that were already dissected during the first placement, sometimes during other procedures. These tissues contain internal scars and are sometimes thinner and less well vascularised. The surgeon must handle them carefully, choose the dissection planes with care and preserve the blood supply to the skin and areola as much as possible. This is one of the reasons why a revision is more delicate than a first augmentation, and why the surgeon's experience matters so much.

Removing the old implants, treating the capsule, adapting or creating a pocket, trying several volumes, performing a gradually adjusted lift: each step takes time. A revision with a lift often takes longer than a first augmentation combined with a lift. This duration reflects the meticulousness required, not a complication.

During the procedure, some surgeons use sizers of different volumes to judge the result with the lift before choosing the final implant. This allows the volume to be finely adjusted to the available skin and the desired shape. Sizers are sterile and removed before the final implant is placed.

The fold under the breast is an essential landmark. If it has descended with the old implant, the surgeon raises it by closing the bottom of the pocket. If it is too high for the new volume, it can be lowered slightly. The position of the fold determines where the horizontal scar of the lift will be, when there is one, and the balance between the upper and lower breast.

This combination mainly concerns women who have had implants for many years, whose breasts have slipped and who want to keep volume. It is also necessary when an implant must be changed for a complication while the breast has descended. You need to be in good health, give up smoking and accept that the new implants will in turn be monitored and then replaced one day.

Between thirty-five and forty-five, the revision often follows pregnancies; the skin retains good elasticity. Between forty-five and sixty, menopause and the age of the implants often prompt the decision, frequently with the choice of a reduced volume. Beyond that, the procedure remains possible if health allows, with the aim of comfort and harmony.

In very active women, a large implant can interfere with sport and speed up the descent of the breasts through repeated movement. During the revision, choosing a moderate volume, a suitable plane and a well-supporting sports bra contributes to a lasting, comfortable result.

Several signs justify making an appointment, even without pain: a breast that hardens or changes shape, an implant that seems to ride up or drop, a breast that seems to hang in front of the implant, an areola that points downwards, new rippling, swelling of a breast, a lump or lymph nodes under the arm. A consultation allows you to take stock with an examination and imaging, and to consider the next steps without rushing when nothing is urgent.

Many women have had implants for more than fifteen years without any symptoms. Check-up imaging may reveal a silent rupture, in which case replacement is advised. If the implants are intact and you are happy with your breasts, nothing obliges you to change them. If the breasts have descended, it is the aesthetic aspect that will or will not prompt a revision with a lift, according to each woman's wishes.

Waiting too long when an implant has ruptured or capsular contracture is setting in can make the procedure more complex: gel migrating out of the capsule, a capsule that thickens and calcifies, tissues that thin. Likewise, the further the gland descends, the more extensive the necessary lift. Without it being urgent, it is often simpler to intervene at the right time, after careful assessment.

Some women have already had one or more revisions. The tissues are then thinner and more scarred, the blood supply poorer, and each new procedure more delicate. The surgeon takes this into account: a two-stage strategy more often, a more moderate volume, sometimes a reinforcing matrix or fat transfer. They may also raise the option of removing the implants permanently, if revisions keep recurring.

Pregnancies greatly change augmented breasts: the gland grows during pregnancy and breastfeeding, then empties, and the skin stretches. After pregnancies, many women notice that their implants still seem to be in the same place, but the breast has descended. Combining replacement and a lift works well in this situation. It is advisable to wait at least six months to a year after breastfeeding ends.

During pregnancy, the mammary gland increases greatly in volume in preparation for breastfeeding, and the skin stretches. With an implant in place, this additional volume adds to that of the implant, stretching the skin even more. After childbirth and breastfeeding, the gland shrinks, often below its previous volume, and the skin remains stretched. The implant, however, keeps its volume. The result is frequently an emptied, descended gland in front of an implant that has stayed in place, a typical situation that prompts a revision with a lift. Several pregnancies accentuate this phenomenon.

It is advisable to wait at least six months after breastfeeding ends, ideally a year, for the gland to regain a stable volume and weight to stabilise. A revision performed too early risks being altered by the natural evolution of the breasts in the following months. If further pregnancies are planned, it is often preferable to postpone the procedure.

With the hormonal drop, the gland shrinks and becomes fattier, and the skin loses its firmness. In augmented breasts, this often leads to an imbalance: an implant that is still firm and a soft gland that slides. Changing the implant, often for a smaller model, and lifting the gland restores a harmony suited to this new stage.

At menopause, the gland atrophies and becomes fattier, and the skin loses collagen. A large implant, placed years earlier on a dense gland, can then seem disproportionate and too firm compared with a gland that has become soft. Many women choose, at this stage, a smaller implant and a lift, to regain more natural, lighter breasts in keeping with their figure.

Significant weight loss empties the gland and stretches the skin around the implants; weight gain makes the breasts heavier. In both cases, the shape may deteriorate. It is preferable to wait until weight has been stable for several months before scheduling the procedure, so that the lift and choice of volume remain suitable for the long term.

Significant weight loss empties the gland and fat of the breast, stretches the skin and can reveal the edges of the implant. The revision then often combines a more extensive lift, an implant volume suited to the envelope and sometimes fat transfer. Weight must have been stable for several months. After bariatric surgery, particular attention is paid to nutritional status, which determines healing.

• Active smoking, because of the risk to the areola and healing.
• A current pregnancy, recent breastfeeding or a planned pregnancy in the near future.
• Unstable weight.
• An infection around an implant, which first requires removal and healing.
• An abnormality on imaging that must be investigated.
• A poorly controlled chronic illness.

Certain medical history influences the strategy: diabetes, which increases the risk of infection; high blood pressure, which encourages haematomas; past smoking, which weakens blood supply; chest radiotherapy, which profoundly changes the tissues; clotting disorders; a family history of breast cancer. Mention them all at the consultation, even if they seem unrelated.

When the breast has been irradiated, for example after breast-conserving treatment for cancer, the tissues are more fibrous and less well vascularised. A revision with a lift is much more delicate in this setting, with an increased risk of complications. It is the domain of teams specialised in reconstructive surgery, who often propose suitable techniques such as fat transfer or other options.

Women who have had implant-based reconstruction after cancer may also need an implant replacement and reshaping of the opposite breast. These situations are part of the reconstruction pathway, with specific insurance coverage, and are managed by teams used to this context.

When an implant is infected, it is generally not possible to replace it at the same time. The implant is removed, the infection treated, then the breast is left to heal for several months. A new implant and a lift can then be considered in good conditions. This particular situation differs from a planned replacement.

Rarely, an implant can become infected years after placement, sometimes from a distant infection such as a dental infection. In this case, the implant is removed, the infection treated, and the revision with a lift is scheduled several months later, once the tissues have healed. Mentioning implants before invasive dental treatment is good practice.

The consultation begins with the history of your implants: date of placement, type, volume, plane, any previous procedures and complications. The surgeon notes your expectations: keep the same volume, reduce or increase it, correct a shape, remove a source of discomfort. They examine the breasts standing and lying down, the position of the areolas relative to the fold, the position of the implants, the softness of the breasts, tissue thickness and skin quality. They then present a plan, with the options for the capsule, the choice of implant, the type of lift and the question of one or two stages.

Gather information about your current implants and recent imaging, and note what bothers you: descent of the breasts, hardness, shape, volume. Think about the volume you want to keep, reduce or increase. Photographs of your breasts shortly after the initial placement can help the surgeon understand how they have changed.

A second consultation allows you to revisit the choices of volume, pocket and lift, ask questions that have come up in the meantime and try volumes again. For a combined revision, it is often invaluable.

The information document describes the replacement of the implants, the work on the capsule and pocket, the lift and its scars, the risks — including the touch-up rate — and the alternatives. Take time to read it and ask your questions before signing.

Unless there is an urgent complication, there is no hurry. Take a few weeks to reflect, compare, possibly ask for a second opinion and obtain the insurer's reply if coverage is being considered.

The surgeon measures the distance between the top of the breastbone and the nipple, between the nipple and the fold, the position of the fold relative to the implant, the width of the breast base and tissue thickness on pinching. These measurements show whether it is the gland or the implant that has descended, how far the areola must be raised and which implant volume is compatible with the planned lift.

Profile photographs clearly show the relationship between gland and implant: the firm roundness of the implant at the top, the gland hanging at the bottom, the position of the areola. They are essential for planning the procedure and judging the result. The surgeon takes standardised photographs, from the front, in profile and at three-quarters, before the procedure and at check-ups.

At the consultation, it can be useful to compare several sizer volumes in a bra that lifts the breasts, to picture the result after the lift. Some surgeons also offer a 3D simulation. These tools are not perfect, but they help clarify your expectations, particularly when considering a reduction in volume. Take time to use them, possibly at a second consultation, rather than deciding in a few minutes.

Photographs of your breasts before the first augmentation and in the months after placement help the surgeon understand how the breasts have changed. They show the original natural volume, the initial position of the implant and the shape you liked. They also serve as a reference for discussing the result you want today.

Before any revision, recent imaging is needed. Ultrasound detects fluid around the implant or an abnormality of the gland; MRI best shows the condition of the shell and capsule; mammography completes the picture depending on age. These examinations guide the surgeon in choosing the procedure for the capsule and the future pocket.

The implant card and the report of the first procedure indicate the brand, model, volume, surface and placement plane. This information helps plan the work on the capsule, the choice of a new pocket and the choice of the new implant. If you no longer have them, the facility where they were placed or imaging can provide indications.

Implants placed more than twenty years ago, from older generations, are more likely to have ruptured, with gel that may have migrated out of the capsule. Their capsule is often thick, sometimes calcified. The revision then requires precise imaging, often extensive capsule removal and careful cleaning. A lift is almost always necessary after so many years.

After an old rupture, gel can reach the lymph nodes of the armpit, which enlarge slightly. These lymph nodes are generally benign and are not routinely removed. They may remain visible on imaging, which should be mentioned at future examinations.

Blood tests, the anaesthesia consultation and imaging are organised during this period. Cigarettes, vapes and substitutes are given up at least four weeks in advance: nicotine threatens the areola and encourages complications around a new implant. An infected tooth, cystitis or a wound must be treated before the procedure. Aspirin and blood-thinning supplements are stopped with the doctor's agreement. Buy two front-fastening support bras and arrange help for the first few days.

Before the procedure, put everyday items at chest height, prepare a few easy meals, tops with buttons or zips, and several pillows to keep your upper body raised at night. If drains are planned, a small pouch makes them easy to carry. Someone present on the first day is invaluable.

A relative present in the first few days helps with everyday tasks, drains and children, and accompanies you to the first check-ups. Explaining the course of recovery to them in advance is useful.

• Two front-fastening support bras.
• The prescribed painkillers.
• Supplies to change the dressings as instructed.
• Pillows to stay on your back.
• Clothes that are easy to put on.
• The team's number and the appointment for the first check-up.

The procedure is performed under general anaesthesia. The anaesthetist reviews your health and treatments, then plans pain relief supplemented by local infiltration.

With you standing, the surgeon draws the midline, the folds, the future position of the areolas and a provisional lift pattern. This drawing takes the implant in place into account, but it will be adjusted during the procedure, once the new implant has been placed, to avoid removing too much skin.

The surgeon begins with the incision, often that of the lift, removes the old implants, treats the capsule and prepares the pocket. They irrigate the pocket with antiseptic solutions, change gloves and place the new implant with as little contact with the skin as possible. They then perform the lift, adjusting the amount of skin removed to the volume in place, check symmetry in a semi-sitting position and close in several layers.

Drainage tubes often remain in the pocket for one to three days, especially after capsule removal. The wounds are covered with dressings, and the support bra is put on before you wake up.

A night at the clinic allows pain, the appearance of the areolas, bleeding in the drains and blood pressure to be monitored. A haematoma, if it occurs, is usually spotted during this night and treated quickly. The surgeon visits the next morning before discharge.

You leave with a prescription, written instructions, the team's number and the date of the first check-up. You travel home accompanied, with a cushion between the seat belt and your chest. At home, alternate rest and short walks.

The breasts feel tight and tender, more so if the implant has been slipped into a new pocket under the muscle. The lift wounds pull a little. Painkillers bring good relief. You are helped to get up a few hours later.

The first two or three days are the most uncomfortable. Avoid raising your arms high and carrying loads. Bruising fades within two to three weeks. The drains are removed when drainage decreases. Showering is allowed as instructed.

Showering is generally allowed after a few days, depending on the dressings and whether there are drains. Remove the bra while seated, gently wash the wounds without rubbing, pat dry and quickly put the support garment back on.

The first week is dominated by a feeling of tightness and tension in the chest, aching if a change of plane was performed, and the discomfort of the drains. In the second week, pain decreases markedly, the bruising turns yellow and a return to sedentary work becomes possible. Between the third and sixth weeks, the support garment remains necessary, the breasts still look high and firm, and the scars are pink. Between the second and third months, the implant settles into its pocket, the gland rounds out and sport gradually resumes. At around six months, the shape is close to the final result and a first calm review can be made.

It is worn continuously for a month to six weeks: it stabilises the new implant, holds the lifted gland and protects the wounds. When the implant is under the muscle, some surgeons add an elastic band above the breasts to help it settle down.

Tops that open at the front avoid having to raise your arms. The support bra is easily hidden under a loose shirt. Fitted clothes wait until the shape has stabilised.

Pain is moderate to significant depending on the procedures: a change of plane behind the muscle or extensive capsulectomy is more painful than a simple replacement in the same pocket. It decreases markedly after a few days. Pain that suddenly increases on one side, with swelling, requires calling the team.

You often feel tired for one to two weeks, more so after extensive capsulectomy or a change of plane. Resting, drinking regularly and resuming activities in stages help recovery.

A revision with a lift, often longer than a first procedure, can cause slightly more marked fatigue during the first two weeks, especially after a change of plane or extensive capsulectomy. It is useful to plan a gradual return and not to schedule important commitments in the days following the procedure. A balanced diet rich in protein and good hydration help you recover faster and promote good-quality healing.

Seeing your breasts change, with new scars and a shape that is still provisional, can raise doubts, especially if you chose a smaller implant. These emotions generally ease when the shape stabilises. Talking to someone close helps; if your mood stays low, consult your doctor.

Pulling at the scars, small shooting sensations as the nerves recover, a feeling of tension around the new implant and, after a change of plane, contractions of the pectoral muscle are common. They gradually decrease over a few weeks.

You must sleep on your back, with your upper body slightly raised, for four to six weeks, so as not to press on the implants or the scars.

Sleeping on your back for several weeks is not always easy. A pillow under the knees relieves the back, pillows at the sides prevent you from turning over, and a slightly raised upper body improves comfort. Sleep generally improves after the first week.

Intimate life can resume when pain allows, often after two to three weeks, avoiding compressing the breasts. Explaining to your partner how the shape is expected to evolve helps you go through this change together.

It is better to wait until you can turn the steering wheel and brake without pain, often one to two weeks. A small cushion between the seat belt and your chest improves comfort.

Cooler months are often preferred: the support garments are easier to wear under covering clothes and the scars are naturally sheltered from the sun.

Avoid carrying a young child for two to three weeks. Arrange help and favour cuddles while seated.

For a self-employed woman, time off for a cosmetic procedure is in principle not compensated. Scheduling the procedure during a quiet period and planning a gradual return limit the impact on your business.

Long journeys are not advised in the first week. If you live far from the clinic, plan to stay nearby until the next day and arrange to be accompanied home. For later journeys, take breaks to walk and drink enough.

Plan about two weeks off for sedentary work, several weeks of precautions for the arms and sport, and check-ups at one, three, six and twelve months. If a two-stage strategy is chosen, the second procedure is added three to six months later. Choosing a quiet period, outside sunny holidays and important deadlines, makes recovery easier.

Once recovery is over, all activities resume gradually. For sportswomen, the plane of the new implant matters: behind the muscle, it may move when the pectorals contract; in front, it does not move but requires good coverage. A well-fitted sports bra protects the result of the lift during high-impact sports.

When the revision involves a change of plane, the pectoral muscle is detached and then reattached or lifted to create a new pocket. It takes several weeks to regain strength and suppleness. Pulling or small cramps are common at first. Strength training resumes gradually, ideally guided by a physiotherapist.

The lift scars go around the areola, run vertically and sometimes follow the fold. The old implant placement scar is often incorporated or used. The scars are pink at first, then fade over one to two years. With an implant, the scar around the areola is under tension and may widen; specific closure techniques limit this risk. Gentle massage, silicone and sun protection help them mature.

The lift scars are fine and pink at first. Between the second and fourth months, they may become redder and slightly thick: this is a normal maturation phase. They then thin out and gradually fade over one to two years. The scar around the areola often blends into the pigmented border; the vertical scar remains visible close up, but becomes discreet. Strict sun protection during the first year and regular care help them mature well.

Once the wounds have fully closed, generally after two to three weeks, gentle daily massage with a neutral cream softens the scars. Silicone gels or sheets, worn for several months, help flatten them. Avoid any unprotected sun exposure for at least a year. If a scar itches, reddens or thickens, talk to the surgeon.

In the first few weeks, baths, swimming pools, saunas and steam rooms are not advised, until the wounds have fully closed and the pocket has stabilised. Heat also encourages swelling. The surgeon specifies the waiting time, often four to six weeks.

At first, the breast looks high, hard and slightly angular at the bottom. Over the weeks, the implant, especially if it is under the muscle, settles into its pocket, and the gland gradually moulds to it. It takes three to six months for the silhouette to settle; be patient before judging.

During the first month, the breasts are high, firm and sometimes slightly angular at the bottom; the scars are pink. The support garment is worn continuously, you avoid raising your arms and carrying loads, and you gradually resume your activities. By the end of the month, most women have resumed normal daily life.

Between three and six months, the implant settles into its pocket, the gland moulds to it and the shape rounds out. The scars may thicken temporarily before thinning. This is when you begin to fully appreciate the result.

Your usual bras wait until the shape has stabilised, at around three to six months. The cup size often changes, especially if the implant volume has been reduced. Many women then enjoy lighter styles. Having your size checked by a specialist fitter helps you choose support suited to the new shape.

Lifted breasts, sometimes lighter, change your overall look: clothes hang better, blouses no longer gape and fitted dresses show off high breasts. It is advisable to wait for the shape to stabilise before renewing your wardrobe. This moment is often experienced as a positive milestone.

At one year, the shape has stabilised and the scars are fading. The one-year review takes stock of the shape, symmetry, scars and satisfaction, and organises surveillance of the new implants. It is also the time to discuss a possible touch-up.

At one year, it is useful to take stock: does the result match what was announced? Are the scars acceptable? Is a touch-up wanted? This review, shared with the surgeon, concludes the journey and organises long-term surveillance of the new implants.

After scheduled follow-up ends, it remains useful to be able to consult your surgeon again for a question, a scar or a wish for a touch-up and, years later, for a future revision. A surgeon who is available after the procedure inspires confidence.

Visits take place at one week, then at one, three, six and twelve months. The surgeon examines the wounds, the colour of the areolas, the position of the new implants and any fluid, and gives you the laboratory report. Usual implant surveillance then resumes, with examination and imaging at regular intervals.

At around one week, the surgeon checks the wounds, the colour of the areolas, the position of the implants and the absence of fluid, removes any remaining drains and adjusts the support garment.

Noting how the pain, the appearance of the wounds and areolas, the medicines taken and your questions evolve helps you prepare for check-ups. Regular photographs, taken under the same conditions, allow you to follow the evolution of the shape without relying solely on the mirror.

After the procedure, you receive a new implant card identifying the new implants. Keep it with the operative report. It will be useful for surveillance, in the event of an alert about a model and for any future procedure.

The new implants, like the old ones, are not placed for life. Regular surveillance is recommended: clinical examination and imaging at the frequency indicated by the surgeon, generally an ultrasound or MRI a few years after placement and then at regular intervals. This surveillance allows silent rupture or another complication to be detected early. It is in addition to usual breast cancer screening, which continues with the radiologist informed of the implants.

Beyond the first year, surveillance comes down to regular breast examination by the gynaecologist or GP, usual breast cancer screening with the implants mentioned, and check-up imaging of the implants at the recommended frequency. Any change in shape, consistency or volume should prompt a consultation.

Health authorities and manufacturers sometimes publish information about the safety of certain models. Keeping your implant card lets you know quickly whether you are concerned. The surgeon or facility may also contact you in the event of an alert. Do not hesitate to ask about your implants at a follow-up consultation.

It is useful to know now that further surgery may be needed in the years to come, for a rupture, capsular contracture or a change in the breasts. Choosing a moderate volume and a good-quality implant, and keeping a stable weight, increase the chances of delaying this next revision. Some women, at a future revision, will choose to remove their implants permanently; this option remains open.

After the procedure, keep the new implant card, the operative report, the result of the capsule analysis and your imaging. These documents will be invaluable for surveillance, in the event of an alert about a model and at a future revision.

The combination brings together the risks of implant replacement, with work on the capsule, and those of a lift, in a revision setting where the tissues have already been operated on.

Blood can collect in the pocket of the new implant, especially after a capsulectomy, whose surface bleeds easily, or after the creation of a new pocket. It generally shows in the first few hours or days, as rapid, tense, painful swelling on one side, sometimes with extensive bruising. A large haematoma usually requires a short return to theatre to drain the blood, control the bleeding and check the implant. It generally does not compromise the final result when treated promptly, but it slightly increases the risk of later capsular contracture. Stopping blood-thinning products beforehand and monitoring the drains help prevent it.

Clear fluid can collect around the new implant in the following weeks, particularly when the old capsule has been left in place or a large area has been dissected. The breast then swells softly, sometimes with a feeling of moving fluid. The surgeon performs aspiration, often ultrasound-guided, taking care not to touch the implant. A persistent seroma may require revision. Wearing the support garment continuously and following the instructions to rest the arms reduce its frequency.

Infection is rare, but it is the most feared complication when it affects a new implant. It shows as redness, warmth, increasing pain, swelling and sometimes fever, most often in the following weeks. Antibiotic treatment may be enough when it is superficial; if the implant is affected, it generally has to be removed, the breast left to heal for several months, and a new implant placed later. Revisions carry slightly more of this risk than a first placement, which justifies particularly strict aseptic precautions.

Any procedure lasting several hours under general anaesthesia carries a small risk of a clot forming in a leg vein. Prevention relies on getting up early, walking regularly, good hydration, compression stockings and, depending on risk factors, anticoagulant injections. A painful or swollen calf, sudden breathlessness or chest pain require calling the emergency services without delay.

After replacement with a lift, the breasts may descend again faster than after a lift without an implant, as the weight of the implant continues to pull on tissues that are already stretched. The risk increases with implant volume, thin skin and weight changes. Choosing a moderate volume, carefully reshaping the gland and tightening the pocket contribute to a lasting result.

After stabilisation, an areola may look slightly too high, notably if the implant has dropped a little in its pocket, or too low if the gland has slid again. An areola that is too low is fairly simple to correct; one that is too high is harder to lower and sometimes leaves a visible scar above it. That is why surgeons prefer to place the areola cautiously rather than too high.

Over time, the distance between the areola and the fold may lengthen again, as the gland and skin descend under the weight of the implant. A small touch-up, removing a spindle of skin in the lower part, corrects this lengthening. A moderate volume and a well-supported gland limit this phenomenon.

The tension exerted by the implant on the lift scars, particularly around the areola, can cause them to widen in the following months. An enlarging areola or a spreading scar are the signs. A scar revision can be offered after a year, often under local anaesthesia.

Some skin reacts to healing by forming red, thick, itchy scars, especially on the breasts and when tension is high. This risk is greater on olive skin and in people who have had this type of scar before. It must be mentioned before the procedure. Early silicone dressings, corticosteroid injections or certain lasers can often improve these scars.

Implant replacement does not protect against new capsular contracture. Several measures reduce this risk: removing the old capsule when it is thickened, creating a new pocket, no-touch placement techniques, a smooth or microtextured implant and sometimes a change of plane. Despite these precautions, contracture can form again.

The new implant may shift downwards, to the side or towards the centre, especially when the pocket was already stretched. Capsulorrhaphy and choosing a suitable implant limit this risk. Persistent malposition can be corrected with a further procedure.

Areola sensation may decrease or, on the contrary, become heightened for several months after the procedure. It usually returns, but a lasting reduction is possible, especially when the areola has had to be raised by several centimetres. In some women whose sensation was impaired by capsular contracture, it improves after removal of the contracted capsule.

A slight difference between the two breasts is common, especially as the two sides may have changed differently over the years: capsular contracture on one side, a more descended gland on the other. The surgeon seeks to balance the two sides, sometimes with implants of different volumes or lifts adapted to each breast. Marked asymmetry that persists after six months to a year can be touched up.

On thin tissues, the edges or surface of the new implant may remain visible as rippling, especially at the sides and bottom. A change of plane, a more filled implant and fat transfer reduce this risk. If rippling persists after stabilisation, a fat transfer session can soften it.

• Sudden, painful swelling on one side.
• An areola that turns dark or bluish.
• High temperature, red and hot skin, cloudy discharge.
• A wound that opens slightly.
• A swollen calf, shortness of breath, chest pain.

During recovery, call the team with any question or concern: a breast that swells, an areola that changes colour, a fever. Sending a photograph, if the team offers this, often allows a quick response. Note down your questions for the check-ups.

Touch-ups are more common after this combination than after a single procedure. They mainly concern the scars, the position of the areolas, the shape of the lower breast or the position of an implant. They are performed after six months to a year, often under local or light anaesthesia. Knowing the surgeon's touch-up policy before the procedure is essential.

Touch-ups are discussed after six months to a year, once the shape has stabilised: a widened scar, a slightly asymmetrical areola, a lower breast that is too long, a slightly displaced implant. They are often performed under local or light anaesthesia. It is useful to know the surgeon's touch-up policy and any cost from the outset.

Even after a successful revision, some elements may persist: slight stretch marks, discreet asymmetry, a scar a little more visible on one side, altered sensation. They are generally accepted in view of the improvement achieved. If one of them is truly bothersome, a touch-up can be discussed after stabilisation.

When the combination is successful, the breasts regain a high, harmonious shape, with gland and implant aligned again, areolas raised and pointing forwards, and a volume suited to the figure. Many patients describe younger, better-proportioned breasts, often lighter thanks to a smaller implant.

Many women find that their breasts look more natural after the revision than with their old implants. Several reasons explain this: an often more moderate volume, a gland realigned over the implant, modern implants that are more cohesive and better suited to body shape, and a less bulging cleavage. This more natural look is often one of the most appreciated benefits, particularly in women who opted for a large volume years earlier.

The main aim of the combination is to put the gland back in its place, in front of the implant, rather than in front of and below it. When this alignment is restored, the breast regains a round, harmonious shape, with the areola at the top and a rounded lower edge. This is what distinguishes a successful revision with a lift from a simple implant replacement on descended breasts.

The most satisfied women are often those who accepted a volume suited to their tissues and knew that a touch-up might be necessary. They appreciate higher, younger and often lighter breasts. Disappointments come mainly from expectations of a large volume on stretched tissues, or from underestimating the visibility of the scars.

The most satisfied women are those who knew in advance that the breasts would at first be high and firm, that the scars would be visible for several months, that a touch-up was possible and that the new implants would need monitoring. A frank discussion with the surgeon on these points is the best prevention against disappointment.

A successful revision is recognisable by breasts in which gland and implant form a harmonious whole, with the areola at the top of the breast, a rounded lower part and a fold at the right height. The two breasts are close in volume and shape. The scars, once mature, are fine and discreet. To the touch, the breasts are soft, with no hardness or palpable edges. Above all, the patient feels at ease with her breasts, in her clothes and in intimacy.

Several observations come up repeatedly. The breasts look very high in the first few weeks, then descend and round out. The lift scars are worrying at first and then become discreet. Many appreciate having reduced the volume, even if they hesitated beforehand. And most say they should have treated the descent of the gland sooner rather than settling for a simple implant replacement.

Regaining high, harmonious breasts often restores confidence, particularly in women who felt uncomfortable with breasts that had descended around implants that stayed high. A change in volume, when there is one, sometimes requires time to adjust. Allowing yourself this time and looking at the progress over several months helps you appreciate the result.

Those around you often notice higher, more harmonious, sometimes lighter breasts, without always identifying a procedure. Whether or not to talk about the revision remains a personal choice. What matters is that the decision reflects your own wishes.

Beyond appearance, many women appreciate regained comfort: breasts that no longer hang in the bra, straps that no longer pull as much, clothes that hang better, and sometimes the disappearance of discomfort caused by capsular contracture. When the volume has been reduced, the lightness of the breasts is often cited as a significant benefit, notably for sport and sleep.

When the gland hung in front of or below the implant, a moist fold often formed under the breast, causing irritation and discomfort, particularly in summer and during sport. By lifting the gland and repositioning the fold, the lift often eliminates this fold. This discreet practical benefit is regularly cited by patients among the everyday improvements, alongside appearance and regained lightness. It also contributes to better skin hygiene and greater comfort with bras, which no longer rub on irritated skin. For sportswomen, it is often a much appreciated change that makes exercise more pleasant across the seasons, particularly during summer activities and long days of walking.

Even when the result is successful, it often takes a few weeks or months to get used to different breasts, especially if the volume has been reduced or the shape has changed a lot. This adjustment period is normal. Photographs taken before the procedure often help you measure how far you have come, beyond first impressions.

For many women, breasts that had descended around old implants had become a source of discomfort, even unease, in clothes and in intimacy. A revision with a lift often allows them to regain confidence, return to activities or outfits they had been avoiding and feel in tune with their image again. This benefit, difficult to measure, often counts for more than cup size.

Sharing the reasons for the procedure, the choice of volume and the stages of recovery with your partner helps you go through this change together. Many appreciate more natural breasts, more in harmony with the figure.

A partner is sometimes involved in the decision, notably regarding the choice of volume. It is important that the final decision remains the patient's, according to her comfort, health and wishes. A partner informed of the reasons for the choice, the constraints and the stages of recovery generally supports the process better.

Allow about two weeks before returning to office work, four to six weeks before stopping continuous wear of the support garment, six to eight weeks before resuming chest exercises, and three to six months before the shape has stabilised. The scars continue to thin for one to two years. With a two-stage strategy, these timescales are partly repeated for the second procedure.

The result lasts several years, but it is not permanent. The new implants will need monitoring and may one day be changed. The breasts will continue to change with age, weight and hormones. A moderate volume, a stable weight and suitable support during sport are the best assets for a lasting result.

Weight gain makes the gland heavier and can make it descend in front of the implant again; weight loss empties it and can reveal the edges of the implant. A stable weight preserves the alignment achieved between gland and implant.

A pregnancy remains possible, but it can make the gland descend again and change the result. If a pregnancy is planned in the short term, it may be preferable to postpone the procedure.

A stable weight, regular physical activity, a suitable sports bra during exercise, not smoking and sun protection for the scars during the first year are the best ways to preserve the result for as long as possible.

When reflecting, it is useful also to consider the option of removing the implants without replacing them, with a lift. The breasts will be smaller, but with no implant surveillance or future revision. Some women, after weighing up the two options, ultimately choose this route. Our page on explantation with a lift presents this alternative in detail.

Choosing to replace your implants means choosing to continue living with implants, with all that this implies: regular surveillance, vigilance about any change in shape or consistency, and the prospect of a future revision. For many women, these constraints are acceptable in view of the aesthetic benefit and comfort that implants bring. It is important to make this choice in full knowledge, comparing it honestly with the option of explantation.

When the implants are recent, intact, well positioned and without capsular contracture, it is sometimes possible to perform a lift without changing them. This is an option to discuss with the surgeon. Most often, however, in women who have had implants for many years, taking the opportunity of the lift to change the implants avoids another procedure in the short term.

When the tissues are thin and the edges of the new implant risk being visible, fat transfer can complement the procedure. The fat is injected into the tissues covering the implant, especially in the upper breast and cleavage. Our page on hybrid breast augmentation describes this principle.

When the tissues covering the new implant are thin, the surgeon can harvest fat by gentle liposuction, often from the abdomen, flanks or thighs, purify it and reinject it in fine threads into the breast tissue, above and around the implant. It thickens the coverage, softens the upper edge of the implant and improves the cleavage. In a revision with a lift, the fat is injected cautiously, outside the pocket and away from areas where the areola's blood supply is under strain. Some of it is resorbed in the following months; a second session may be useful.

Some surgeons prefer to perform fat transfer as a second stage, a few months after the revision, when the pocket has stabilised and the tissues have healed. The fat then survives better, and the areola's blood supply is not strained by the lift and the injections at the same time. Others include it in the revision when the situation allows. The choice depends on the condition of the tissues.

An increasingly common strategy involves placing a clearly smaller implant and compensating for part of the lost volume with fat. The result is lighter breasts with a more natural look and feel, but a slightly smaller volume than with the original implant. This approach suits women who want to lighten their breasts without giving up implants completely.

Each option is expressed relative to an index whose base of 100 corresponds to replacement of the implants in the same pocket with partial capsule removal and a vertical lift, in Geneva, implants included, paid in full by the patient.

For details, see the page on breast implant replacement with lift prices.

When the replacement responds to a medical problem — rupture, marked capsular contracture or fluid around the implant — the surgeon can apply to basic insurance before operating; its medical adviser decides case by case, applying sometimes restrictive rules when the first placement was cosmetic. The new implants and the lift usually remain at the patient's expense. Wait for the written reply before setting the date.

When the revision is prompted by a complication, the surgeon writes a request accompanied by imaging and a description of the symptoms. The insurer's medical adviser examines the file. If the request is accepted, it generally covers removal of the defective implant and the work on the capsule; the new implants and the lift usually remain cosmetic. The quote then distinguishes the two parts.

For any covered part, a hospital stay in another canton may change the reimbursement, depending on your canton of residence's hospital list and your supplementary insurance. For the cosmetic part, the choice is free. Have your insurer clarify these points before choosing the facility.

Some women choose to change their implants and have a lift before any complication, at a time that suits them, rather than waiting for a rupture or capsular contracture. This approach allows them to choose the date, prepare calmly and avoid an emergency revision. It remains entirely cosmetic and at the patient's expense.

Some clinics offer staggered payment for the cosmetic part. Calculate the total cost before committing, bearing in mind the future costs of monitoring the new implants.

More or less extensive capsule removal, a new pocket, the lift technique, the implant model, fat transfer, nights at the clinic and the facility explain the differences. Operating in two stages increases the total bill.

The proposal should detail what will be done to the capsule and in which pocket, the brand, model and volume of the new implants, the lift technique, any fat transfer, laboratory examination of the tissues removed, the night or nights at the clinic, the support garments, follow-up visits and what is planned in the event of a revision. If part is covered, the split of costs must appear clearly.

The quote is supplemented by prior imaging, support bras, tissue analysis, any fat transfer session and, in the longer term, surveillance of the new implants and a future revision. Adding them up helps measure the commitment.

Implant replacement combined with a lift is a revision procedure that requires specific experience. The table compares, for twenty-two cities, local experience with these revisions and the price level compared with Geneva.

For a complex revision, the surgeon's experience clearly outweighs proximity or price.

In French-speaking Switzerland, experience with complex revisions is concentrated around Lake Geneva, in Geneva and Lausanne, while the Riviera, central Valais, Neuchâtel and Fribourg offer alternatives. In German-speaking Switzerland, Zurich leads, ahead of Basel and Bern; Lucerne, Zug, Aarau and St. Gallen complete the network. South of the Alps, Lugano has most of the practitioners. From the small cantons, patients generally travel to one of these centres.

Capsule, pocket, choice of implant, likelihood of a revision: these concepts must be clear. Practices in French-speaking Switzerland work in French; in Zurich, Basel, Bern or Lugano, many surgeons are happy to see patients in French. Insist on written documents in a language you read fluently.

Opting for a revision specialist far from home is often a sound choice. In that case, plan to stay overnight nearby, travel home accompanied and entrust the first check-ups to a doctor close to home. The six- and twelve-month appointments are in principle with the operating surgeon; implant surveillance can then continue close to home.

If you have surgery far from home, organise local follow-up in advance: your GP can check the wounds and spot fluid accumulation, and refer you to the surgeon if necessary. The six-month and one-year check-ups, important for judging the result and deciding on a possible touch-up, generally take place with the surgeon.

A second opinion is particularly useful for a revision with a lift: it allows you to compare strategies — one or two stages, same pocket or neo-pocket, volume of the new implant — and to check whether a lift is worthwhile. If opinions differ, ask each surgeon to explain their reasons.

You need a practitioner comfortable with revisions and with lifts over implants, two demanding skills. Ask how many revisions with a lift they perform, their criteria for operating in one or two stages, how they manage the capsule and pocket, and how often they need to revise. Look at results of cases close to yours, photographed more than six months on.

The procedure involves the surgeon, the anaesthetist, the theatre and ward teams, and the laboratory that analyses the capsule. Ask who your contact is after discharge and how to reach the team at any time.

The GP or gynaecologist then handles breast surveillance and can prescribe follow-up imaging of the new implants. Sending them the operative report and the new implant card makes this follow-up easier.

A reputable surgeon will explain what has moved in your breasts, why they propose a particular volume and pocket, when they prefer to operate in two stages, what the risk of a touch-up is and that the new implants will need monitoring. They will not hesitate to advise against an excessive volume.

Ask for photographs of revisions with a lift, in women whose starting situation resembles yours, more than six months on. Look at the position of the areolas, the shape of the lower breast, the alignment between gland and implant, and the scars.

• Have my breasts descended because the gland has slipped or because the implant has dropped?
• Do you recommend one or two stages, and why?
• What will you do with the capsule? Will you create a new pocket?
• What implant volume and shape do you propose?
• What type of lift, with what scars?
• What is the risk of the breasts descending again, and how do you limit it?
• What is your touch-up policy?
• Would fat transfer be useful?

• Changing the implants without a lift when the gland has descended.
• Choosing a larger implant on stretched tissues.
• Underestimating the likelihood of a touch-up.
• Continuing to smoke.
• Judging the shape before six months.
• Forgetting that the new implants will need monitoring.

Breasts that slip

A forty-six-year-old woman has had implants behind the muscle for fifteen years. After two pregnancies, her breasts hang in front of implants that have stayed high. The surgeon proposes slightly smaller new implants, a partial capsulectomy and a vertical lift. The gland returns to its place over the implant.

The dropped implant

A thirty-nine-year-old woman has large implants under the gland that have dropped below the fold. The surgeon raises the fold with a capsulorrhaphy, places smaller implants behind the muscle in a new pocket and performs a limited periareolar lift.

Capsular contracture with ptosis

A fifty-two-year-old woman has capsular contracture on one side and ptosis on both sides. The surgeon proposes a total capsulectomy on the affected side, a neo-pocket, new smooth implants and an inverted-T lift, in two stages to protect the blood supply to the areolas.

The wish to lighten

A fifty-five-year-old woman finds her implants too heavy. She wants to keep a little volume. The surgeon proposes clearly smaller implants, a vertical lift and fat transfer to the upper breasts.

A forty-seven-year-old woman has had medium-sized round implants behind the muscle for fourteen years. After two pregnancies, her gland has slid in front of the implants and her areolas point downwards. She does not want to give up volume, but would like lighter breasts. MRI shows intact implants and thin capsules. The surgeon proposes keeping the same pocket, placing slightly smaller smooth-surface implants and performing a vertical lift. The procedure takes three hours, with one night at the clinic. She returns to work after two weeks. At six months, her breasts are higher, the gland well aligned over the implant, and the scars are beginning to fade. She says she is happy to have chosen a more modest volume.

The journey of a revision with a lift has several milestones: realising that the breasts have changed, the consultation and imaging, choosing the volume, the procedure and waking up, the first check-up, then stabilisation of the shape between three and six months. Knowing them in advance helps you go through them calmly and set concrete milestones rather than waiting impatiently for the final result.

• I have recent imaging of my implants.
• I know the type of my current implants and their plane.
• I understand whether it is the gland or the implant that has descended.
• I know the volume, shape and surface of the new implant.
• I know which lift is planned and what scars will result.
• I know whether the procedure will be done in one or two stages.
• I have stopped smoking.
• I know the touch-up policy and, if applicable, my insurer's reply.

The decision rests on a few questions: do you want to keep implants and therefore long-term surveillance? What volume suits you today? Do you accept the lift scars and the possibility of a touch-up? Do you prefer to do everything at once or in two safer stages? The answers, shared with the surgeon, naturally point towards the most suitable plan.

Implant replacement combined with a lift is for women who want to keep volume but whose breasts have descended around old implants. The surgeon replaces the implants, often with smaller or better-suited models, treats the capsule and pocket, and raises the gland and areola with a lift. The balance between an implant that fills and a lift that tightens is delicate, which explains a higher touch-up rate and, sometimes, the choice of two stages.

The result is higher, harmonious breasts, with lift scars and new implants to monitor. A replacement for a complication may be the subject of a request for partial coverage. Depending on the canton, fees can be up to fourteen per cent lower than in Geneva; the surgeon's experience in revision remains the decisive criterion.

Understand what has changed in your breasts. Choose a volume suited to your tissues rather than the largest possible. Accept that a lift leaves scars and that a touch-up may be useful. Stop smoking. Consider two stages if the surgeon recommends it. Wear the support garments as instructed. And give yourself six months before judging the result.

If your implants have aged and your breasts have slipped, an appointment will establish what has moved — the gland, the implant or both — and which strategy to choose. Bring your documents and examinations, and compare without haste. Our service puts you in touch, free of charge, with a surgeon experienced in breast revisions.

Budget

Price differences between cities and cantons, the quote breakdown and ways to save are detailed on our page Breast implant replacement and breast lift: prices in Switzerland.

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• Hybrid breast augmentation in Switzerland
• Breast implant removal and breast lift in Switzerland
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• Breast fat transfer and liposuction in Switzerland
• Facelift and facial fat transfer in Switzerland
• Rhinoplasty and genioplasty in Switzerland

The procedures that make up this combination

• Cosmetic hip implants in Switzerland

Our guides

• Combined procedures in Switzerland
• Cosmetic surgery in Switzerland

Descended gland, displaced implant, volume, pocket, one or two stages, touch-ups: the most frequent questions before a revision with a lift.

Understanding the procedure

What does implant replacement with a lift involve? The old implants are replaced with new ones and the gland and areola are raised with a lift, during the same procedure or in two stages.

Why is a simple replacement not enough? Because a new implant neither raises a descended gland nor a low areola.

What is the waterfall appearance? A breast that hangs in front of an implant that has stayed high, with a firm roundness at the top and a gland that falls below.

Can the implant also descend? Yes, it can slide below the fold and pull the breast down, especially if it is large.

Should I change volume? Not necessarily, but many women choose smaller implants, better suited to stretched tissues.

Can I change implant shape? Yes, switching from a round implant to an anatomical one, or vice versa, depending on the desired result.

Why is this procedure delicate? Because an implant that fills and a lift that tightens must be reconciled, in tissues that have already been operated on.

Who is it for?

Who is it for? Women who have had implants for several years whose breasts have descended and who want to keep volume.

Is it suitable after pregnancies? Yes, it is a common situation, ideally six months to a year after breastfeeding ends.

And at menopause? This is also a common time, often with the choice of a smaller implant.

What if I smoke? You must stop completely before the procedure: the areola is particularly at risk.

What if my implant is infected? The implant is first removed and the infection treated; replacement with a lift can be considered later.

The technique

What is a neo-pocket? A new pocket created for the implant, in a different plane from the old one.

What is a capsulorrhaphy? Tightening of the pocket with stitches on the capsule, to hold the implant in the right place.

What is done with the capsule? It is left in place, opened or removed depending on its condition; if removed, it is analysed.

Can the plane be changed? Yes, moving from in front of to behind the muscle, or sometimes the reverse, depending on the problem to be corrected.

What is a sizer? A temporary implant used in theatre to choose the final volume in conjunction with the lift.

Are reinforcing matrices necessary? Rarely, in difficult revisions with very thin tissues.

One or two stages

Why two stages? To better protect the blood supply to the areola and adjust the lift to the new, stabilised implant.

When does the surgeon propose two stages? With a change of plane, extensive capsulectomy, a major lift or in a former smoker.

How long between the two procedures? Generally three to six months.

The procedure

How long does the procedure take? From three to four and a half hours, longer with a neo-pocket.

Do I need to stay at the clinic? Generally one night.

What scars? Those of the lift: around the areola, often vertical, sometimes in the fold.

Is the old scar reused? It is often incorporated or used.

Are drains used? Often, for one to three days.

Recovery

Is the pain severe? Moderate to significant depending on the procedures, especially after a change of plane behind the muscle.

How long is the support garment worn? A month to six weeks, without removing it at night.

How much time off work should I plan? About two weeks for an office job.

What position should I sleep in? On your back, for a month to six weeks.

When can I do sport again? Jogging after five or six weeks, chest exercises after six to eight weeks.

Risks

Is the risk of a touch-up high? Higher than after a single procedure, especially for the scars and the position of the areolas.

Can the breasts descend again? Yes, faster than after a lift without an implant, especially with a large volume.

Can the areola be compromised? Rarely, but the risk is higher than with a simple lift.

Is new capsular contracture possible? Yes, although several techniques reduce this risk.

Can the scars widen? Yes, under the tension of the implant, especially around the areola.

Results

When can the result be judged? From the sixth month; the scars continue to fade for one to two years.

Is the result lasting? For several years, but the new implants will need monitoring and will one day need changing.

Will the breasts be lighter? Often yes, if a smaller implant is chosen.

Price and insurance

Does insurance reimburse it? A request can be made for a replacement prompted by a complication; the new implants and the lift generally remain at the patient's expense.

Where do price differences come from? From the treatment of the capsule, the pocket, the type of lift, the implant chosen and the facility.

Do two stages cost more? Yes, because there are two procedures.

Does the canton influence the fee? Yes, the difference with Geneva sometimes reaches fourteen per cent.

Choosing

On what criteria should I choose the surgeon? Their experience of revisions combined with a lift and photos of cases similar to yours.

Is a second opinion needed? It is strongly recommended for a complex revision.

Can I consult in French in German-speaking Switzerland? Without difficulty in most Zurich practices.

Particular situations

Can just one implant be replaced with a lift? It is possible, but balance between the two breasts often leads to treating both sides.

My implants have ruptured: do I need a lift? Not necessarily; a lift is only useful if the breasts have descended.

Can I switch to smooth implants? Yes, this is common during replacement, notably to replace textured implants.

Can an anatomical implant rotate? It is possible; the stability of the pocket and the surface of the implant limit this risk.

Can a double bubble be corrected? Yes, by repositioning the fold and the implant, often with a lift if the gland has descended.

Can breasts that are too far apart be brought closer? To some extent, by tightening the pockets at the sides.

Can breasts that touch be separated? Yes, by closing the inner part of the pockets.

Can the areolas be reduced? Yes, during the lift, with particular attention to tension around the areola.

Is fat transfer useful? When the tissues are thin, it improves coverage of the new implant.

Is a band needed after the procedure? Some surgeons prescribe one to help an implant placed behind the muscle settle down.

What happens to the old implant? It is generally discarded unless an abnormality justifies examination; it is mainly the capsule that goes to the laboratory.

What if I cannot find my implant card? The facility of the first procedure or imaging can help identify the implants.

My implant model no longer exists; is that a problem? No, suitable new models are chosen during the replacement.

Does areola sensation change? It may be altered for a few months, then usually returns.

Will I be able to breastfeed afterwards? It varies according to the lift and the implant plane.

Will a pregnancy change the result? Yes, it can make the breasts descend again and require a touch-up.

What happens if I gain weight? The breasts may become heavier and descend faster.

Is the result natural? With a suitable volume and a well-performed lift, yes, the breasts look younger and better proportioned.

Should implant surveillance continue? Yes, with clinical examination and regular imaging.

How long will the new implants last? Often more than ten years, but they are not guaranteed for life.

Can the procedure be done at sixty? Yes, if health allows, with careful assessment.

What if I eventually want to remove my implants? Explantation with a lift is an alternative to discuss before deciding.

Is a periareolar lift enough? Only for mild ptosis; it carries a risk of the scar widening.

Why does the surgeon use temporary staples? To judge the shape before permanently removing skin.

Is the gland fixed onto the implant? The surgeon reshapes and fixes the gland so that it stays aligned with the implant.

Can I wear an underwired bra afterwards? After several weeks, according to the surgeon's advice.

When can I go swimming? After about six weeks, once the scars have fully closed.

Do I need help at home? Yes, for the first few days, for movements that involve raising the arms.

Is one season preferable? Winter is more comfortable for wearing the support garments and is kinder to the scars.

Should I tell my employer? No, a sick note is enough.

How should I prepare for the consultation? Gather your implant documents, your imaging, your expectations and your questions.

Is a new implant card needed? Yes, it is given to you after the procedure.

Does contracture pain disappear? In the vast majority of cases, after removal of the contracted capsule.

Can the plane be changed without a lift? Yes, if the gland has not descended.

Is the risk of infection higher in a revision? It remains low, but aseptic precautions are essential.

What should I do if a breast swells late on? Consult promptly for an ultrasound.

Can the lift be done under local anaesthesia? Not in this combination, which is performed under general anaesthesia.

Will both sides be identical? Rarely perfectly; a clear difference is corrected after stabilisation.

Is the second stage lighter? Often yes, especially if it is only the lift.

What is Medespoir Suisse's role? To put you in touch, free of charge, with a specialist in breast revisions.

Can I resume pectoral training? Yes, gradually after six to eight weeks, knowing that an implant behind the muscle may move during exertion.

Is the result visible in a swimsuit? Yes, higher, harmonious breasts are noticeable, with discreet scars under the swimsuit.

What if the scars widen? A touch-up can be offered after a year.

Will my stretch marks go? Only those on the skin removed disappear.

Should I stop the pill? This is discussed with the anaesthetist according to your risk factors.

What happens if the insurer refuses? The replacement and lift then remain entirely at your expense.

Are calcified capsules removed? Generally yes, as they harden the breast.

Can visible rippling be corrected? Yes, by a change of plane, a more filled implant or fat transfer.

Should I see photos of results? Yes, of revisions with a lift, more than six months on.

Can the surgeon refuse a volume that is too large? Yes, if they believe the tissues will not support it; it is a sign of seriousness.

What if I do not like the shape after six months? Talk to the surgeon: a touch-up can be considered after stabilisation.

Does the result depend on the surgeon? Very much: experience of revisions with a lift is decisive.

Can liposuction be combined? It is possible, notably to harvest fat, but it lengthens the procedure.

Will the ptosis come back one day? Over time, the breasts change; a moderate volume slows this down.

Tell us the history of your implants, what bothers you today and the region that suits you: an adviser will suggest, free of charge, a surgeon used to revisions with a lift.