Breast implants do not last forever. Manufacturers warranty them for ten years, but many last significantly longer. At some point, most women with implants will consider or need an exchange — whether to change size, replace a ruptured implant, upgrade to a newer generation, or switch from saline to silicone.
The question that comes up immediately, especially for women who had their original augmentation through the armpit: can the exchange be done through the same incision, or will I need a new scar?
The short answer is yes. In the majority of cases, implant exchange can be performed through the original armpit incision using endoscopic technique.
Why Exchange Is Easier Than Primary Augmentation
During your original breast augmentation, the surgeon creates the pocket from scratch — dissecting the plane between the pectoralis muscle and the chest wall, releasing muscle attachments, defining the pocket boundaries. This is the technically demanding part of the procedure.
When you return for an exchange, the pocket already exists. The surgeon re-enters the established space through the same armpit scar. The old implant is removed, the pocket is inspected with the endoscope, any necessary adjustments are made, and the new implant is placed.
Because the pocket is already formed and the tissues have adapted to housing an implant, the procedure is typically shorter and recovery is noticeably easier than the original augmentation. Most of my exchange patients report less soreness and a faster return to normal activity.
Going Bigger
One of the most common reasons for exchange is wanting a larger implant. Women frequently ask whether a significant size increase is possible through the armpit incision.
In most cases, yes. If the new implant is moderately larger than the current one, the existing pocket may accommodate it with minimal modification. For more substantial size increases, the pocket may need to be expanded. With the endoscope, I can extend the pocket dimensions precisely under direct visualization, ensuring the larger implant will sit in the correct position.
I routinely place implants up to 800cc through the axillary approach. Even sizes up to 1445cc are possible. For the majority of women seeking a size increase on exchange, the armpit incision provides adequate access.
Going Smaller
Downsizing presents a different technical consideration. When you place a smaller implant into a pocket that was created for a larger one, the excess space can allow the implant to shift or settle unevenly.
This is where endoscopic capsulorrhaphy becomes valuable. For mild tightening, the capsular tissue can be heated by cautery – the electrical knife we use during surgery. Also, I place sutures inside the capsule to tighten the pocket around the smaller implant, redefining its boundaries so the implant sits centered and stable. This is precision work that requires visualization of the capsule interior — exactly what the endoscope provides.
Switching Implant Type
Saline to silicone, smooth round to a different profile, older generation to newer cohesive gel — these conversions are all routinely performed through the armpit. The Keller Funnel insertion technique allows pre-filled silicone implants to be placed through a small incision without the implant shell contacting the skin. This reduces contamination risk and keeps the incision length minimal.
What About Women Whose Original Surgery Used a Different Incision?
This is a more nuanced question. If your original augmentation was performed through an inframammary or periareolar incision, switching to the axillary approach for revision is sometimes possible but not always. It depends on the specific revision needed, the condition of your capsule, and the anatomy of your axillary space.
For straightforward implant exchanges without significant pocket modification, the switch to an axillary approach can work. For complex revisions involving capsulectomy or significant pocket restructuring, the original incision site may provide better access.
This is a decision that requires individual evaluation rather than a blanket recommendation.
The Recovery Difference
Patients are often pleasantly surprised by how straightforward exchange recovery is compared to their original augmentation. The muscle has already adapted to the implant. The tissues have already stretched. The inflammatory response is more subdued because the body is not encountering a new foreign material in a new location.
Most exchange patients through the armpit return to desk work within a few days and resume full activity within two to three weeks. This compares favorably to the typical four-to-six-week full recovery from primary augmentation.
Planning Your Exchange
If you have breast implants and are considering an exchange, the most important step is a thorough evaluation by a surgeon experienced in your specific incision approach. If your original surgery was transaxillary, confirm that your revision surgeon routinely performs endoscopic exchange through the armpit — not just primary augmentation.
For patients outside Hawaii, I offer virtual consultations where we can review your surgical history, current imaging, and goals to determine whether endoscopic exchange through the armpit is appropriate for your specific situation.