Breast Implant Replacement Most patients have their implants replaced because of rupture or leakage or because the augmented breasts have become very hard. Most patients opt for new saline filled implants although some opt for new silicone gel implants that are available though two clinical trials for which I am an investigator. Occasionally a patient will request implant removal with no replacement implant. Often such a patient will benefit from a breast lift. There are several factors that will determine how extensive and costly implant replacement surgery will be; whether the implants are ruptured or leaking, whether they are on top or under the muscle, the size of the current implants, whether or not there is ptosis (sagging) of the breasts, what size is desired, the type of incision that has been used in the past and whether excessive scar tissue around the current implant is present. At the initial consultation, I review your history, do an examination and determine the best approach. It is extremely helpful to have the operative report and other patient records from your former surgeon. This gives me information about the placement of the implant and the implant size and shape. Most surgeons keep their operative records for many years. Please call your former surgeon and try to obtain these records. This type of surgery is done as an outpatient either in my AAAASF certified office operating room or at Seattle Surgery Center which is located next door to my office building. Either a local anesthetic with intravenous sedation or a general anesthetic is used. The cost is variable depending on what procedures are done and what type of implants are used. Insurance occasionally pays for some of the procedure (removal of the old implants and surrounding scar tissue). Insurance always requires written preauthorization in the form of a letter explaining the need for surgery and photographs. Preauthorization usually takes about three weeks to obtain.