Removal, Exchange, or Going Smaller: How Dr. Agullo Counsels Patients on Their Implants
A decade ago, most patients who came to Southwest Plastic Surgery about their breasts wanted to go bigger. Today, a striking number want the reverse. They have carried their implants ten or twelve years, they have read something online, and they want a clear answer about whether to remove, exchange, or simply go smaller.
Dr. Frank Agullo walks each of them through the same honest framework. What follows is that conversation, offered as education rather than a verdict on any one case.
What Dr. Agullo Tells Patients About Breast Implant Illness
If you have lived with your implants for years and felt fine, Dr. Agullo says, you are most likely never going to develop a problem. It is uncommon. Across the thousands of augmentations he has performed, only ten or twelve women have asked to have them removed because they felt the implants were affecting them, and most of those women did feel better afterward.
He is candid about the uncertainty. A lot of the time, he explains, it is hard to know whether the implants caused it or whether ordinary aging did, since aches and fatigue arrive on their own as the years pass. The science is still developing, so he will not hand a patient a certainty the evidence does not support, and he will not talk anyone out of removal who genuinely wants it.
Why Textured Implants Get a Closer Look
Textured implants have been linked in a small number of patients to a specific type of lymphoma. The risk is low, on the order of one in a few thousand, and it is tied to the textured surface rather than to smooth implants.
For that reason, Dr. Agullo tells patients with textured implants that exchanging them for smooth ones is reasonable even when everything feels fine. If a risk can be sidestepped, he would rather sidestep it.
What Removal Does to the Shape
This is the part that surprises patients most. Remove an implant of any real size, Dr. Agullo explains, and the breast drops a cup size or more and tends to sag, because the implant was holding up volume the skin had stretched to accommodate.
That is why removal alone is rarely the full plan. Most patients get a better result with a breast lift at the same time, which raises and tightens everything. If a patient still wants a little fullness on top, fat grafting can be added a few months later, once the pocket has closed off.
The Options at Southwest Plastic Surgery
| What the Patient Wants | The Path at the Practice |
|---|---|
| Implants out, simplest plan | Removal, often paired with a lift |
| Smaller but still shaped | Remove, lift, small implant |
| Soft, natural fullness | Lift now, fat grafting later |
| Textured shell, no symptoms | Exchange to a newer implant |
| Touch-ups over time | Injectables and follow-up at the Med Spa |
Going Smaller, on Purpose
Many patients choose the middle path. Dr. Agullo removes the large old implant, performs the lift, and places a small one, sometimes only 150 or 200 cc, mostly to hold a little cleavage and shape. A small implant is more predictable than fat, gives a reliable size, and does not change when a patient’s weight goes up and down.
The Motiva implants Dr. Agullo places now carry a very low rupture rate, under half a percent, and a very low rate of capsular contracture, also around half a percent, compared with ten to fifteen percent for some older implants. Because of that, he no longer tells patients they must swap every ten years, and he often adds an internal mesh to hold the result in place.
About Dr. Frank Agullo
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years. Removal and exchange is more involved than a first-time augmentation, which is why he examines each patient, reviews imaging, and is honest about how the shape will change before making a plan.
Ready to Talk?
If you are weighing whether to remove, exchange, or downsize your implants, the team at Southwest Plastic Surgery will help you build a plan around what you actually want.
For the surgeon’s editorial take on this topic, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.
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