Hello and thank you so much for being here.
The short answer is: Yes, implant exchange can be done under local anesthesia. It's one of my favorite procedures.
The decision on whether to use general anesthesia or not has a lot to do with what we are trying to achieve. Changes in volume that go down a hundred or so cc's or up a hundred or so cc's are pretty easy to accommodate. Going up or down more than that can be tricky and is kind of case by case.
Also, if we decide that just swapping out implants is not going to get you where we want to get, like if we need to tighten or loosen the space the implant sits in, sometimes it is best to go to sleep.
It would be exceedingly unlikely that an exchange would be more painful than your first. It's much more likely that it's a good bit easier.
Hope this helps, please reach back out to us if we can be of any use!
Have a great day,