Objective To compare the clinical effects of simultaneous implant exchange with fat (SIEF) and delayed autologous fat grafting breast augmentation after breast implant removal. Methods A total of 62 patients who intended to restore breast volume after breast implant removal and were treated in the Plastic and Aesthetic Center of Beijing Tongren Hospital, Capital Medical University from January to November 2023 were selected. According to different surgical methods, they were divided into the control group (n=32) and the study group (n=30). The control group received delayed autologous fat grafting breast augmentation after breast implant removal, and the study group received SIEF. The total operation time, total hospitalization time, total volume of grafted fat, total liposuction volume at donor site, three-dimensional breast volume distribution at 12 months after operation and complication rate were compared between the two groups. Results There was no statistically signiffcant difference in total operation time between the two groups (P>0.05). The total hospitalization time in the study group was shorter than that in the control group, and the total grafted fat volume and total liposuction volume at donor site were higher than those in the control group (P<0.05). The proportion of upper pole breast of the study group at 12 months after operation was higher than that of the control group (P<0.05). There were no statistically signiffcant differences in the proportion of nipple plane and lower pole breast between the two groups (P>0.05). The incidence of complications in the study group (6.67%) was lower than that in the control group (18.75%), but the difference was not statistically significant (P>0.05). Conclusion SIEF after breast implant removal is superior to delayed autologous fat grafting breast augmentation in terms of hospitalization time, grafted fat volume and fullness of the breast upper pole, without increasing the risk of complications. It can be a preferred surgical method for breast volume restoration after implant removal.