Breast Implant Removal
One of the common misconceptions about breast implants is that, once they are in, they can not be removed without replacing them. Not true – we’ve helped many women who, for a number of reasons, decide they no longer wish to have breast implants. These reasons commonly include:
Comfort: With time, many women report being a larger size than when they first got their implants, and wish to return to a slimmer, more proportional appearance.
Maintenance: Since all breast implants require future surgeries for replacement, some women decide they just don’t want to face another surgery down the road and opt for removal.
Repeated Capsular Contracture: For women that have tried “everything”, and still get repeated capsular contracture resulting in breast hardness, removing the implants altogether (without replacement) may be the best answer.
Implant rupture: Sometimes, after implant rupture, women decide not to replace the implant.
Health concerns: When systemic symptoms exist, some women ask for implant removal to see if that will help their situation, once they’ve ruled out other causes with a thorough rheumatology workup.
Surgical Options
Depending on your situation, there is a range of procedures that might be suitable. Two common ones are…
Total Capsulectomy/ en-bloc removal: In general, ruptured silicone implants, those with thickened or abnormal capsules, those with ALCL, and those with systemic symptoms are usually treated with “total capsulectomy”. Here, all the capsule and the implant (or implant material) are removed, using a breast crease (inframammary) incision. Many times, this can be done as an “en-bloc” capsulectomy procedure, a french term that simply means “in one piece” – but this may require a much larger access incision. This is a significant procedure, that requires several hours of OR time to perform correctly.
Currently, there is some online controversy about the use of the en-bloc technique for non-cancerous situations. There is no published scientific data in the plastic surgery literature to suggest that the en-bloc (one piece) method gives a better result or treatment outcome than total capsulectomy (more than one piece), although some internet sites and physicians claim, without much evidence, that this is so. It’s a little bit like removing an orange peel in one long piece versus 2 smaller pieces – either way, all the peel is removed from the orange. However, if it is important to you that the implant is removed this way, we will make diligent efforts to do so. However, there are some clinical situations where en bloc capsule removal can actually cause more risks to the patient, including skin necrosis, pneumothorax (collapsed lung), lymphedema, or nerve injury. These situations may require a modification of the surgical technique.
As you can appreciate, it is a complex topic.
A drain tube is usually used, which handles the fluid that the tissues make for the first week or so.
Further procedures to enhance the final shape and appearance of the breast are commonly performed at a second stage, 6 months or so later, to allow the tissues to heal first.
Simple removal: For women that have intact implants, no significant capsules, no systemic symptoms, and simply want their implants out, simple explantation is performed. The old incision is re-opened with the removal of the old scar, and the implant removed. The pocket is rinsed clean, and the incision carefully re-sutured. No capsulectomy is performed, unless there is an abnormality noted during the inspection of the pocket. This method is the least expensive, has the quickest recovery, and is suitable for many, but not all, patients. Additional procedures to be performed at the same operation, such as breast lift or fat grafting, may be considered with this option, to enhance the cosmetic appearance of the breast.
Questions and answers:
What happens to the old implants and capsules?
Capsules are sent for pathologic examination and are evaluated for any abnormalities. If you are within the warranty time period for your implant, commonly the manufacturer will demand the return of the ruptured implant. Otherwise, implants are typically discarded, as biomedical waste.
Will my capsule be checked for ALCL?
If there is any clinical suspicion of this problem, we will have the capsule and fluid tested for the appropriate markers.
Can you give me a photo of the implants and capsules?
Yes – just remind us on the day of surgery.
Do I need pre-op MRI or ultrasound?
If you are hoping that your insurance will cover part of the cost of surgery, they will require documentation of a ruptured silicone gel implant with one of these methods, prior to your procedure.
Have you ever seen mold inside a saline breast implant?
Not so far, after 20+ years of practice. Although it has been reported in the plastic surgery literature, it is very rare in practice, now that the closed filling system – where the saline goes from the sterile IV fluid bag, through a sterile tubing, right into the implant – is routinely used for the initial filling of saline implants.