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 breast implants.
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 non-implant related causes that can cause similar symptoms with a thorough workup.
Surgical Options
Simple removal: For women that have intact implants, no significant capsules, no systemic symptoms, and simply want their implants out, a “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.
Explantation with Total Capsulectomy: In general, ruptured silicone implants, and those with thickened or abnormal capsules are usually treated with “total capsulectomy”. Here, all the capsule and the implant (or implant material) are removed, using a breast crease (inframammary) incision. This is a significant procedure, that requires several hours of OR time to perform correctly, and a drain is used post-operatively.
What about “En-bloc” capsulectomy? What is that?
This is a French term, which simply means “in one piece”. It was initially used in certain cancer-removing surgeries, but has caught on in social media circles for more involved capsulectomy operations. It is indicated for women with proven ALCL.
Currently, there is controversy, especially online, about the use of the en-bloc technique for non-cancerous situations, like severe capsular contracture or BII.
Current data suggests that, for most patients with BII, the most important part seems to be removing the implant. It’s the treatment of the capsule where there are some strong opinions, especially regarding the use of the en-bloc capsulectomy technique. In terms of actual science, though, there is no published data in the peer-reviewed plastic surgery literature to suggest that the more radical en-bloc method gives a better result or treatment outcome for the patient, compared to total capsulectomy. It is as yet unknown if there might be a subset of patients who could potentially benefit from this more radical operation. Research is ongoing.
If it is important to you that the implant is removed this way (en-bloc style), we will make diligent efforts to do so. It typically requires a longer incision, and often has a worse cosmetic outcome. However, it is important to realize that this is not a benign decision.
There are more risks and complications to the patient with “en-bloc capsulectomy”, including skin necrosis and wound healing issues, tissue thinning, pneumothorax (collapsed lung), and others. Sometimes, surgical findings make doing the en bloc removal highly risky or ill-advised. These situations may require a modification of the surgical technique, based on what we find intra-operatively.
As you can appreciate, it is a complex topic. Further procedures to enhance the final shape and appearance of the breast – such as a breast lift or fat grafting to the breast – are commonly performed at a second stage, 6 months or so later, to allow the tissues to heal first.
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 any fluid around the implant 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, the insurance companies will require documentation of a ruptured silicone gel implant with one of these methods, prior to your procedure. They don’t cover other issues, though.
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 really quite 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.