Breast Implant Removal (Explantation)
The goal of breast implant removal surgery is to remove breast implants and any scar tissue from around the implants. In addition to the breast implants themselves, the surgeon may also remove silicone material from implant leaks. This is often detected on mammograms and it is important to understand that your implants should be removed in the setting of a silicone leak.
Another thing that the plastic surgeon may need to remove during a breast implant removal procedure is the breast capsule, which is the scar tissue that forms after the placement of a breast implant. Often, the scar tissue capsule that forms after the placement of an implant is soft and does not need to be removed. However, in some patients, the capsule can become reactive and harden, thus causing the patient to have an abnormally firm breast with associated pain and discomfort. This is an entity known as capsular contracture and is often a reason to have the implants and scar tissue removed.
Breast implants are not lifelong devices. The decision to remove them is typically based on the individual needs of the patient and her desires.
Why Do Patients Want to Have Their Breast Implants Removed?
Reasons for breast implant removal vary from health concerns to personal preference. Some patients feel they are at a different place in their life and wish to move on without their implants. Alternatively, common health-related reasons why an individual may want to undergo explant surgery include apprehension over BII and BIA-ALCL. While these conditions are extremely rare, we believe comprehensive patient education can help individuals make the best treatment decision for their needs.
Breast Implant Illness
Some patients believe their breast implants are causing symptoms of pain or discomfort, which may indicate a condition known as Breast Implant Illness (BII). At Gryskiewicz Twin Cities Cosmetic Surgery, it is our responsibility to listen to and serve our patients. Patient safety is our plastic surgeons’ top priority. If you have experienced any adverse symptoms to your breast implants, such as the chills, fatigue, chronic pain, or memory loss, you may be experiencing a reaction to the materials in your implants.
While the FDA is still looking into a concrete medical link between breast implants and potential illness, don’t hesitate to contact our practice for an expert opinion on your treatment options if you are experiencing any negative symptoms. We treat BII with a procedure called en bloc bilateral capsulectomy. During the surgery, both breast implant capsules are sent to MicroGenDX® for a DNA analysis in detecting fungus and bacteria. Biofilm is scraped from the implant surfaces as well as the valve areas, and sent for DNA testing. Click here for answers to some frequently asked questions about BII.
The image below is one example of a patient who underwent an explant procedure after experiencing the symptoms of Breast Implant Illness (BII).
In extremely rare instances, patients with textured implants may develop BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) and require implant removal. Also called ALCL, the condition most often presents with obvious swelling and is curable if treated in its early stages.
Our plastic surgeons at Gryskiewicz Twin Cities Cosmetic Surgery are highly skilled in both preventing and treating ALCL. This very rare cancer of the immune system currently appears to develop exclusively in some women with aggressively textured implants. To date, there has not been a single case of BIA-ALCL in patients who have smooth implants. Given this information, individuals can rest assured that our Minneapolis practice only utilizes smooth implants. On July 24, 2019, Allergan® reported a voluntary recall of all BioCell® textured implants and expanders worldwide in response to a request by the FDA. Based on current research, ALCL appears to be purely related to the surface of the implant and not to the material inside the implant.
In this example, a patient formed a “double capsule” around her BioCell® textured breast implants and required “en bloc” removal of the double capsules and implants on both sides. She replaced her textured implants with new smooth, silicone gel implants.
To learn more about ALCL, click here for answers to common patient questions regarding the condition.
Who Is a Good Candidate for Breast Implant Removal?
Breast implant removal surgery is a highly individualized procedure. It should be performed if you have capsular contracture (hardening of the breast), pain caused by your implants, if imaging has shown a leak of the implant material, and/or if you no longer desire implants.
In general, you may be a good candidate for breast implant removal if:
- You are physically healthy and at a stable weight
- You have realistic expectations
- You are a nonsmoker
- You are bothered by the appearance of your implants
- You have experienced discomfort or pain
- You feel your breasts are too heavy
- You are starting to feel your breast scar tissue is getting harder or tighter
- Imaging suggests a leak or rupture of implants
- You have experienced a rupture or leak of implants
- You desire removal or you believe your implants are causing you symptoms
If you’re considering surgery, spend some time reviewing before-and-after photos and learning about what to expect during recovery. Preparation ahead of time helps patients have reasonable expectations and a smoother recovery.
The final results of breast implant removal surgery will depend largely on the size of the implants being removed and the quantity and quality of your breast tissue that is left. The scar tissue that was surrounding your implants also will play a large role in your overall outcome. Swelling and postoperative changes will also need time prior to the final results. Healing can take up to one year before the final results are visible.
The practice of medicine and surgery is both science and art. With this particular surgery, after removal of the implant patients may desire restoration of their breast volume with the natural use of their own fat. This technique, known as lipotransfer or fat grafting, uses fat harvested from the abdomen, flanks, or thighs and carefully injects it into the breast tissue to add volume. This can be performed at the same time as breast implant removal or in the future. Lipotransfer helps restore volume, but can also improve contour. After removal of the implants, the breast tissue often thins as a result of having implants for an extended period. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.
What Should I Expect During a Consultation for Breast Implant Removal?
First and foremost, pick a plastic surgeon who will patiently listen to your concerns. If you do not feel that you and your surgeon are a good match for any reason, never hesitate to seek out a second opinion.
During your breast implant removal consultation, be prepared to discuss:
- Your surgical goals
- Medical conditions, drug allergies, and medical treatments
- Current medications; vitamins; herbal supplements; alcohol, tobacco, and drug use
- Previous surgeries
Your plastic surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Examine your breasts
- Take photographs
- Discuss your options and recommend a course of treatment
- Discuss likely outcomes of breast implant removal surgery and any risks or potential complications
The success and safety of your breast implant removal procedure depend very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle. If you have symptoms you believe are from your implants (BII – Breast Implant Illness) you will be asked to fill out a detailed questionnaire that we provide to help us understand what you are experiencing.
Be sure to ask your plastic surgeon questions. It’s very important to understand all aspects of your breast implant removal surgery. To help, we have prepared a checklist of questions to ask your plastic surgeon that you can take with you to your consultation.
It’s natural to feel some anxiety. Don’t be shy about discussing these feelings with your plastic surgeon.
How Much Does Breast Implant Removal Cost?
A surgeon’s fee for breast implant removal will be based on his or her experience, the type of procedure used, and the geographic office location.
Many plastic surgeons offer patient financing plans for breast implant removal in instances where health insurance does not cover it, so be sure to ask.
Breast implant removal costs may include:
- Surgeon’s fee
- Hospital or surgical facility costs
- Anesthesia fees
- Prescriptions for medication
- Post-surgery garments
- Medical tests and x-rays
When choosing a plastic surgeon for breast implant removal surgery, remember that the surgeon’s experience and your comfort with the physician are just as important as the final cost of the surgery.
What Are the Risks of Breast Implant Removal?
The decision to have breast implant removal surgery is dependent on many factors, including your overall health, if the implant is leaking, if the implant has ruptured, and your personal desires. You’ll have to decide if the benefits will achieve your goals and if the risks and potential complications of breast implant removal are acceptable.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.
The possible risks of breast implant removal surgery include, but are not limited to:
- Poor healing of incisions
- Anesthesia risks
- Fluid accumulation (seroma)
- Skin loss
- Numbness or other changes in skin sensation
- Numbness or other changes in nipple/areola sensation
- Skin discoloration and/or prolonged swelling
- Unfavorable scarring
- Recurrent looseness of skin
- Fatty tissue found deep in the skin might die (fat necrosis)
- Deep vein thrombosis, cardiac and pulmonary complications
- Suboptimal aesthetic result
- Possibility of revision surgery
- Persistent pain
- Lung collapse – especially for total capsulectomy or en bloc explantation
These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon.
How Should I Prepare for Breast Implant Removal?
In preparing for breast implant removal, you may be asked to:
- Get lab testing or a medical evaluation
- Stop smoking
- Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding
What Are the Steps of a Breast Implant Removal Procedure?
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor and anesthesiologist will recommend the best choice for you.
Step 2 – The Incision
A breast implant removal requires an incision to be placed along the lower fold of your breast (the inframammary fold) or an incision around or below the areola.
Step 3 – The Operation
This will depend on your particular surgery and your surgeon. Often, the breast capsules and implants are removed using a combination of techniques.
We are experienced with en bloc removal of the implants, which is removal of the capsule and implant at the same time, with the implant still inside the intact scar tissue capsule. En bloc removal allows the silicone and other chemicals to stay inside the intact scar tissue capsule as it is removed. This also prevents silicone, other chemicals, and bacteria from leaking into the woman’s body during surgery. The details of the procedure, which is called an en bloc capsulectomy, are explained in more detail below.
Step 4 – Closing the Incisions
Sutures, skin adhesives, tapes, or clips close the skin incisions.
Your breast implant removal will result in a different shape of the breast profile, which may be flatter or droopier than before surgery and have irregularities and/or indentations. You may also notice that the breast can take on a different shape with indentations depending on how much scar tissue was produced around your implants.
What Is En Bloc Capsulectomy?
En bloc capsulectomy refers to an explantation procedure that removes the implant and surrounding scar tissue at the same time, leaving the implant encased in the scar capsule at the time of removal. Since one of the prime benefits of the en bloc technique is the decreased risk of silicone and chemical leakage, this technique is often preferred when addressing implants that are ruptured, old, or silicone filled. While a capsulectomy aims to remove both the implant and scar capsule, not all capsulectomy procedures are performed using the en bloc approach—for example, a surgeon performing a total capsulectomy may open the scar capsule, remove the implants, and then subsequently remove the surrounding scar tissue. An en bloc capsulectomy specifically refers to the simultaneous removal of the implant and scar tissue while the implant remains inside the unbroken scar capsule.
Dr. Joe and Dr. Chopra have considerable experience performing an en bloc capsulectomy and would be happy to discuss this procedure to Minneapolis and/or out-of-town patients seeking breast implant removal. It’s important to note that depending on how thin the capsule is, as well as how tightly the scar tissue adheres to the chest wall, en bloc implant removal may not be possible. Along the same vein, complete extraction of all scar tissue may not be feasible in situations where removing a portion of the capsule threatens injury to the lungs or other tissues. In these cases, Dr. Joe or Dr. Chopra will take the appropriate steps to enable proper sterilization of the remaining capsule. Rest assured that your plastic surgeon will review your medical history and anatomical indicators to determine the best method of explantation for you.
What Should I Expect During My Breast Implant Removal Recovery?
Following your breast implant removal surgery, there will be gauze dressings or bandages applied to the treatment areas, and you may have drains placed, as well – which are small, thin tubes temporarily placed under the skin within the pocket to drain any excess blood or serous fluid that may collect. You may be placed in a support bra or surgical garment, and there are times that a compression garment may be used to minimize swelling following surgery.
You will be given specific instructions that may include:
- How to care for your surgical site(s) following surgery
- Medications to apply or take orally to aid healing and reduce the risk of infection
- Specific concerns to look for at the surgical site or in your general health
- When to follow up with your plastic surgeon
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Will there be drains? For how long?
- When can I bathe or shower?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
Healing will continue for several weeks as swelling decreases. Continue to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.
Before & After Images of Breast Implant Removal
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself and for your incisions, as well as advise you about any activity restrictions.
To learn more about breast implant removal procedures, or to schedule a consultation, please contact our plastic surgeons.