Breast implant removal surgery requires precise management, evaluation, and surgical execution to achieve the most predictable results. Breast implant removal is considered by many to be a new trend.
For many women, the recent awareness of Breast Implant Illness (BII), has created awareness for those with symptoms, and for many who have no symptoms but feel their implants no longer are desired, implant removal is being considered. Those women with “shaped” anatomic “tear drop textured surface” implants are also aware that these implants are no longer recommended for use in the US due to a rare association with ALCL (Anaplastic Large Cell Lymphoma), a lymphoproliferative disease, and desire implant removal.
Many Plastic surgeons have little experience with implant removal, and subsequent breast restoration, and frequently tell their patients that the “won’t be happy” with the results. And yet we have been successfully removing breast implants and restoring breast for over 3 decades.
Reasons For Having Breast Implants Removed
Any women with implants can have them removed. The result after removal will depend on your breast characteristics at the time of removal, how much tissue is currently there? Has the breast thinned out over time due to weight and position of the implant? Has the size and weight of the breast changed over time? Have the skin characteristics changed since implantation? Have life events occurred-pregnancies? Have lifestyles changes impacted your tissue-smoking? Has your health changed?
There are those women who had struggle with implants over time, with discomfort due to implant displacement, recurrent capsular contractures, asymmetry, discomfort, and ruptures and desire removal so as to not have the concern for surgery as they age.
Every patient will need a thorough consultation to assess her current condition, and then a plan can be developed, most often with options for breast implant removal surgery and with reasonably defined expectations for healing, down time, risk and complications, and aesthetic outcome.
Style and Fashion
There are many women who made an important decision to undergo breast augmentation when relatively young. Sometimes because that never really developed enough breast tissue to fill out even a small bra or baiting suit, sometimes because the size of the breast seemed out of balance with the rest of their body, sometimes just to have a fuller figure. And most were ecstatic with their decision and outcomes.
Congenital Breast Concerns
Some women sought out Plastic surgery because their breast were “not normally shaped”, “too droopy” for their age, or disproportional in contour, and were advised that breast implants were the “only” option. Many of our clients today find before surgery that there are sophisticated approaches to breast surgery without implants to achieve excellent outcomes, and those with prior implants have options as well.
Many women have decided that breast implants, even those that look great, may be too big for their desired look. This can occur with aging, after pregnancy, and even soon after breast augmentation in women who just do not like the feel and look of an implant. Women change their desires as well, would rather look more athletic, and realize that at some point they are way more likely than not to need revision breast surgery.
It is very common to have women in a consultation who tell me their bra size was a C for years, that their weight has changes minimally, and now they are a D to DD. Many women, even those with no pregnancies, will undergo hormonal changes before during and after menopause that result in increase in breast volume.
There are some women regardless of age who simply feel that the implants are not for them. Even after careful thought and consideration before surgery, they just don’t like the feel and or look and want them removed. Too often I meet these women who have been simply dismissed by their surgeons, and who feel that their desires and concerns have not been addressed. I often hear “I really never liked them”, “I wanted them removed” and “my surgeon just told me I look great and would not take them out.” It was your decision to undergo breast augmentation, it is definitely your decision to have implant removal.
Breast Surgery for Implant Removal
A detailed consultation is always required before surgery. There are many more factors at play that must be considered before implant removal, and the technical and artistic approach is clearly dependent on experience. Most patients fall into 3 categories:
- Those that can undergo implant removal and look “normal”
- Those that may undergo removal and have the option for breast renovation
- Those that will require surgery after implant removal to have a more normal appearance
Breast Surgery Options After Implant Removal
Consider that your breast is made of 2 units, the nipple and areolae and attached breast glandular tissue, and the skin envelope that holds it. After pregnancy many women have a droopy breast due to decent of the breast, too much skin, and too much breast tissue at the lower part of the breast. A bra no matter how well constructed, has a difficult time mechanically moving the breast far enough up to make it look youthful. Breast lift operations allow for movement and repositioning of the breast tissue to the upper chest wall where most breast tissue resides in younger breast.
After women have had breast implants for some time, the tissue often changes, with loss of volume, and thinning of the breast, particularly from the nipple areolar area toward the breast fold. This results in greater breast volume in the upper breast and less at the bottom.
In effect, when an implant is removed, its equivalent to having too much natural skin for the remaining volume. Surgery to address this condition may have incisions that look like a breast lift. However, the operation is a renovation of the breast more than a lift, designed to achieve a greater balance between remaining volume of breast tissue and skin and soft tissue support. Many women find that after implant removal where the implant weight and pressure have thinned the tissue, that some of the volume will return with time.
Do I Need a Capsulectomy With Breast Implant Removal?
Any foreign object in a body will stimulate the creation of a capsule. A capsule is a layer of scar tissue that often is described as pseudo-skin. It will occur around a pacemaker, implants of almost any type (breast, orthopedic, facial, neuro, spine, etc.). When breast implants are removed, the capsuled most often will not resolve (disappear). The lining can be found years later on re-operation, not due to a defect, but because there is not a signal for the tissue to remodel.
When capsules are surgically removed (capsular contracture surgery) with implant removal , the tissue has the best chance to heal back to pre-implant conditions. For implants placed above the muscle, this allows the breast tissue to heal back to the surface of the pectoral muscle where it was naturally before augmentation. For implants under the muscle, this allows for the muscle to heal more naturally to the chest wall, again more anatomically.
Rarely is any muscle repair required. The reason that implants can be positioned under the pectoral muscle is that the muscle typically has minimal attachments there during normal function and has an origin (attachment to the area next to the breastbone) and insertion (into the main bone of the upper arm – the humerus) and functions normally this way. There are specific cases where excess detachment of the pectoralis occurred during augmentation. In these cases, if repair is done it most often requires more sophisticated approach often with a graft material to reattach to ribs. Be wary of surgeons charging for a procedure that is frequently unnecessary and often not reliable.
There is confusion as well regarding en bloc operations. En bloc has the definition of removal of tissue with a “normal” tissue margin particularly in tumor surgery. En bloc has been described and removal of the breast implant as a single unit. This operation is extremely demanding and carries in some cases very significant risk of damage to surrounding normal tissue that can result in both short-term complications (pneumothorax or puncture of the lining around the lung), damage to the cardiac space, and long-term scar tissue between the ribs that can result in impact on chest wall function, as well as damage to muscle and regional nerves.
Be wary of “en bloc” experts who guarantee this outcome. Patients should expect to achieve a total capsulectomy, which starts as an en bloc technique, and is careful to remove all resectable capsule while preserving normal tissue.
Patients with BII (Breast implant illness) often are found to have extremely thin capsules, often “see through” cellophane thin, and require surgical expertise to remove this tissue and not damage surrounding tissue. Patients with capsular contracture, ruptured gel implants, and older implants, may as well have very thickened implants, and may as well have calcification, eggshell type flakes due to cell death of scar tissue, and this tissue should be completely excised as well.
This technique of precise total capsulectomy clearly is effective in our patient population of approximately 1,000 implant removals, where we frequently have patients who come to the office a day after surgery and repost resolution of symptoms from facial eye swelling to resolution of skin rashes (objectively documentable) and go on to have resolution of many other symptoms of concern. All tissue that we remove in surgery is sent to expert pathologist trained in breast and soft tissue disease diagnosis.
Making the Decision to Remove Implants
The decision to remove implants by some is easy. They may feel they had good years of results, and no longer desire the “look and feel”.
For many, there is anxiety. How will I look? Can I get my shape back? How will my clothing fit? How will my partner feel about the change, especially for those who had implants before meeting their partners. And for those with health concerns, will I feel better? Is it worth the risk to remove implants when I can’t be sure? And many other concerns.
All these are valid. My job as a board-certified plastic surgeon is to consult with you, educate you as to your options, risks, and benefits, and help manage your expectations realistically so that you can make a decision that is best for you. There is plenty of advice on the web and social media. We work to advise you as precisely as possible for you own concerns and conditions, to give you peace of mind, and the best potential outcome available.
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Dr. Rudderman has over 25 years as a leading plastic & reconstructive surgeon in the Atlanta area. He listens to your concerns and goals and conducts a thorough evaluation of you health, activities, general lifestyle and family history. From the consultation evolves…trust, respect, mutual understanding, and a personalized treatment plan.