Breast Implant Removal

Desire for Size Change

Breast implant removal may be considered for a variety of reasons.  Some who had a breast augmentation when young find after aging, lifestyle changes such as pregnancy or weight change, that their breasts are now larger than they desire.  Often during and after menopause breast size will increase even when weight remains stable.  Some women will find that after weight loss from exercise or other issues, that breasts are now too large for comfort with current implants.

Many of these women wish to be evaluated for breast implant exchange or removal.  The concerns with implant removal often are “how deflated will I look,” “how will my clothing fit,” e“how will my partner feel about my change,” and “will I need or have to have additional surgery to address drooping or sagging or uneven breast.”

These questions reflect real and legitimate concerns, and can be addressed during a breast consultation.  During the consultation, your breast will be examined for implant positioning, size, and soft tissue covering. Probable volume and contour changes following implant removal will be estimated and reviewed, as will potential need for additional surgical procedures.

Desire for Shape Change

Breast implant removal may be considered when shape changes have occurred over time that are either unpleasing or uncomfortable. Some women with implants will see changes with aging, after weight fluctuations, and after pregnancy that will result in asymmetry, misshapen breast or breast that appear unbalanced. Even soft implants that were appropriately placed might cause discomfort or visual concern with changes in lifestyle and aging. Some women indicate that they have always felt their implants were not appropriately matched to their body from the beginning, or noted postoperative asymmetry from the beginning, and either desire revision or implant removal.  In many cases implant removal alone may result in return to a more natural looking breast.

During the consultation we will examine your breast and implant position size and soft tissue characteristics will be assessed and discussed as well as possible volume and contour changes anticipated following implant removal. Some women may consider a breast lift as well at the time of removal or as a secondary operation depending upon desire after healing. It is not uncommon for women to see improvement in breast contour and skin consistency within several months following implant removal.

Desire for treatment of hard breast (capsular contraction)

A known complication of breast implant placement is the occurrence of capsular contraction. All breast implants placed in the body become surrounded by a layer of tissue called a capsule. This is the body’s natural response to an implant. In most women this capsule lining is thin. Most breast capsules formed may not significantly change over the life of the implants. However some women will find that one or both breast become firm for hard overtime often associated with a change in shape. This hardness can occur quite rapidly and be noticeable over days or weeks. In some women the tightening of the capsules may be so gradual that they may not be able to remember when their breast first became firm, hard, or misshapen.

Capsular contraction is believed to occur in some women as result of reaction to the natural bacteria within the breast tissue that stimulate response causing the capsule tissue to contract. These are not considered infections and treatment with antibiotics does not result in resolution. Capsular contraction is as well often associated with ruptured implants, particularly when significant chronic inflammatory changes occur. Capsules when tightened may become thickened or remain thin and still cause implant shape change. Capsular contraction can occur with saline or silicone implants, textured or smooth implants and with implants placed above or below the muscle.

Many patients will complain of pain, discomfort, soreness, or interference with physical or sexual activity when a capsular contraction occurs. The capsule can adhere to surrounding muscle and breast tissue and can cause interference during movement and result in nerve inflammation. Patients may experience  discomfort in the chest, shoulder, rib, and back, numbness, tightness, heaviness, or non specific irritation from capsular contractures. Some will be generally embarrassed to give someone a hug because their breast just feel too hard.

Treatment options for capsular contraction

Some women may decide to have implants removed after developing a capsular contraction or may wish to have a revision and replacement of the implants. Current studies have shown that implants should be replaced or removed. Keeping the original implants is not recommended since the implant surface has adherent bacteria called a biofilm. In most cases,  a capsulectomy (the surgical removal of the capsule) is performed at the time of implant replacement to improve the likelihood of soft breast and potentially reduce the recurrence rate of the capsular contraction. Removal of the capsule generally results in a dramatic breast shape change.

During the consultation implant positioning, size, capsular contracture severity, and soft tissue characteristics will be assessed to estimate expected postoperative appearance. Many symptoms may resolve quickly after implant and capsule removal. Capsules removed are typically sent for pathologic evaluation, and patients receive a written report of findings from the pathologist.

Concern regarding ruptured (leaking) breast implants

Breast implant removal is recommended when evidence of rupture or leak is encountered. Most commonly patients will have a routine mammogram that is suggestive of a rupture or may have a MRI or ultrasound test that are suggestive of a rupture or leak. A ruptured implant is considered and mechanical failure of the implant with a break in the silicone lining of the implant. If the implants are saline, the breast will often become much smaller within one to several days as the saline is absorbed by the surrounding tissue. Many women will experience some soreness or discomfort from mild inflammation caused by this process. In the distant past some surgeons were known to add antibiotics or soap solutions such as Betadine to the saline implants when filled, and these patients may experience more inflammation during rupture. When the implants are silicone gel filled, any rupture of the implant may allow the gel to leak into the capsule. Older implants were constructed with less cohesive sticky gel that acted more like a thick sticky liquid. The most recent implants are made using cohesive gel technology that helps restrict leakage even with implant rupture. Implants in some cases may be ruptured for years before a patient experiences any shape changes and in some women a ruptured implant may not result in a dramatic shape change. Some women will develop significant inflammation following implant rupture. This will often result in thickening of the capsule around the implant and in many women long term ruptures may result in calcification of the capsule. Calcification results in changes of the visible lining of the capsule where calcified areas may resembling eggshell fragments. These changes are always associated with some inflammation of the surrounding capsular tissue. When implants are removed for any reason and calcification is encountered, a capsulectomy is performed, and the capsules are sent for pathologic evaluation, and patients receive a written report of findings from the pathologist.

Concern of implants and general health issues

There are a number of women who desire to have implant removal because of concern that the implants are impacting their general health. Many studies have been done in the US and internationally indicating difficulty in relating implants to specific medical conditions. However there are a number of women who do not do well with breast implants. Some women will voice concern within a year of general medical and health changes. Many will present years later with concerns regarding breast implants and general health. Some women may have localized discomfort and visible changes. Other will have no visible breast changes or local pain or discomfort and may have a normal breast exam and still experience other health issues. Patients may notice a gradual onset of new symptoms relating to some specific condition or may just generally not feeling well.

Women who presented to our office for evaluation are often sent by their general practitioner for evaluation for implant removal. Some women have been evaluated by other surgeons who may either dismiss their symptoms of concern or recommend extreme solutions for treatment. It is not possible to accurately predict with any single woman with implants who is experiencing other medical problems if removal of implants alone will positively impact their health. However, many women will report significant and often dramatic improvement in concerns soon after implant removal. Symptoms can range from general fatigue to rashes, digestive issues, and a wide variety of issues often seen in autoimmune complexes. Many of these women report improvement or resolution of specific complaints often soon after implant and capsule removal. In most cases, when women present for evaluation for implant removal who have concerns with health issues, the general recommendations include implant removal and capsulectomy. Additional operations such as lymph node removal and extensive breast lift operations are generally not recommended in order to limit surgery to the safest least invasive method of to help restore prior breast health. There are some who as well report such significant improvement that they can reduce or eliminate other medications that they have been taking often for years to treat symptoms.

“En bloc” implant removal

Some women may be a candidate for “en bloc” implant capsule removal. This technique involves removing the implant with surrounding lining as a single unit.   In order to successfully achieve this result a significantly larger incision is required.  Patients realize that when implants are first place the incisions may be quite short often 4 cm or less. However removal of an implant cannot be done through the same incision size and if an “en bloc” resection is to be performed, incisions can be as long as 8 or more centimeters. The incision is usually in the inframammary crease which is the fold under the breast and may include the original incision if the implant was placed through the site. Implants placed above the muscle may be most successfully removed “en bloc”. Implants placed below the muscle maybe removed “en bloc” if the capsules are significantly thick to allow for dissection without disturbing surrounding normal tissue. Some implant capsules behind the implant that are adjacent to the ribs will be so thin that “en bloc” resection may cause damage to ribs and muscle depending upon intraoperative findings.  The potential advantage of “en bloc” resection is that it helps control removal of ruptured gel and calcified tissue, potential biofilm from bacteria and other inflammatory components during implant and capsule removal. Implant removal alone will not result in reliable capsule resolution or disappearance. A consultation is required to evaluate your potential for performing and block resection. It is not accurate to state that all implants can be removed safely by “en bloc” resection and the pros and cons should be seriously review during your exam to determine realistic options and expectations.

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    Susan Parker | Atlanta, GA

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Dr. Rudderman’s unique, integrated approach to plastic surgery employs only safe, effective, predictable surgical techniques that are driven by uncompromising respect for the natural condition of the human form. He understands that the body changes with time – as do desires. His primary goal is to deliver the best possible plastic surgery … specifically matched to each patient…in a safe environment with ultimate respect for every single individual…their concerns and goals. LEARN MORE »

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