Breast implant removal (also called breast explant surgery) 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 or different shape 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 or not in keeping with their age or style preference.
Many of these women wish to be evaluated for breast implant exchange or removal. The concerns with implants are removed often are: “how deflated will I look,” “how will my clothing fit,” “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, and can this be safely and reliably done.”
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 anticipated after removing implants will be estimated and reviewed, as will the potential need for additional surgical procedures.
Let’s explore some reasons why women will consider removing their existing breast implants.
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Change in Breast Shape
Breast implant extraction 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 breasts 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 breast revision or implant removal. In many cases getting rid of the implants may result in a 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 removal of your implants. 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.
Hard Breasts (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 may 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 a result of a 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 the 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 nonspecific irritation from capsular contractures. Some will be generally embarrassed to give someone a hug because their breasts just feel too hard.
Encapsulated Breast Implant
- Breast Implant Age: 28 years
- Breast Implant Type: Saline
- Breast Implant Size: Unknown
- Breast Implant Placement: Subglandular
- Reason for Explant Surgery: Breast implant age, bilateral hardening of breasts, pain, and discomfort
- Surgery Performed: Bilateral breast implant removal and bilateral capsulectomy, enbloc
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 removed and if replaced after capsule removal, brand new implants should be used. 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. These options, however, do not ensure that a capsular contraction will not recur, and patients that have had a contraction may be at significantly higher risk of subsequent capsular contractions.
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
Ruptured or Leaking Breast Implants
Breast implant should be removed and this 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 an MRI or ultrasound test that is 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 the 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.
Concerns for General Health
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 placement of implants 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. The 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.
Unexplained Symptoms and Poor Health
Women who present to our office for evaluation for removing breast implants are often sent by their general practitioner, rheumatologist, health consultant, or concerned friend. 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. The most common complaints are extreme fatigue that simply does not resolve with “adequate” rest. Women that have a history of enjoying being physically active find that instead of being energized after exercise, more rest is required. Hair loss, allergies, skin changes that don’t seem to respond to treatment even with the best dermatologic evaluation are common as well. Joint pains that seem to migrate, sleep disturbance, and a range of other symptoms have been reported as well.
Most if not nearly all women describe a similar story, they have been to their family practice doctor, and or gynecologist who could find no objective lab evidence, and have often spent additional time and resources on more extensive labs, test, x-rays, scans, all without a diagnosis. This at a minimum leads to frustration, unresolved concern, and in some cases depression.
The decision to take out implants is neither easy and can be agonizing particularly trading aesthetic concerns for uncertainty on if “I will be better”. However many of these women report improvement or resolution of specific complaints often very soon after implant and capsule removal.
Women have seen rashes resolve, hair growth resume, allergies subside, pain resolves, all beyond what would be expected by placebo alone. 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.
Surgical Options for Breast Implant Extraction
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. The capsule is the tissue that your body makes that surrounds the implant. This is the “normal” reaction to foreign objects placed in the body. This tissue is living tissue with a vascular supply (blood supply). Many patients who present desiring to take out their implants for other reasons may often undergo capsule removal as well. Additional operations such as lymph node removal are generally not recommended. These operations carry additional long term and significant risk and are not considered appropriate unless other issues are documented as being suspected as health concerns. Limiting surgery to the safest least invasive method is often the best way to help restore prior breast health.
Modified “En Bloc” Implant Removal (Total Capsulectomy with Implant Removal)
Some women may be a candidate for “en bloc” implant capsule removal. This technique involves removing the implant with the 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, and 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 may be 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 is 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 the 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.
Enbloc Breast Implant Removal & Exchange
- Reason: Breast Implant Capsulectomy
- Patient Age: 55 years old
- Breast Implant Size: 300CC
- Breast Implant Age: 20 years
- Breast Implant Type: Textured Silicone
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 reviewed during your exam to determine realistic options and expectations.
Mastopexy After Removal of Implants
We have treated women for decades that have had breast implants placed at one time in their life and decided later to return to a more natural orientation. The reality is that anyone who has breast implants at some point will need implant removal. The decision is then to address the extra skin and soft tissue, or replace the volume with another device or method.
Larger breasts often become more droopy after removing implants. These clients benefit from a breast lift (mastopexy).
Breast lifts also work well for small breast volume women who are often most concerned and may report “traumatized” by the thought of removal of implants when it seems that the “only” tissue they have implants. A breast lift in these cases can effectively reduce the skin laxity to “repackage” the remaining breast tissue optimizing the volume in a “smaller” package to improve appearance.
Some women have minimal concern regarding appearance or may decide to have a breast lift at a later date. Fat grafting can be effective in patients that have dimpling, residual asymmetry, and need for “modest” volume. But this should be done by those with years of experience and for specific indications.
Contact us at 678.566.7200 to meet with Dr. Rudderman in our Alpharetta office or Midtown Atlanta office.
Real Patient Reviews
Written and reviewed by:
This article was written by Dr. Randy Rudderman, who is board certified by the American Board of Plastic and Reconstructive Surgery (1994). He practices medicine at his offices in Alpharetta and Atlanta.
Learn more about Dr. Rudderman, his medical training, and credentials.
Should I Remove My Breast Implants?
Some decisions seem quite obvious: hard breast, breast pain or discomfort with exercise, droop, feeling that “my breast are under my arms” or end up there when reclining, capsular contractions that recur, asymmetry, excessive size for comfort physically or psychologically. Some women are simply “tired of having breast implants”.
There are millions of women that love their breast with implants, have no symptoms of concern, and no issues with health. Then there are those who have what they describe as “great looking and feeling breast” with implants but have unexplained health concerns, some so severe that now daily life is effected.
These are the difficult decisions, requiring long and thoughtful consultations, and careful deliberation and reflection before selecting surgery as an option. Managing risk and expectations can be effectively and safely done with good patient communication and excellent staff and facility options. Being nervous before surgery is expected, being anxious that you have not made the best choice of surgery or surgeon means you need more time, better education, and a clearer path to health.
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