Breast Implant Removal

Breast Implant Removal

 

Women may occasionally request elective removal of their breast implants. Although many women choose to have their implants exchanged, a significant number request removal without replacement.

There are a number of reasons why a woman no longer wishes to have breast implants. These include:

  • No longer want bigger breasts:
  • Breasts have become bigger with age (and weight gain): for some women who had a breast augmentation when they were young and had small breasts, their breasts may have naturally become larger due to hormonal changes, or weight gain. The implant can be removed to leave a natural, smaller breast.
  • Some patients dislike the fact that there is a ‘foreign body’ in their breasts:
  • Never ‘got on’ with their breast implants: some women find that having bigger breasts did not meet their expectations, or find them uncomfortable, and decide that they would prefer to be without the implants.
  • Recurrent capsular contracture: a small group of patients will get recurrent capsular contracture, and after several breast augmentations, accept that their body will just keep rejecting the implants.
  • Concerns over silicone: there are some patients who have experienced a range of non-specific symptoms such as ‘brain fog’, lethargy, loss of concentration, generalised aches and pains and feel this could be related to their silicone breast implants – the so-called ‘silicone syndrome’. There is no good scientific evidence to support this; large studies have shown that these symptoms appear to be as common in women without breast implants as they are in women with silicone breast implants. However, some women have found that their symptoms have improved, sometimes dramatically, once their implants have been removed.

 

Treatment Options

There are two considerations when removing an implant. Firstly what should be done with the capsule which has formed around the breast implant? Secondly what can be done to improve the shape of the empty breast?

A) Managing the Capsule

  • Explantation (removing the breast Implant). This is a very simple procedure which involves opening the old scar and removing the implant. The implant is usually surrounded by a flimsy capsule, which can be left in place. Flimsy capsules tend to re-absorb spontaneously. However, if the capsule is a little thickened, and is left in the breast after explantation, it may be possible to feel lumpiness in the breast after surgery, or it the thickened capsule may show up on subsequent mammography – leading to further investigations and even surgery.
  • Explantation and capsulectomy: This can be done through the same scar that the implant was inserted through, by first removing the old implant and then cutting out the old scar from the lining of the empty pocket.
  • Explantation and En-bloc capsulectomy: this removes the capsule and the old implant as a single block of tissue. It is generally considered safer to undertake an en-bloc capsulectomy, to avoid opening the scar tissue and spilling any contents of the capsule into the breast cavity. However, this requires a bigger scar to remove the en-bloc capsule and implant together (because this hard block of tissue cannot be squashed to get it out through the original small incision).
En-bloc capsulectomy specimens removed from breasts intact shown above – and shown below opened

 

The above En-bloc capsulectomy specimens opened ex-vivo to reveal a heavily calcified (but intact) right implant

B) Reshaping the empty breast

  • Leaving the breasts smaller and empty: some women choose not to have implants re-inserted. In these cases the shape of the final breast is a little unpredictable but can be very acceptable. The final shape depends, to some degree, upon the amount of natural breast tissue and the size of the original implant. See the above gallery for examples of patient’s explanted breasts.
  • Fat grafting – it is possible to fill the empty breast by taking fat from the tummy or thigh area and injecting this into the breast. This avoids having an implant and thus there is no risk of recurrent capsular contracture. It may however require several episodes of fat grafting to achieve a fuller breast.
  • Mastopexy – to reshape the breast. This is generally more successful for larger breasts, where there is more tissue to manipulate into a pleasing breast shape.