Breast | Breast Implant Removal

What is breast implant removal?

Explant is a straightforward but exacting procedure performed under local or general anesthesia. The procedure starts with a reopening of the initial incision. The implant is then carefully removed and any scar tissue that surrounds it (called the capsule) can then also be excised. Removal of the capsule is a more invasive procedure but remains an option for our patients after their careful review and consideration of the risks and benefits. In most cases, removing the implant itself is sufficient. The incision is then stitched closed and covered with a surgical dressing and drains may be placed to prevent the buildup of fluids while healing. The patient is then given post op instructions that will usually include the use of compression garments for about a week for optimal healing. Pain and discomfort can be managed by prescribed pain medication, as the patient stays home and recovers.

Why you may want breast implant removal

While breast implants are not rated as life-long devices, even the instance of contracting something like capsular contracture can be as low as 4-8% over one’s lifetime. Nevertheless, local or systemic pathology, as well as a shift in one’s beauty or personal goals, occasionally indicates the potential benefits of removing breast implants. A host of conditions may present that could signal the need for explantation.

Conditions Indicative of the Potential Necessity to Explant

Capsular Contracture: Capsular contracture can occur for reasons that differ from patient to patient. It begins asymptomatically and may first become noticeable as one or both breasts begin to feel tight and firm, and become painful particularly when lying facedown. Visually, the breasts may appear misshapen or high-riding. Capsular contracture can occur within 4-6 weeks of surgery (thus the importance of gently massaging the breasts for 5 minutes, 2 to 3 times daily the first two months after surgery) and is unlikely to develop after 6 months of the surgery. Capsular contracture is divided into four grades, from mildest to most severe. Surgery becomes a necessity in Grade 4 (hard, misshapen, soreness, tender and painful to the touch), and much can be done before then to prevent it, including Aspen therapy.

Rippling: Rippling is an uncommon condition in breast implants that can occur for reasons such as: poor tissue coverage over the implants, over- of under-filled saline implants, or when the natural scar capsule around the breast implant causes the implant to droop. This can become evident in “rippling” of the breast skin. In most cases, correcting this requires a surgery of some kind, whether it be replacing the implant with a larger or different type implant, adding or removing silicone from an over- or under-filled implant, or a fat graft.

Implant Rupture: The outer shell of a breast implant can potentially tear or develop a hole from such things as aging of the implant, trauma, or accidental needle insertion during a medical test. It can also occur iatrogenically due to damage by surgical instruments in the initial breast implant surgery. Rupture in saline implants are often quickly noticeable to the patient as a deflated breast, as the saline solution is absorbed by the body. In silicone implants, the gel may slowly leak out over time and can spread to other areas of the body. Correcting implant rupture requires surgery.

Breast Implant Illness (or BII): Breast Implant Illness (or BII) is a growingly popular term used to describe a host of usually non-diagnosed symptoms that patients have come to feel are due to breast implants. BII may present to each individual uniquely and some of the common symptoms associated with it include chronic fatigue, foggy memory, difficulty concentrating, headaches, depression, anxiety and headaches. Following a thorough consultation, Dr. Rahban will advise the best method of treating it.

BIA-ALCL: BIA-ALCL (or Breast Implant Associated Anaplastic Large Cell Lymphoma) is a rare and easily treatable lymphoma that can develop around both silicone and saline breast implants. Women with breast implants have about a 1 in 2,500 to 86,000 chance lifetime risk of contracting BIA-ALCL. Symptoms of BIA-ALCL include breast enlargement, pain, and hardening of the breasts or a lump in the breast.

Malposition: Breast implant malposition occurs when implants are incorrectly placed or when they migrate out of correct placement slowly due to capsular contracture, trauma or other conditions. This unsightly condition can affect the lateral, medial or inferior positioning of the breast or breasts and can be corrected in a number of ways, one of which is explant, although malposition alone is usually not treated with explant.

Total Capsulectomy, En Bloc Capsulectomy

If you suspect you are experiencing the effects of Breast Implant Illness (BII) or you have capsular contracture, En Bloc Capsulectomy removes the breast implant and all of the surrounding scar tissue, or “capsule” that forms around a breast implant. En Bloc Capsulectomy is done during breast implant removal in order to address all breast implant related complications, minimizing health risks. While En Bloc Capsulectomy is advised for patients with free silicone, biofilms and other conditions, it can be much more stressful on the body and is best decided upon after a personal consultation with an experienced cosmetic surgeon who can help you weigh its pros and cons. Nevertheless, should a patient demand it, Dr. Rahban is well suited to perform the surgery. What he will never do, however, is operate at the risk of his patients, no matter how demanding, if clinical data and pathology contraindicate it.

Post Procedural Recovery

Most people who undergo breast implant removal are left with a breast shape that is still pleasing to them, though obviously smaller. Naturally, there will be a loss of volume where the implant previously provided fullness. If your implants were large, the loss of volume will likewise be large, thus for some, a breast lift will be recommended after the explanation is done and the breasts have had a chance to fully heal and settle.

Safety that never compromises beauty

Rahban may also use fat grafting to naturally lift the breasts after the artificial explants have been removed. Where warranted, Dr. Rahban may combine breast implant removal or explant with an internal breast lift to restore a more optimal angle and degree of lit in the breast. By repositioning skin tissue, moving it from the lower half of the breast to the mid breast, he can restore that optimal angle and degree of lift, filling up the once-depleted portion of the breast.

An Exacting Procedure for a Precision Surgeon

Breast implant removal is a more exacting procedure than the initial implanting was and there are several reasons for this. For instance, your surgeon will now be dealing with tissue that has already been manually manipulated, scar tissue will have formed, and care must be taken to ensure the implant isn’t ruptured or damaged during the explant, dangerously leaving pieces of it behind. Each of these and more can eventually result in further complications cropping up after the explant surgery — something we want to avoid at all cost.

However, exacting does not mean impossible. Rather, it means your choice of cosmetic surgeon is crucial. You’ll want to find a surgeon who is very well versed in explant procedure and all of its variations and potential complications; someone who has performed this surgery many, many times before and can call on a vast library of experience, options and education. Dr. Rahban is unarguably such a surgeon. As a world-renown board-certified cosmetic surgeon known for professional integrity and a highly refined aesthetic edge, his hundreds of patients have put their body and health into his caring and experienced hands and come out very satisfied with the outcome.