Breast Implant Removal

Breast implant removal (explantation surgery) has always been an option for women in Scottsdale and the Phoenix area who have breast implants, regardless of their reasons, but in recent times this surgical option has become more common due to some patients’ concerns regarding breast implant illness (BII) and breast implant associated anaplastic large cell lymphoma (BIA-ALCL), the latter of which has only been associated with textured implants. The removal of implants can be a very simple process in certain cases, but the surgery can become significantly more complicated when there is a decision to remove the capsules (the scar tissue that naturally forms around implants), or if the breast has been stretched or compromised by the implants and will require volume addition (via new implants or fat grafting) or a lift to return the breasts to a truly aesthetic appearance. Your surgeon  will review the basic range of explantation options we offer at the Scottsdale Center for Plastic Surgery to elucidate some of these surgical choices.

Simple Explantation

Simple explantation involves removing the breast implants while leaving the capsules in place. This procedure can be done though a small incision in the breast crease and often under local anesthesia.  In this surgery, the scar tissue layers that formed around the implants (the capsules) are left in the pocket as this is just another tissue type and is part of the patient’s body. Implant removal alone is useful in patients who still have relatively tight breasts without drooping or implant complications, but no longer want the volume of their implants. Once the implants are removed, the tissues will generally shrink back close to their original shape and size, although this process can take a few weeks to a few months. The capsules left inside will naturally shrink as well, and generally are not noticeable and do not cause any issues.

Explantation With Capsulectomy

Explantation with capsulectomy is the removal of implants and the scar tissue surrounding them. There has been a lot of confusion amongst patients regarding the significance of capsules and whether they should be removed. Capsules naturally form around any type of implant placed in the body. For most patients, the capsule is a thin, almost translucent layer of scar tissue that has blood supply and is a part of the patient’s body. Typically, normal capsules are very thin (like tissue paper), although there is some variation between patients.

When Should the Capsules Be Removed?

Most normal capsules do not need to be removed, and in fact, unnecessary removal of capsules can increase the risk of complications such as pain and bleeding since the process of removal will leave a raw surface in the entire pocket where the implant resided. That being said, the capsules are generally removed in the following situations:

  • The patient has textured implants, and the surgeon wants to reduce the future risk of ALCL.
  • There is capsular contracture where the capsules are thickened and have a likely bacterial biofilm.
  • The capsules are very old and have calcified and hardened.
  • There is a confirmed case of BIA-ALCL.

What Is En Bloc Resection?

A hot topic lately (particularly online) is the idea of “en bloc” resection, where the implant and capsules are removed as one complete unit. En bloc resection techniques are associated with cancer surgery, which is generally not applicable to standard capsulectomy procedures (with a possible exception being in the case of BIA-ALCL).  For patients with normal (in other words, very thin) capsules, particularly when they have implants under the pectoralis (chest) muscles and therefore sitting right on the ribcage, a true en bloc excision can literally be physically impossible. In some of these cases, the capsule can have the thickness and consistency of wet tissue paper and cannot be removed intact off the ribs without tearing.  A true en bloc surgery is much more feasible when capsules are thicker, and particularly when the implants are over the muscle.

Even with these more anatomically favorable cases, in any en bloc case, the surgery requires a much larger incision in order to remove the implant and capsule as one unit, which generally is not worth the tradeoff. A complete capsulectomy is generally the best option to remove the entire capsule while reducing the incision length and amount of tissue trauma. In this situation, the capsule dissection is performed with the implant in place for as long as possible, then the implant is removed from inside the capsule, and the remainder of the capsule is dissected and removed. This can all be performed through a short breast crease scar. For any gossamer-thin capsule stuck on the ribs, the Bovie electrocautery device can be used to vaporize any capsule still adherent to the ribcage.

As an honest, ethical surgeon, Dr. Cohen never promises an en bloc resection because it is not always physically possible. He can, however, promise a complete capsulectomy where every speck of capsule in the pocket is removed directly or vaporized. There are known cases of surgeons who wish to gain the business of patients seeking en bloc resections who, in cases where a true en bloc is not possible, remove the capsules piecemeal and sew the capsules back around the implants to make it look like it was removed as one unit. There is no reason for this type of deception, and Dr. Cohen tries to educate patients as to why a complete capsulectomy is a proper, achievable, and less traumatic option than an attempted en bloc resection if they desire total removal of their capsules.

Explantation Requiring Volume Addition and/or Mastopexy (Breast Lift)

For many patients desiring implant removal for whatever reason, the breasts have been stretched or damaged from the implants, and simple removal or removal with a capsulectomy will result in an unacceptable aesthetic result. This can be due to two reasons:

  • Loss of breast volume
  • Skin and tissue laxity causing drooping

Implant Replacement

For patients that will not look acceptable with a loss of volume (particularly if large implants compressed and thinned out the breast tissues), adding volume back in can be helpful to maintain a youthful and aesthetic breast shape. The simplest option for volume would be to replace the old implants with new breast implants, which can be adjusted to provide the best shape and size. With implant replacement, it is generally best to add a reinforcement material (like Galaform, a resorbable mesh) to stabilize the pocket because once the capsules are removed, the tissue is more prone to stretching.

Fat Grafting

For patients that want their implants removed and do not want new implants, fat grafting can be an excellent option. The biggest issue with fat grafting is the unpredictability of volume compared to an implant. With breast implants, you know exactly how much volume you will have. With fat grafting, a surgeon faces multiple unknowns, including:

  • How much fat can be harvested
  • How much fat will be available to graft once the harvested fat is filtered and purified
  • How much of the fat will stay long term, although 60 to 70% is often a reasonable expectation

On the upside, fat grafting is all-natural and will not require the maintenance or upkeep of implants.

Breast Lift

For many patients having explantation, the breast skin will be somewhat stretched and droopy after the implants are removed. While the skin will rebound somewhat over time, in many cases a breast lift is needed to improve the shape and perkiness of the breasts. Please refer to the Breast Lift page for further details, but understand that a breast lift can be done alone or in combination with implants and/or fat grafting for the best overall result. We encourage you to read our Post-Op FAQ for general information about recovery after surgery.

Bottom Line

Any patient that would like their implants removed has that right, and there is no need to seek out someone who claims they ”specialize” in explantation. A highly skilled aesthetic breast surgeon will naturally have a great deal of experience in explantations, capsulectomies, mastopexies, and fat grafting as this is already a routine part of performing complex revision cases.

Most importantly, your surgeon should understand what is prompting you to consider explantation and should be able to ascertain what your goals are, both aesthetically and in regard to the techniques (new implants, fat grafting, mastopexy) you are open to. Then a discussion can occur that determines the best surgical plan based on your anatomy and goals.

To learn more about breast implant removal, request a cosmetic consultation using our online form or call (480) 423-1973 for an appointment. Our facility is conveniently located for residents of Tempe, Paradise Valley and other areas of Greater Phoenix.

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