Breast Implant Removal
Breast Implant Removal, often referred to as explant, is a very common procedure. Breast implants are not lifetime devices and you may choose to have these replaced, removed, or adjusted for various reasons. The most common reasons for implant removal include capsular contracture, a desire for a different breast size, implant rupture or due to changes you see after menopause or childbearing.
At your personalized consultation with Dr. Capek, she will discuss the best options for you, to keep you looking and feeling your best.
Your revision surgery may include a breast lift, replacement of the implants with a different type or size, or a fat transfer procedure using your own fat (Natural Breast Augmentation). This alternative to implants and is becoming a very popular choice.
There are now more options than ever to give you an excellent cosmetic result and Dr. Capek is well experienced with all these procedures.
Before Your Procedure
Before your surgery, a consultation with Dr. Capek is necessary for her to assess your unique situation, and to explain and choose your various procedure options. She wants you to be an informed participant in the planning of your procedure so that you are ultimately comfortable and satisfied with your results. Knowing what to expect and being prepared every step of the way will ensure a positive outcome.
As always, you want to be in optimum health when considering elective surgery. Follow a healthy lifestyle, including diet and exercise, don’t smoke since this decreases your body’s ability to heal normally, and follow your primary care physician’s advice when treating chronic conditions like high blood pressure.
Reasons for Explant Surgery
With breast implant removal surgery, the choice of procedure will depend on the problem and your aesthetic goals. The main concerns that lead to breast implant removal include:
Desiring a Different Size
This is one of the 2 top reasons that patients have implant revision surgery. You may desire larger size implants or smaller breasts. In some cases, especially after pregnancy and menopause, your breasts may be significantly larger or smaller and no longer serve your lifestyle.
This is also one of the two top reasons for implant revision surgery. Capsular contracture refers to the hardening and tightening of scar tissue around an implant which may occur shortly after your first surgery or many years later. This may make your breasts look distorted, asymmetric, and may even be painful.
Breast Implant Rupture
Both saline and silicone implants can rupture due to daily wear and tear, usually after years and sometimes decades. With saline implants, this is usually very obvious because the breast simply deflates as saline leaks out and is absorbed. With silicone implants, there may be no symptoms or you may notice a shape change, lump, or new discomfort. With silicone implants, rupture may not be detected on a mammogram. It is usually confirmed with high definition ultra-sound or a breast MRI.
In some cases, the implant position behind your breast may end up too low, too high, too close together or too far apart. This can occur shortly after your first procedure or gradually over many years. There are various reasons this may happen, including capsular contracture, gravity, asymmetric pocket creation, and tissue changes with age, weight, pregnancy, and menopause. Additional surgery is usually needed to improve or correct the problem and may include internal suturing techniques (capsulorrhaphy), implant replacement, or the use of an internal biological mesh ‘sling’ for additional support.
Concern: Implant Rippling
This is a cosmetic concern that occurs most often with saline implants in thinner patients. However, even a silicone implant can show visible rippling if the tissues covering it are thin to begin with or stretched out with a very large implant. This can be a difficult problem to correct but procedures like switching to a cohesive ‘gummy’ silicone implant or fat injections into the thin tissues to camouflage the rippling may be effective.
Concern: Recalled Implants, ALCL and BII
More recent concerns with breast implants include the rare but serious risk of ALCL (Anaplastic Large Cell Lymphoma) associated with textured implants and the recall on the sale of these implants. Breast Implant Illness (BII) a term used by women who self-identify complaining of a wide range of symptoms, is also a growing concern expressed by some breast implant patients. This is a very broad topic that cannot be fully covered on this page.
In both cases, breast implant removal may be considered, including capsulectomy and any of the procedures listed below, depending on your unique evaluation.
You can get more detailed information about Breast Implant Illness (BII) and Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) through the FAQs linked below:
Your breast implants removal and how it is done will depend on factors such as type of implant, problems that are present, and what other procedures are being done at the same time to optimize your breasts.
Simple implant removal can potentially be done in the office under local anesthesia for both saline and silicone implants. This is when no capsule removal is needed and the silicone implants are not ruptured. Saline implants are sometimes drained prior to simple removal to allow for the skin to contract over several weeks, and for the patient to decide whether they want them replaced. There is minimal downtime and discomfort with this limited procedure.
If you have a capsular contracture, Dr. Capek performs a procedure called a capsulectomy to remove the scar tissue. This also creates a fresh pocket for a new implant. Sometimes this includes switching from a pocket under to gland to one under the muscle. Dr. Capek may use the same incision used to insert the original implants but a different or larger incision may be needed. Once you have had a capsular contracture you are at higher risk for getting it again of implants are reinserted.
Patients sometimes ask about an ‘en bloc’ capsulectomy. This refers to removing the capsule in one piece with the implant contained in the capsule. It is more accurately called a total capsulectomy because ‘en bloc’ resection is a medical term that is used when referring to cancer surgery. Capsulectomy is most often done for ruptured silicone implants but may not be technically feasible if the capsule is very thin or adherent to the ribs in submuscular implants.
Capsulorrhaphy and capsulotomy refer to either tightening or releasing the capsule surgically. This is done for implant malposition and is sometimes combined with the addition of a biological mesh ‘sling’ when the tissues are too thin to support an implant in a stable position.
Replacement with Implants
In many cases, we replace your breast implants at the same time as your explant. If you decide to update your implant size, Dr. Capek will most likely use the original incision for implant removal and replacement. If you want a larger sized implant, Dr, Capek will have to surgically enlarge the “pocket,” or space under the breast and surrounding your implant in order to accommodate the larger volume. If you want to go smaller, Dr. Capek may surgically reduce the size of the pocket with permanent sutures to allow for smaller sized implants to be properly positioned.
Dr. Capek will review and recommend the type of implant that would be best to achieve your goals, as well as any additional procedures that may be needed, like a breast lift.
Replacement with Fat
If you are choosing to go smaller, or want a more natural look and feel, your implants can also be replaced with your own fat. This is a very popular and successful procedure in our practice and works well when your breast tissue has already been ‘pre-expanded’ with implants. For details on fat transfer to the breasts visit our Natural Breast Augmentation page.
This procedure usually involves modifying the capsular tissue surrounding your implants. Capsulorrhaphy and capsulotomy refer to either tightening or releasing the capsule surgically. This includes releasing tight areas and/or placing permanent internal sutures to tighten or close off areas of the capsule. In rare cases, Dr. Capek adds a biological mesh ‘sling’ to support an implant in a stable position. The most common incision for this procedure is in the fold under the breast and it may be combined with other options such as a breast lift.
Simultaneous Breast Lift and Resizing of the Areolae
If you are going smaller, or loose skin is a problem, you may also need a breast lift (mastopexy) at the same time. This may be a simple resizing of the areola to make it smaller and the breast skin a little tighter, or a more extensive skin removal which results in a lollipop or anchor scar.
The goal of Dr. Capek and her entire staff is to help you achieve the most beautiful and natural-looking results. We want you to feel confident and have the correct procedure(s) to make all your goals a reality while maintaining realistic expectations.
After Your Procedure
You can look forward to a better-proportioned figure, as well as improved self-confidence!
Following your surgery, plan to rest quietly for 24 to 48 hours. You can shower after 48 hours and we recommend that you wear a bra around the clock for the first 2-3 weeks. The type of bra will be specified depending on your procedure. You may have drains for a few days if you’ve had a capsulectomy. We use dissolvable sutures and glue so very little wound care is required.
Patients with sedentary jobs may typically return to work within a week. Strenuous or high-impact activities like running may be restricted for 6-8 weeks. It is important to follow Dr. Capek’s aftercare instructions to avoid any complications. Recovery times vary from patient to patient depending on your health and the extent of your procedure. Follow-up appointments will be scheduled to oversee your recovery process.
Over the long term, you should continue with your regular mammograms and breast exams with your PCP or GYN. If you have silicone implants, periodic MRI’s are recommended to screen for silent implant rupture.
What are the Risks?
Even with the care of a professionally trained, Board-Certified Plastic Surgeon like Dr. Capek, every surgical procedure carries some risk. The most common early risks include bleeding, infection, problems with anesthesia, and changes in the sensation of the nipple or breast. However, with Dr. Capek’s care before, during, and after your surgery, serious risks and complications are infrequent.
Dr. Capek and her staff are available to her patients for follow-up visits and long-term care to help you navigate any questions that arise any time after your surgery.
To learn more about breast implant removal and revision, and to find out which procedure is right for you, schedule your consultation with Dr. Capek today. Our office is centrally located in Latham, New York just minutes from Albany, Schenectady, Troy and Saratoga Springs. Dr. Capek also offers telehealth virtual consultations that can be done from the comfort of your device.
Be sure to visit our before and after photo gallery.