Breast Implant Revision: Explant, Replacement or Both?

Breast augmentation with implants continues to be the most common cosmetic surgery performed in the United States, and has increased annually for at least 2 decades. In 2018, over 313,000 women had breast augmentation, a 48% increase since 2000. By some estimates, 4% of American women have breast implants today; that’s one in 26, and represents millions of women.

As plastic surgeons, we know that this procedure makes our patients very happy as a rule, but like any operation it has risks. Implants are a foreign body and are not expected to last forever. Most patients will require additional surgery during their lifetime. Statistics show that about one in three women with breast implants has had a second surgery within 10 years of her initial breast augmentation.

Breast implant removal, or revision, is a common procedure and the reasons for it vary. One of the most common issues is a build-up of scar tissue around the implant called capsular contracture. This can make your breasts look distorted and may be also be painful. An implant may rupture after years of ‘wear and tear’.   Or your body may have changed with child-bearing and menopause, leaving you with breasts that are too large, uncomfortable or droopy. The good news is that we have more options than ever to address these concerns.

The most obvious procedure for breast implant revision is removal and replacement with new implants. Newer implants, made of cohesive silicone gel and nick-named ‘gummy implants’, may be more durable and less prone to rippling. Removal of scar tissue (capsulectomy) is often done at the same time. Another great alternative for women looking to downsize is fat transfer in combination with a breast lift. This includes having the surgeon harvest your own fat from stubborn areas with a gentle form of liposuction, adding the benefit of body contouring. This is a popular approach in my post-menopausal patients who don’t want implants anymore.

My colleagues and I are starting to see a trend toward “explant” surgery, at the request of patients who want their implants removed. Besides the reasons described, there is a growing number of women who self-identify as having what they refer to as Breast Implant Illness (BII), a collection of non-specific symptoms that includes fatigue, hair loss, headaches, chronic pain, anxiety, and brain fog to name a few. After decades of breast implant safety studies, there has been no proven, scientific link between breast implants and any systemic disease. But these patients’ symptoms are real and explant surgery does make some of them feel better. We are listening, and the American Society of Plastic Surgeons is designing a clinical study to look into this further. For more information, please visit my website: https://www.capekplasticsurgery.com/breast-implant-removal/

Breast implant revision is a complex topic. The best approach for any patient with breast implant concerns is an in-person consultation with a board-certified plastic surgeon who can fully review your options for the best possible outcome.