What is breast implant removal surgery?
Before getting breast implants you might not have thought about eventually removing them. However, data from the International Society of Aesthetic Plastic Surgery reveals that in 2018, 4,505 Australians underwent explant surgery or breast implant removal.
The motivations behind a patient's decision to remove their breast implants can be as diverse as the reasons for having them inserted in the first place.
Among the prevalent reasons for explant surgery include health worries, implant malfunctions, or complications. Some women may also prefer to transition to a more natural look or reduce their breast size. Many older women who experience breast growth due to menopause often seek to downsize via implant removal.
Many of these women might also opt for additional procedures following their breast implant removal. These could include a breast lift (mastopexy), fat transfer, or even multiple procedures to tackle issues like drooping skin and volume loss. Meanwhile, other women decide to embrace a flatter chest after their implant removal. In the end, it all comes down to an individual's preference.
What are the pros & cons of breast implant removal surgery?
- Women who are anxious about the health implications of breast implants may find that removing them can provide a sense of relief. This encompasses worries related to Breast Implant Illness (BII), an umbrella term for a variety of symptoms yet to be formally recognized by the medical community and Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare type of lymphoma associated with textured implants.
- Removing breast implants simplifies the detection of breast cancer via a typical mammogram.
- Removals negate concerns about silent undetected ruptures in silicone breast implants. Doctors prescribe regular screenings such as MRIs or ultrasounds to watch for these and other complications. Opting for implant removal avoids the need for potentially expensive and time-consuming checks.
- Choosing to remove breast implants also does away with future replacement surgeries or other related operations.
- The process of breast implant removal will inevitably impact the size and shape of your breasts. Predicting the post-operative appearance of your breasts is often a challenge, even for experienced, board-certified plastic surgeons. The chance that your breasts will regain their natural pre-surgery look is greater if the implants were smaller or had been installed for a shorter duration. Nonetheless, you might notice reduced volume, drooping or surplus skin, asymmetry, and a reduction in elasticity. There might also be abnormalities or indentations.
- Feeling in the breast and nipple might also change, but this generally improves with time as the nerves recuperate.
- Certain removal methods, like en bloc capsulectomy, come with significant risks, such as punctured or collapsed lungs and breast disfigurement. These techniques can also result in substantial scarring.
- Since breast implant surgery is elective and cosmetic, Medicare and most private health providers will not cover breast implant removal, potentially leading to additional costs.
Melon Hint: If you are contemplating the removal of your implants, and your original surgeon insists that "you look fantastic and there's no reason to remove them," a second opinion might be beneficial. This can pose a challenge for women who believe they are dealing with breast implant illness or have other health-related concerns, you might need to consult multiple surgeons until you find a good fit.
How much does it cost to remove breast implants?
Average Cost: $10,800
Range: $4,700 - $21,450
The price of your breast implant removal will be contingent upon several critical elements, including your plastic surgeon's expertise, their geographical location, and the specific type of explant surgery conducted, among other significant aspects.
If you decide to pair your breast implant removal surgery with a breast lift (mastopexy) or fat transfer, prepare for an additional charge potentially adding thousands of dollars to the total cost.
To help make the explant procedure more accessible, most surgeons provide payment plans or accept alternative financing options such as AfterPay.
Who is a good candidate for breast implant removal surgery?
Breast implant removal could be a viable option for you if:
You are dissatisfied with your breast implants appearance
A significant number of women opt for breast implant removal due to a desire for some kind of cosmetic change in their breasts. Various factors such as ageing, weight changes, or pregnancy may cause some women's implants to move or sag.
Others might wish to revert to their natural bust size. Many patients feel that their breast augmentation no longer aligns with their proportions or lifestyle. This could be due to weight gain, childbirth, menopause, or a significant lifestyle change like taking up distance running.
The scar tissue or capsule surrounding your implants constricts
On occasion, the capsule around your implant may harden, calcify, or shrink, leading to discomfort, deformity, or the implant becoming firm. This condition, known as capsular contracture, is the most common complication associated with breast implants.
Your implants have leaked or ruptured
Research on silicone gel implants, the most common variety, indicates that most implants have a lifespan of 7 to 12 years. Nonetheless, some might fail within the first several months or years, while others could last well over 15 years.
The reported rupture rates vary with the implant type, ranging from 3.9% to over 16%. The likelihood of an implant rupture increases with every passing year.
You are experiencing symptoms that you believe are linked to your implants
While doctors emphasize a lack of conclusive evidence to suggest a connection between breast implants and certain symptoms, they acknowledge that some women have reported consistent symptoms that appear to subside once their breast implants are removed.
What happens during breast implant removal surgery?
The duration of a breast implant removal procedure varies greatly, typically ranging from 1 to over 3 hours. Factors influencing surgical time include the surgeon's approach, whether you're combining the procedure with a breast lift or fat transfer, and if the removal of scar-tissue capsules (capsulectomy) is included along with your implant removal.
The decision to remove a capsule generally depends on its grading (from 1 to 4), determined by its appearance and texture. A denser, calcified capsule must be extracted during the explant procedure; otherwise, it might be visible or noticeable under the skin.
Here is a brief outline of the different kinds of breast implant removal surgery:
When there are no implant complications (like dense scar tissue) or BIA-ALCL concerns, the surgical process can be quite straightforward and completed with local anesthetic and oral sedation. Removal is typically done via an incision at the breast crease in the inframammary fold, often the original incision area. Alternatively, it can be done through an incision around the areola.
Explant with Capsulectomy
When capsular contracture or BIA-ALCL is suspected, the capsules are extracted alongside the implants under general anesthesia or intravenous sedation. This procedure has a similar pain and recovery period compared to the original implant surgery.
Implant Deflation and Removal
Many patients with saline implants decide to deflate their implants prior to removal, aiming to reduce scarring. This procedure can be completed under local anesthesia. Fluid is drained through the skin via a needle and syringe, allowing the breast tissue to slowly settle. This allows the patient and their surgeon to predict the appearance of the breasts post-explant and decide whether a breast lift may be necessary to rectify any drooping skin.
Post-breast implant removal, you will be moved to a recovery space for monitoring until you're cleared to return home. A surgical bra will likely be provided to support your recovery, facilitating the closure of the implant area and preventing fluid accumulation which could lead to complications, such as infection.
There is no consensus on whether compression gear should be worn post-explant. While it does not conclusively prevent fluid accumulation, it certainly doesn't cause harm. So if available, it could be beneficial to wear.
In some scenarios, surgeons may decide to place surgical drains to prevent fluid buildup. These are usually removed for 3 to 5 days post-surgery.
Given that this is an outpatient procedure, ensure you have arranged for someone to drive you home and stay with you for at least the first night after surgery.
Can you have a breast lift with a breast implant removal?
A breast lift, or mastopexy, is frequently performed together with explant surgery, but numerous surgeons advise waiting a few months to evaluate the breast's size, shape, and tissue condition following the removal of the implant.
During all implant removals, the tissue is expanded and thinned out. However, within a few months, the tissue regains thickness, resulting in a less saggy or rippled appearance. This delay also provides time for the tissue to contract, allowing the individual to consider if a breast lift would enhance satisfaction.
Instead of combining implant removal with a lift, some individuals choose breast fat transfer to replenish lost size and prevent a flat look post-breast implant removal. Surplus fat is extracted from another body part, frequently the tummy, handles, or thighs, through liposuction, and then injected into the breasts. Although not all of the transferred fat survives, any remaining after 4 months is permanent.
Aside from rectifying breast deflation post-explant, fat transfer can also address minor abnormalities often visible in photos after implant removal. Precise fat injections can smooth crinkled skin, lift small indentations, and balance out any asymmetries that appear post-explant.
While many decide to have these procedures simultaneously with explantation to counteract some of the sagging and lost volume, they can also be performed separately if the patient prefers to assess the results of the implant removal beforehand.
What is en bloc capsulectomy breast implant removal?
En bloc capsulectomy involves removing the entire capsule that houses the implant, along with the implant itself, in one piece. While this procedure has gained popularity recently, its primary use is for medical breast implant extractions.
En bloc resection has traditionally been employed to remove burst silicone implants to avoid leakage and lessen inflammation. Furthermore, it is the standard practice for treating Breast Implant-Associated Anaplastic Large Cell Lymphoma, since it is a lymphoma of the capsule, hence the importance of removing the capsule without spilling the surrounding fluid (seroma).
In the context of Breast Implant Illness (BII), patients often request en bloc removal, fearing potential health effects of both their implants and the capsules. However, there's no scientific proof that supports en bloc capsulectomy in BII cases. A recent study published in the Aesthetic Surgery Journal (ASJ) found no link between the type of capsulectomy (en bloc, total, or partial) and symptom improvement.
Additionally, an en bloc operation carries significant risks and constraints. Occasionally, the capsule is too fragile to be removed entirely without harming adjacent objects like the chest muscles or ribs. If the implant is situated under the muscle, safe removal may be nearly impossible. Without the muscle layer as a shield, ribs, lungs, large blood vessels, and lymphatic channels in the arm are exposed to potential injury. The area between the ribs and lungs is so thin that the tissue can rip, resulting in a punctured or collapsed lung.
Given the potential for chest tubings, chronic rib pain, or lymphedema in the arm, en bloc surgery risks are often not worth taking. The surgeon should stop the procedure whenever the risks become untenable.
En bloc capsulectomies also necessitate a large incision to remove the implant and capsule as one unit. Typically, if a surgeon can't reach around the capsule using a smaller incision, they will remove the implant first, then the capsule, in a method known as a total or precise capsulectomy.
However, if the patient insists on an en bloc removal, the only option is to substantially enlarge the incision. If a lift is performed simultaneously, the incision is typically larger, which simplifies the capsulectomy process.
How long does it take to recover from breast implant removal?
Except for en bloc surgery, recovery after breast implant removal generally tends to be more comfortable than the original implantation surgery. While you can expect some discomfort, it's usually minimal, and painkillers are typically not needed for more than 1 to 2 days.
24 to 48 hours post-surgery and you will be resuming everyday activities, such as bathing, eating, and walking. Depending on your job, you might even be able to return to work after a couple of days, provided your role does not involve heavy lifting.
The overall healing time and activity limitations following breast implant removal will be contingent on the surgical method used and how swiftly you recover. During your follow-up appointments, your surgeon will help you gauge your progress and recovery timeline
When will breast implant removal results show?
A reduction in bust size will be immediately noticeable after the removal of the implants, but it will take time for swelling and bruising to settle before revealing the final outcome.
Patients must be ready for a significant transformation in their breasts following implant removal. Many have not observed their natural breasts in 10, 15, or even more years, and they are a decade or a decade and a half older than when they first got the implants. Brace for the initial surprise and doubts when you first your 'current-age’ breasts.
However, after a few weeks, most people find themselves happier with their smaller breasts. While the results are permanent, natural aging will carry on, potentially leading to a loss in firmness, volume and possible sagging. As you age, thick breast tissue is often replaced by fat, so if weight gain occurs, the size of the breasts may increase.
Will removing my breast implants make me feel better?
Generally speaking, the majority of patients experience improved well-being after their implant removal; however, it's important to note that there are also women who regret their decision and subsequently opt for re-implantation. The outcome largely depends on the initial reasons for explantation and how the tissue recovers post-surgery.
As stated earlier, by removing implants, you are doing away with a number of risks, including the potential for rupture, capsular contracture, ALCL, discomfort, and future surgeries; which can in itself bring about a sense of relief. Many women express feeling as if a burden has been lifted from them after explantation, both physically and emotionally.
A significant number of those who choose to explant due to symptoms of Breast Implant Illness (BII) report feeling better, at least in the short term, once their implants are removed.
Insights from a recent Aesthetic Surgery Journal (ASJ) study explains symptom resolution after breast implant removal. This study assessed 3 groups of women: those who had their implants removed due to BII symptoms, those who had removal without implant-related symptoms, and women who had a breast lift without ever having implants.
Surveys evaluating symptoms were conducted prior to surgery, then again at 3 to 6 weeks, 6 months, and one-year post-surgery. As anticipated, the pre-operative surveys revealed that the BII cohort suffered from a greater number of symptoms, such as cognitive impairment, anxiety, and joint pain, compared to the 2 control cohorts. 6 months after surgery, 94% of the Breast Implant Illness patients reported at least some improvement in symptoms.
What are some alternatives to breast implant removal?
Breast implant revision encompasses both the removal of existing breast implants and their subsequent replacement with new ones, these can be larger, smaller, or simply more up-to-date models.
The technology around breast implants has made considerable strides in recent years, with enhancements in safety featuring more resilient shells and more fluid silicone gel that gives a very natural feel. In some cases, surgical mesh may be utilized for support, acting as an 'internal bra' to position implants higher on the chest wall.
For patients who initially wanted implants as part of a breast reconstruction, revision reconstruction can now be carried out using donor tissue taken from other parts of the body. Surgeons are now applying these donor tissue processes for cosmetic purposes in instances of explantation, but it's important to note that these methods are significantly more complex and expensive than traditional techniques. They involve a much longer recovery period, and the removal of tissue from donor sites may result in shape abnormalities.
Sources & Studies
Glicksman, C, McGuire, P, Kadin, M, Lawrence, M, Haws, M, Newby, J, Ferenz, S, Sung, J & Wixtrom, R 2021, ‘Impact of Capsulectomy Type on Post-Explantation Systemic Symptom Improvement: Findings From the ASERF Systemic Symptoms in Women-Biospecimen Analysis Study: Part 1’, Aesthetic Surgery Journal, vol. 42, no. 7, p. sjab417, viewed 19 July 2023, <https://pubmed.ncbi.nlm.nih.gov/34915566/>.
Headon, H, Kasem, A & Mokbel, K 2015, ‘Capsular Contracture after Breast Augmentation: An Update for Clinical Practice’, Archives of Plastic Surgery, vol. 42, no. 5, p. 532, viewed 19 July 2023, <https://www.mybib.com/#/projects/zoDBxb/citations/new/article_journal>.
Spear, SL & Baker, JL 1995, ‘Classification of capsular contracture after prosthetic breast reconstruction’, Plastic and Reconstructive Surgery, vol. 96, no. 5, pp. 1119–1123; discussion 1124, viewed 19 July 2023, <https://pubmed.ncbi.nlm.nih.gov/7568488/>.
Therapeutic Goods Administration n.d., Risks and benefits, Therapeutic Goods Administration (TGA), viewed 28 June 2023, <https://www.tga.gov.au/products/medical-devices/breast-implant-hub/risks-and-benefits>.
TherapeuticTherapeutic Goods Administration n.d., Breast implant associated cancer (BIA-ALCL): Information for consumers, Therapeutic Goods Administration (TGA), viewed 19 July 2023, <https://www.tga.gov.au/breast-implant-associated-cancer-bia-alcl-information-consumers>.