Removed breast implants. Right side intact, Left side ruptured. With implant capsule removal.
Breast Implant Removal
Breast implants are not lifelong devices. They will need to be removed at some point in their lifespan. Common medical reasons for implant removal are rupture, severe capsular contracture causing pain and malposition, breast implant illness and the rare condition of breast implant-associated anaplastic large cell lymphoma. Some women also opt for removal for personal reasons.
Removed breast implants. Right side intact, Left side ruptured. With implant capsule removal.
Why do breast implants need to be removed?
Breast implant removal is also called explantation surgery. Breast implants are not lifelong devices and may need to be removed at some point in time because of potential complications that may occur.
Some common complications of breast implants include implant rupture, malposition of the implants, hardening of the capsule causing pain, breast implant illness or if you simply decided you no longer want your implants. Generally, the older the implants are, there is an increased risk of these complications happening.
There is also an association with macrotextured breast implant and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This is a rare condition but with possible serious implications.
MRI image of fluid accumulated around the breast implant over the right side contained within the implant capsule.
What is breast implant associated anaplastic large cell lymphoma (BIA-ALCL)?
BIA-ALCL is an extremely rare form of lymphoma that presents in woman who have breast implants, particularly textured implants either currently or in the past. As of August 2022, the worldwide number of cases is over 1200. Majority of the cases are linked to Allergan Biocell macrotextured breast implants which had been taken off the market since July 2019.
Woman who suffers from BIA-ALCL usually presents late, the average time is about 8 years (0-34 years) after the implant had been inserted. This usually occurs in two clinical forms: localised to within the capsule (most common and good prognosis which is easily treated with surgical removal of the implant and the capsule as a whole) and spread outside the capsule (rarer and more serious requiring systemic treatment like chemotherapy and radiotherapy).
The most common presentation is fluid accumulation around the implant inflammation or pain around the breast and less commonly lesions around the capsule or outside the capsule.
A series of investigations will need to be performed to confirm the diagnosis. These investigations include radiological study (Ultrasound / CT scan / MRI) as well as a sample of the fluid around the implant for specific tests. Should you develop one sided or bilateral swelling of your breast years after the implantation, do arrange for a plastic surgeon to assess the condition.
What is breast implant illness?
It generally presents with vague symptoms that are not related to the breast implant location. Patients have complained about chronic fatigue and headache, persistent joint pain, hair loss, skin rashes, depression, anxiety, insomnia, poor concentration, and memory. There is no one predetermined way to diagnose this. We will first have to eliminate other inflammatory conditions prior. Removal of breast implants may be the potential next step to see if it relieves the symptoms.
How do I know if my breast implants are ruptured?
Implants that have ruptured may or may not present with any symptoms. Ruptured implants which do not have any symptoms tends to be unnoticed as the silicone gel is still encased within the capsule. This is known as a silent rupture.
Symptomatic ruptured implants can cause breast pain or changes in the shape and volume of the breasts. It can also cause pain, firmness and swelling as they continue to remain within the breast tissue. The silicone gel that has leaked out can also worsen any capsular contracture. If the implants are made of saline, the volume of the breast will deflate. The best way for diagnosis is using radiological imaging to assess the implant. An MRI often provides the clearest visualization of the implant. Other options include the CT scan or the ultrasound.
What happens if I do not remove my ruptured breast implants?
Ruptured breast implants that are not removed can potentially cause some health related issues. Ruptured breast implants can be separated into two types: intracapsular or extracapsular.
Intracapsular rupture is when the silicone gel is contained within the capsule formed around the implant. The risk of these gel leaking out of the capsule is about 10-15%. During removal, the entire implant and the gel will need to be removed completely together with part of all of the breast implant capsule.
Extracapsular rupture is when the silicone gel have leaked outside the capsule. There is potential risk of the silicone gel causing associated swelling of the surrounding lymph nodes. During removal, all the gel within the breast tissue will have to meticulously removed.
Consultation and planning?
An in-depth discussion will be done at the initial consultation, to understand about your general health and symptoms, as well as a thorough examination and evaluation. During this visit, a 3D pictures using Quantificare 3D camera will be taken to aid with the evaluation and discussion. The method of explantation surgery will be explained to you.
It would be helpful to bring along any previous mammogram or other imaging scans and reports.
How is the Surgery done?
The breast implant removal is done under general anaesthesia in a day surgery setting. The procedure takes less than 2 hours. You can return home on the same day or stay overnight if you prefer.
The implants and the breast implant capsule are usually removed using the same scar you had from the breast augmentation/implant procedure. Sometimes it is removed through the lower breast fold (inframammary fold) if your breast augmentation is performed via the axillary or the peri-areolar approach. You may need to have post-operative drains for several days after the surgery to allow for excess blood and serous fluid to drain out. There will also be compressive dressing placed to aid with the recovery process.
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What are the risks and complications of Breast Implant Removal Surgery?
This surgery is performed under sedation/general anaesthesia. If you do not have any significant medical conditions, general anesthesia or sedation is very safe and the risk of adverse outcomes are very low at 1%.
Some of the surgical risk includes bleeding and in severe cases accumulation of the blood called hematoma. To mitigate this risk, there will be a drain bottle inserted into the breast for a few days to encourage drainage. Bruising and swelling are common risk and resolve over the next 1-2 weeks. Some pain and discomfort over the wound site is common and easily managed with oral analgesia and compression dressing.
The most significant change is the shape of your breast after breast implant removal. This new appearance is something that may take a while to get used to.
An example of deflated breast after breast implant removal
Will my breasts look normal after the removal?
Often the breast tissue had been stretched by the implants, together with aging changes of the breast tissue and skin, after removal of the breast implants, your breast may look saggy and deflated. Often the superior portion of the breast appears hollow and empty.
Are there other methods other than removal?
Instead of only removing the implants, some other options can include downsizing the implants together with or without a breast lift (mastopexy), removal of the implant and fat grafting and removal of the implant and an immediate breast lift (mastopexy). The possible options are best discussed during the consultation.
What should I prepare for the Surgery?
It would be ideal for someone to take you home after the surgery and have someone to stay with you at least for the first night. We will teach you how to handle post-operative drains before you are discharged, so you can handle at home. Do prepare plenty of comfortable front-button dresses or shirts to wear after the surgery.
Frequently Asked Questions about Breast Implant Removal
Yes, the breasts will look flat and sometimes saggy after implant removal. The deflation is often over the top portion of the breast. An example is as shown here.
The surgery is less painful and uncomfortable when compared to the original breast augmentation or breast reconstruction surgery when the implants were being inserted. There will be slight discomfort over the incision site (generally using your original scar location) which is easily managed with oral analgesia and a compression dressing.
A small amount of weight will be reduced, depending on the total volume of the implants you originally have. It is usually not significant enough for an obvious reduction.