Plastic and Reconstructive Surgeon
Plastic and Reconstructive Surgeon
The decision to remove your breast implants can be brought about by many factors such as complications of the implants themselves such as rupture, wrinkling, displacement, or movement of the implants.
In some cases, the outside shell of the implant breaks down causing the saline or silicone to leak. When a saline implant leaks the breast simply deflates without harm to the body. When silicone leaks it may remain within the fibrous capsule that the body has produced surrounding the implant (intracapsular rupture) or if the silicone breaks through this fibrous capsule it may penetrate the breast tissue or surrounding muscles (extracapsular rupture) or even travel to the lymph glands. It is important to understand that your implants should be removed if a silicone implant has ruptured.
Alternatively, the body may form a very dense fibrous or calcified capsule around them, causing your breasts to harden, deforming their shape. This is often uncomfortable and unsightly but does not necessitate removal of the implants unless they are symptomatic.
Other reasons for removal are that as you age your breasts may increase in size and the implants may no longer be necessary or that the breasts may sag especially after prolonged breast feeding, leaving the breast tissue sitting lower than the implants. Other women no longer feel comfortable with a larger breast appearance or the concept of implants.
There is now also a recognized tumour related to predominately to textured breast implants - Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). If you have textured breast implants, you have a small, but increased risk of developing BIA-ALCL, a rare type of non-Hodgkin’s lymphoma (cancer of the immune system). In most cases, BIA-ALCL develops around the implant producing fluid and changes in the fibrous capsule that is formed by the body around the implant. In most cases it is limited to this fibrous capsule but in some cases, it can spread throughout the body. Rare cases of death have been reported. The symptoms of BIA-ALCL are swelling of the breast, pain, lumps, or asymmetry. It may develop anytime, frequently many years after having a breast augmentation. The risk of developing ALCL depends on the degree of texturing and brand of the implants you have. The more textured – macro (e.g. Allergan 410, polyurethane coated) having a higher risk than the micro textured (e.g. Mentor). The risk of developing BIA-ALCL with textured implants varies from approximately one in 2,800 (macro) to one in 80,000 (micro).
For those women with textured breast implants the TGA advice remains that BIA-ALCL is still very rare, and that for women without symptoms, it is not necessary to remove your breast implants. Instead, patients who have breast implants, should regularly check their breasts and see their doctor if they notice any changes
Some women feel the implants are affecting their general health known as Breast Implant Illness (BII). There is no strong evidence to confirm that they are a factor causing BII but recent research is possibly showing a link between several non specific auto immune type symptoms and breast implants. More research is required. Unfortunately removing the implants may or may not improve your health.
It is a major decision to remove your implants and frequently a more extensive operation than their insertion. It may also have cosmetic implications apart from the obvious smaller size of your breasts. For example, increase sag (ptosis), wrinkling, divots, or indentations especially if breast tissue has to be removed due to silicone leakage. The rib cage itself may have been indented by the implants.
The results of breast implant removal surgery will depend largely on the size of the implants being removed and the quantity and quality of your breast tissue that is left. Removal of breast implants that are subpectoral (beneath the muscle) will usually give a better result than those just under the breast tissue, especially if the capsule needs to be removed.
The scar tissue that was surrounding your implants will play a large role in your overall outcome. This will need to be removed if it is very hard and calcified, if you have had silicone implants that have been leaking or if there is any question that you have developed BIA-ALCL. If you have textured implants currently and are having breast implants removed should you have the capsule removed too? Currently there is insufficient evidence / medical knowledge to state whether it is necessary or not. Below is a flow chart helping you make a decision whether the capsule needs to be removed.
This is usually done through an inframammary incision (ie in the crease line at the bottom of your breast). If you have a saline implant the procedure just uses a small incision (<5cm long). The implant can be deflated and easily removed and wound sutured. This is usually done as a day case in hospital, with a fairly quick recovery time, returning to work within 3-10 days depending on your occupation. If you had silicone implants the incision may have to be slightly larger to get a larger implant out.
This is a more involved procedure and may take up to several hours. A raw area is left inside which may ooze fluid and blood for 2-10 days. During this time, a drain is left in the wound cavity. Hospital stay varies with discomfort level and ability to cope with having a drain in at home. If silicone has leaked into the breast tissue, muscle of the chest wall or rib cage then certainly there may be indentations / divets in your breast left after the surgery. Normally they are mild but if severe then secondary surgery may be required e.g. fat grafting to correct the deformity.
Implants that have not developed significant complications such as extracapsular silicone leakage, severe capsule formation or BIA-ALCL can be replaced. Depending on your situation they may be able to be replaced into the same pocket or on occasion a new pocket needs to be formed either above or below the pectoralis muscle.
Removal of implant and breast lift +/- capsulectomy
If there is excessive sag of the breasts a lift can be performed simultaneously with implant the removal. Again, it is a more involved procedure and may take several hours. Hospital stay is usually 1-10 days depending on whether the capsule was removed or not.
Swelling and postoperative changes will also need time prior to the final results. Healing can take up to one year before the final results are visible. The practice of medicine and surgery is not an exact science. With this surgery, the results are not always perfect because the breast tissue is thin as a result of having implants for an extended period of time. The results can also be affected if the implants have been leaking. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary. It may also be necessary to have a mastectomy if silicone has gone throughout the breast and the free-floating silicone is no longer within the scar tissue.
Bleeding, Infection, Poor healing of incisions, Hematoma, Deep vein thrombosis, cardiac and pulmonary complications, Anesthesia risks
Seroma - Fluid accumulation in the cavity that the implant was removed from
Numbness or other changes in skin sensation
Skin discoloration and/or prolonged swelling
Wrinkling, indentation or looseness of the skin
Fat necrosis -fatty tissue found deep in the skin might die
Suboptimal aesthetic result with asymmetry, dents and wrinkles possibly requiring revision surgery
Ruptured silicone breast implant and calcified capsule