Breast Implant Removal
Millions of women have breast implants and for various reasons they want their breast implants removed. Some patients develop a medical condition that they believe is related to their breast implants and then want them removed for their peace of mind (there is no evidence that breast implants cause medical issues). Other patients become frustrated with overly large breasts that have interfered with their daily living and inquire about breast implant removal to get them “out of the way”.
The initial breast augmentation procedure typically takes about an hour and your surgeon must make an incision to place the implant and then create a home for the implant above or below the muscle. Removing breast implants can be a relatively straightforward procedure but this is not always the case. There are three main issues related to breast implant removal that need to be taken into consideration:
- the quality of the breast skin and tissue
- the position of the chest muscle
- the breast implant capsule
Making the choice to get a breast augmentation does not mean that you need to have the implants for life. The questions then become:
- What will my breasts look like after I remove my implants?
- Will additional procedures be necessary to ensure that my breasts look their best?
- Will I be happy with my decision to remove my implants?
- How will implant removal impact my life?
Removing Saline Implants Versus Removing Silicone Implants
Saline breast implants are filled with salt water and silicone implants are filled with silicone gel material. A ruptured saline implant will deflate and the solution is absorbed by the body so the breast will become smaller in a short period of time. The silicone variety will maintain its volume as the silicone material is contained inside the implant capsule (scar tissue that surrounds all implants).
Women with saline implants can opt to have the saline removed with a needle as an in-office procedure so they can see how their breasts retract over time. After 4-6 weeks, they can then decide to remove or replace the implant and determine if they would like a breast lift as well.
Silicone implants require more careful consideration when deciding how to remove them. If they are intact, the procedure is straightforward and performed under local anesthesia. If ruptured, this silicone material will need to be cleaned from the implant pocket and this often requires anesthesia services for your comfort and safety. The problem is that it is difficult to determine if a silicone breast implant is intact on examination. Radiology scans are helpful but often not performed. Therefore your surgeon has to make his or her best guess based on the age of the breast implant and examination findings.
Breast Lift After Breast Implant Removal
A breast implant expands the tissue of the breast and thins it out to some degree. The larger the implant, the more the breast and muscle are expanded or stretched – this is why choosing the smallest implant that does the job is always best. When considering breast implant removal, the potential for the breast to retract back to normal is always in question. Young patients with high quality skin can expect excellent retraction. Women with children, weight loss patients and older patients are less likely to enjoy full retraction and may benefit from a breast lift after implant removal so that the shape of the breast is not saggy and deflated in appearance. Those patients who chose large breast implants to fill out saggy breasts most certainly will need to consider a breast lift after implant removal because they were saggy even before they had their breast augmentation.
The benefits of a breast lift (mastopexy) are an improved shape with tighter skin and smaller, better placed nipple-areola complexes. A breast lift is not inexpensive and it will result in permanent scars on the breasts. I recommend that you visit with several surgeons if you are considering a breast lift as experience and maturity matter in the quality of your results.
Removing Breast Implant Capsules
All breast implants develop a thin layer of scar tissue around the implant capsule as part of the normal healing process. This capsule can become thicker and even develop calcifications and become brittle as they age. In some cases the thicker capsule can be the cause of firm, tender breasts – capsular contracture. A decision must be made about what to do with the implant capsule based on the age of your implants, whether or not you have a capsular contracture or implant rupture and if you have rippling and ridges around your implant. A capsule that remains after breast implant removal will not necessarily be resorbed by the body and some or all of it can remain (it will shrink considerably after removal of the implant however and it is harmless). A thick, calcified breast implant capsule may interfere with mammography of the breast, although this is uncommon. A firm capsule with sharp edges can cause pain and even visible irregularities of the breast.
The removal of the breast implant capsule (capsulectomy) is a tedious procedure and is often difficult, time consuming and bloody. Drains and full anesthesia are needed. This cannot be done under local anesthesia. It’s a much, much bigger deal than just removing the breast implants and leaving the capsules in place. In general, I will leave the implant capsules in place in those patients with soft breasts who have implants not older than 10-15 years. The ultimate decision is made on a case by case basis.
Changes To The Chest Muscles After Breast Implant Removal
The status of the chest muscle after breast augmentation is poorly appreciated or understood. During the breast augmentation procedure, surgeons will often cut the muscle along the breast fold as well as for a short distance along the breast bone. The consequence of this can be significant displacement of the muscle upwards towards the clavicle so that very little of the muscle actually covers the breast implant (when it was placed under the muscle to begin with). This can cause, among other things, a dynamic muscle deformity whereby the breast appears oddly shaped when the chest muscle is flexed. It can also cause lateral displacement of the breast and bottoming out.
The chest muscle works best when it is in the position that mother nature intended it to be in. Excessive pocket dissection, overly large breast implants and aggressive muscle release can all lead to displacement of the chest muscle causing visible deformities and probably some weakness of the chest muscle in general.
When removing breast implants, it is best to access the muscle location and if it is displaced significantly to secure it to its natural, normal position on the chest wall while the muscle is soft and expanded. Timing is important here because this retracted muscle will heal shorter in the weeks and months to follow implant removal and it will not be possible to move or stretch the muscle to the ideal location in a future operation if desired.
Breast implant removal can be a simple procedure performed under local anesthesia or it can be a much more involved procedure requiring full anesthesia depending on each patient’s individual circumstances. Your surgeon must be aware of your goals, review your history and examine your breasts so the most appropriate procedure is performed.