Breast implant removal procedures have been fairly common in plastic surgery. In the USA, about 300,000 patients request a breast augmentation every year, while around 10% of that number, about 30,000 patients, request implant removal.
All women undergoing breast augmentation with implants will require at some point in their life a revision surgery: this is because implants don’t last forever and it is usually advised to change them with new ones after 10 to 15 years, although they may be able to last far longer than that.
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Reasons to remove breast implants
Reasons to request the implant explantation procedure vary from patient to patient and the exact procedure(s) performed on each patient vary accordingly. The following are some of the many reasons why patient ask for the removal of their breast implants.
Capsular contracture is the most common complication of breast augmentation procedures, with an incidence averaging 7-15%; we have a better understanding of this complication now than we had a decade ago and because of this some surgeons have been able to lower the incidence in their practices significantly to just 1-2% of cases. The management of capsular contracture is just surgical with the removal of part or the totality of the fibrous capsule; in some cases, the patients ask for a new implant to be placed, while in other cases they just want the implants removed.
The rupture of a breast implant requires surgical management; after both the implant and the silicone gel are removed, a new implant may or may not be placed in exchange according to patient’s preference.
Dissatisfaction with the cosmetic result of the augmentation
Poor outcome from a primary cosmetic augmentation is one of the reasons patients request a breast revision. Rippling and wrinkling in underfilled saline implants, oversized implants, and malpositioned implants are some of the many causes of dissatisfaction with a breast augmentation. In these cases, breast revision surgery may involve repositioning of the implant, or removal of the old implant with selection of a more appropriate one, or in some cases just the removal of the implant without augmentation.
Implant pocket infection
Breast implant infection rates vary according to different sources from 1-35%. By following the latest infection control protocols, the rate of infection following breast augmentation can be effectively minimized to around or below 1%. Pre-Peri-Post Op antibiotic treatment, implant pocket irrigation with antiseptics and/or antibiotic solutions, the use of an introduction sleeve to avoid contact between the patient skin and the implant, and minimizing the time between the opening of the sterile implant packaging to the placement in the surgical pocket are just some of the many preventive strategies to minimize the risk of infection when performing a breast augmentation. In most cases, breast implant pocket infection can be successfully treated with an early antibiotic combination therapy; when antibiotics are not successful, breast implant removal is indicated, and it may or may not be replaced with a new implant according to patient’s preference.
Breast Implant Illness
Breast implant illness is an increasingly reported unofficial diagnosis for a diverse range of symptoms that may be linked to breast implants and to the immune response to foreign material inside the body. Some women request breast implant removal to address this issue.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) worries
Although not recommended by any medical associations or government agencies, awareness of the slightly increased risk of developing BIA-ALCL in patients who have a textured breast implant has led to patients requesting implant removal for peace of mind. In some cases, they are swapped with smooth implants, while in others they simply opt for no augmentation anymore.
Age related changes in the body or in the mindset, pregnancies, weight gain or weight loss, trends concerning the public opinion on breast implant and women’s image are some of the non-medical reasons for which a patient may choose to have her implant removed.
- Mammograms. Women at average risk for breast cancer are encouraged to get a yearly mammogram since age 40. This may prove difficult depending on implant size, implant placement and fibrous scar tissue formation.
- Pain due to the weight. Large natural breast is a known cause of upper back pain. The same can result from large implants in breast augmentation patients.
- Saving from recurrent costs. The FDA recommends performing implant rupture screenings for all patients with breast implants. An MRI is advised in all asymptomatic patients 5 years after surgery and then every two years. An MRI is also recommended when the patient experiences any symptom that may be due to implant rupture. Previous recommendations were to perform an MRI at year 1, 2, 4, 6, 8, and 10 post-surgery. Depending on your geographical location, MRIs may be quite costly.
Breast Implant removal procedures
Depending on the characteristics of the patient and the reason for undergoing the breast implant removal surgery, different procedures may be performed. When there are no symptoms or complication and the capsule is thin, it is generally left in place. Depending upon symptoms, complications and additional procedures to be performed, the fibrous capsule may be partially or totally removed.
A capsulotomy involves cutting into the capsule of fibrous tissue that formed around the implant living it in place. Usually, the implant pocket is accessed by performing an incision in the same place where the old scar from the augmentation is. This is the simplest and safest procedure for implant removal.
A partial capsulectomy involves the excision of part of the fibrous capsule around the implant. The anterior section of the capsule is most commonly the one excised.
A total capsulectomy involves the removal of the whole fibrous capsule around the implant. It is more invasive and carries more risks than the previous two techniques. It may be indicated in patients with breast implant illness, or in case of implant rupture or in case of complicated capsular contracture (such as when the capsule is calcified).
An en-bloc capsulectomy is the removal of the whole fibrous capsule around the implant in a single piece, without breaking it apart. It requires a larger incision and it’s more invasive. It is generally indicated only in patients diagnosed with BIA-ALCL.
When the implant is removed and not exchanged with a new one, patients may opt for additional procedures to address the excess breast skin and the ptosis. Some of the most commonly performed procedures are:
- Mastopexy, also known as breast lift.
- Fat graft, also known as fat transfer.
- Breast PRP also known as breast booster or vampire breast lift.
The most appropriate procedure will depend upon the patient’s characteristics and expectations.
Are there any risks to having breast implants removed?
Like any other medical or surgical procedure there are some risks and possible complications associated with this type of surgery. Anesthesia risks, asymmetry, bleeding, DVT, infection, changes in nipple/skin sensation, scarring, bad aesthetic result are some of the possible risks and complications which will be explained in detail by your plastic surgeon.
Breast implant removal cost
Cost of breast implant removal surgery will vary according to what procedure is specifically performed, if new implants are placed or other additional procedures are performed, what clinic and surgeon are chosen and the country where you undergo the procedure. If done for medical reasons it may be covered by your health insurance.
In the US the price for just the breast implant removal is in the 2,500-4,500 USD range.
In Australia it costs around 4,000-7,000 AUD (3,100-5,400 USD).
In the UK the price for removal only is around 3,000-6,000 GBP (4,150-8,300 USD).
In Thailand breast implant removal costs 60,000-100,000 THB (1,900-3,200 USD).
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American Society of Plastic Surgeons (ASPS)
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KZ Paydar – Annals of Plastic Surgery, Apr 2013
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