Breast Implant Removal
There are various reasons why women may choose to have their breast implants removed. This is usually many years after having implants and may be because their body shape has changed with time or possibly because the old implants have gone hard. Some people feel that breast implants are just not for them any longer. When considering breast implant removal there are a number of considerations that will depend on each persons individual situation.
- Should the capsule layer around the implant be removed?
- Will a breast lift be required?
- Should new (smaller) implants re placed?
- Is a general anaesthetic required?
Frequently Asked Questions
There are a variety of reasons that women may choose to have their breast implants removed. Some of the reasons I have seen include:
- Rushed into having surgery overseas and regretted choosing a size that was too large for their frame.
- Initially very happy with their implant size but over time their body shape has changed with pregnancies, menopause or weight gain and the implants are now too large for their frame.
- Over time they have developed a capsular contracture and one or both implants are now hard and uncomfortable. The risk of capsular contracture is up to 5% with modern implants but higher with older implants.
Everyone who has a breast implant has a capsule layer around the implant. A normal capsule layer is very thin, perhaps a quarter of a millimetre thick and is the body’s reaction to any foreign body. The capsule layer is made of your body own scar tissue (mostly collagen).
If your implant is soft and the capsule layer is normal then there is usually no medical reason to remove this. This has the advantage of surgery being able to be done under local anaesthetic if you wish. If the capsule is not removed, then healing is much faster because you do not leave a large raw area around the implant as a capsulectomy does. If there is no medical reason to remove it then I would not do so unless the patient specifically requests this for some reason.
If this capsule layer has become hard (capsular contracture) or the implant has ruptured, it is normally recommended that the capsule layer is removed at the same time as a breast implant is removed. This is called a capsulectomy.
A capsular contracture can occur for many reasons and can occur many years after surgery. The most common reason I see is trauma to the breast (eg road accident or falls onto your front). Mastitis whilst breast feeding can also cause thickening of the capsule layer, as can any local infection or inflammation. Radiation (for breast cancer) can cause a contracture. If the cause of a contracture can reasonably be linked to a trauma, and there is a clearly documented ACC claim of trauma to the breast preceding the contracture, then ACC may fund the cost of a capsulectomy.
An en-bloc capsulectomy removes the entire breast implant and capsule in one piece and this is the ideal way to do the procedure but not always possible. A normal breast implant can be placed through a very small incision but because a capsular contracture causes an immobile mass, a much larger incision is needed if the capsule is to be removed in one piece.
Additionally if the implant has been placed under the pectorals muscle layer, it is likely to be stuck on to the rib cage and cannot be separated in one piece from this layer. In this case a total capsulectomy is performed.
A total capsulectomy removes the entire capsule however not all in one piece as an en-bloc capsulectomy does. It is very important to remove the entire capsule if a new implant is being placed and not doing this correctly increases the risk of another contracture.
After a capsulectomy, the capsule tissue is sent to the laboratory for routine screening for conditions such as ALCL. I always take a photos of the implant inside the capsule so the patient has a record of what type of device was implanted as often they do not have this.
This depends on what caused the first capsular contracture. If the contracture was caused by trauma or infection or radiation, and these factors are no longer present, then in most cases a contracture does not form again. People who smoke have a higher risk of capsular contracture.
Not everyone wants a replacement implant after a capsulectomy. Most people do although often a smaller implant is used. Sometimes the implant is placed in a different plane. For example if a capsular contracture had been present above the muscle layer, the new implant may be placed under the muscle layer and there are a number of advantages to doing this.
This depends on the size of the implant and how much tissue stretch occurred when the implant was inserted. Some people will need a lift when their implants are removed to tighten excess skin and prevent their nipples looking too low. In cases that are marginal, I would recommend not doing a lift at the same time but allowing a few months to see where everything settles. If skin tightening is later desired then this can usually be done under local anaesthetic.
Implants can be placed either at the time of implant removal or at a later stage. It is much easier to place an implant at the time of removal. If placed at a later stage, the space for the implant needs to be recreated and there will be some internal scar tissue to seperate (whether or nor a capsulectomy was done).