Breast Implant Removal (Explantation)
Breast implant removal surgery, or explantation, can be performed due to a number of reasons. Complications such as rupture or capsular contraction may require the removal of an implant. Other patients desire larger implants or conversely, wish to downsize due to back and shoulder pains. Implant removal is a fairly simple surgery with considerably less down time than a breast augmentation procedure.
According to research from the American Society of Plastic Surgeons, breast augmentation surgery continues to be the #1 leading cosmetic procedure in the United States, with over 300,000 operations performed in 2017 alone. The same statistics report also claims that 27,507 breast implant removal procedures were completed the same year, a number that has been steadily declining over the last two decades.
This decline (statistics show that breast implant removal is down 33% from the year 2000, is perhaps due to modern advancements in breast implant surgery techniques and improved materials. While the jury is still out on whether these advancements have truly had an influence on the quality of silicone implant devices, many believe that the new materials and designs of breast implants offer far superior results for patients seeking maximized comfort, a more natural appearance, and better health outcomes. Patients who desire implant removal are sometimes hoping to replace older, outdated materials with new implants that are not only safer, but feel and appear more realistic.
There are many reasons why patients might become dissatisfied with their implants and would want to replace them or remove them completely. If you are interested in breast implant removal surgery after augmentation, this guide to breast implant removal will help you understand what this procedure entails, and whether it is the right choice for you.
Who is the Ideal Candidate for Breast Implant Removal?
The typical candidate for breast implant removal surgery is no longer satisfied with their breast implants and would like to have them removed. The most common reasons for removal include pain or discomfort associated with the implants, damage to one or both implants (such as a rupture or a leak), capsular contracture, or because the patient is unsatisfied with the way the implants look or feel.
An ideal candidate for breast implant removal is one that feels motivated to remove the implant, and is also: At a healthy, stable weight
- In good physical health
- Is a non-smoker
- Has realistic expectations about their surgery
A board-certified plastic surgeon will discuss the patient’s medical history, their cosmetic surgery background, physical health status, and their motivations for breast implant removal during an initial consultation. If the prospective patient is considered a good candidate for breast implant removal, they will be given more information on the procedure and how to prepare themselves for surgery.
Breast Implant Removal Procedure
Breast implant removal is a minimally invasive procedure. To begin, the patient will be administered local or general anesthesia for comfort during surgery. Once sedated, the plastic surgeon will create a new incision over the old incision site, or possibly underneath the fold of the breast, or along the areola, depending on various factors. The surgeon will then use one or more techniques of his or her choosing to remove the implant, and in the case of a rupture, the breast tissue, breast capsule, and any other areas where silicone leakage has spread.
Once the breast implant is removed, the rest of the surgery will be completed--either with a breast implant replacement, breast revision (a breast lift, breast reduction, or another surgery), or without a secondary procedure. Patients that are not having new implants or revision surgery might need some time to adjust to the new shape of the breasts, which may have noticeable irregularities--especially if there was an excessive amount of scar tissue removed during the procedure.
How to Prepare for Breast Implant Removal
Pre-operative planning for breast implant removal includes a complete physical examination which will be ordered by the plastic surgeon performing the surgery. Once the doctor clears the patient for surgery, they will be given instructions to follow in preparation for their surgery date.
Your doctor will likely ask you to stop taking NSAIDs like ibuprofen and aspirin, herbal supplements, and certain vitamins that are known to increase bleeding during surgery. You will also be asked to stop smoking at least two weeks before and after your procedure. For the best results, patients will be advised to quit smoking permanently and can ask for resources to aid in smoking cessation.
You will also be given instructions on aftercare before the day of your surgery. Your doctor may give you prescriptions for pain medication that you should have filled before your surgery so that they are ready for you immediately when you need them. Patients that are having their procedures performed in an outpatient setting (instead of staying overnight at the hospital or clinic as an in-patient) will need to arrange transportation following the surgery. Patients that do not stay overnight in the hospital will also need to arrange for someone to take care of them at home for 24 hours.
Breast Implant Removal: Aftercare Instructions
After a breast implant removal procedure, you will be given aftercare instructions by your doctor. These may include surgical incision site cleaning and maintenance instructions, directions on caring for bandages, gauze, or compression garment wear, post-surgery medication dosages and topical treatment application information, and other vital details.
If you have excess blood or fluid dripping out from the surgical site, you may have drains placed under the skin after surgery. Your doctor will also advise you on how to care for the tubes and when you can expect to have them removed after surgery.
Swelling and other symptoms should decrease after a few weeks. For best results, be sure to follow all of your doctor’s instructions on aftercare, and to return for your follow-up appointments as scheduled.
What are the Pros of Breast Implant Removal?
The pros of breast implant removal will vary depending on the patient, their reason for removing the implant, their medical history, health background, and many other factors unique to their situation. In general, those that wish to have breast implants removed are doing so for important reasons—whether to improve their health, eliminate pain or discomfort, boost their self-confidence, or a combination of these.
In general, the pros of breast implant removal also include reduced implant-related stress. Having implants requires regular maintenance and attention, especially monitoring implant rupture. The U.S. Food and Drug Administration recommends that women have regular MRI screenings performed after having a breast augmentation with silicone implants—starting three years after surgery and every two years after that, for as long as the patient has the implants. The cost of regular MRI screenings can add up over the lifetime of the patient, and breast implant removal can sometimes come as a relief that rids the patient of this monetary and time-consuming obligation.
Living in constant fear of the rupture of an implant can cause emotional stress in some patients while dealing with an actual leak can be quite tricky in and of itself. Stress-related anxiety over implant ruptures is especially true for patients with older breast implants. Rupture rates for both silicone and saline implants were as high as 10% in the recent past—before the availability of cohesive gel silicone materials, which are much less likely to become damaged. Ruptures can be quite expensive to fix as well, with estimates for breast implant revision, screenings, and rupture and revision surgery costing anywhere between $637 and $2908. In other words, breast implant removal can be quite a relief for some patients, even if they are having them replaced with newer and superior implant materials that are safer, more comfortable, more attractive, and less likely to rip, tear, leak, or cause other problems.
Another significant health benefit that can come with breast implant removal is safer mammogram screening. According to the FDA, women with breast implants are at risk for delayed detection of breast cancer and other breast diseases during mammogram screenings. Implants can obscure the visibility of the breast tissue during examinations, which results in lower-quality and less-thorough or accurate results. They are also at risk for capsular contracture, rupture, pain, and other adverse reactions during the compression and imaging process.
Pain relief is another significant benefit for many patients of implant removal surgery, especially if they have larger, heavier implants that cause shoulder, back, and neck pain. Patients that have suffered from capsular contractures might also experience relief from pain with implant removal once the scar tissue that has hardened around the breast implant is removed. Similarly, for many women with unexplained health problems thought to be connected with their breast implants, a breast implant removal procedure is an excellent option that often results in curing all symptoms and relieving health-related stress.
The Cons of Breast Implant Removal: Side Effects and Complications
As with any cosmetic procedure, there are also cons that accompany the pros. In all surgeries, the biggest downside of surgery includes risks and complications from general or local anesthesia, infection, scarring, swelling, deep vein thrombosis, hematoma, and fat necrosis.
For breast implant removal in particular, the most common downsides are cosmetic. These include decreased fullness, loose, sagging or excess skin, uneven breast shape, and a loss of elasticity in the natural breasts after implant removal. For some patients, the doctor will need to remove more breast tissue than expected, which can intensify this adverse aesthetic effect. This is usually due to a rupture of an implant (and leakage of the gel or other materials into the breast tissue) and can result in the patient appearing to have had the entire breast removed—such as in a full or partial mastectomy. In some cases, patients will want to have a breast lift done to decrease these symptoms, or breast augmentation with fat transfer procedure to mitigate these side effects.
Complication risks that are not cosmetic include increased loss of feeling in the nipples (especially if your previous augmentation surgery resulted in a partial loss of sensation) and poor healing around the incision sites that could lead to infection.
Ask your doctor what cons you can realistically expect for your breast implant removal, and what you can do to deal with or reduce the risk of these downsides if you decide to proceed with the surgery.
Questions to Ask During a Consultation for Breast Implant Removal
Once you have made a consultation appointment with a qualified plastic surgeon, you will discuss your medical history, background, and other details relevant to your potential surgery. It is a good idea to prepare a list of questions you would like to discuss before your meeting to determine whether the doctor is right for you. Some critical questions to ask include the following:
- Am I a good candidate for breast implant removal surgery?
- What types of techniques would you use for my breast implant removal surgery?
- How many breast implant removal procedures do you perform each year?
- Where would my surgery be performed? In a hospital, surgery center, or somewhere else?
- Would my surgery be in-patient or an outpatient procedure?
- What are the potential complications that can occur during my surgery?
- How can I reduce the chances for complications?
- How long will it take for me to recover from surgery?
- What other recommendations do you have for me regarding breast implant removal?
- What can I expect to look like after surgery, and how long will it take to see results?
Deciding to remove breast implants is a personal choice. Patients should do all that they can to evaluate their options and make an informed decision on whether or not to have the surgery, based on a consultation with a highly qualified and experienced plastic surgeon.
If you are considering breast implant removal surgery, finding the right doctor is the first and most crucial step towards a successful outcome. It is highly recommended that patients refer to plastic surgeons that are board-certified by the American Board of Plastic Surgery, the American Society of Plastic Surgeons, or another reputable organization in the country, and have the proper licensing required to perform the procedure in the state where you reside.
List of Sources
- Breast Implant Removal: Candidates
- Breast Implant Removal: Preparation
- Breast Implant Removal: Recovery
- The Pros and Cons of Breast Implant Removal
- What questions should I ask my plastic surgeon about breast implant removal?
- Economic Analysis of Screening Strategies for Rupture of Silicone Gel Breast Implants
- A Retrospective Analysis of Ruptured Breast Implants
- FDA warns of risks from breast implants
- Breast implant adverse events during mammography: reports to the Food and Drug Administration.