Breast implant removal is an important and now, ever-increasing request. This is due firstly, to the ever-growing sum total of women implanted since breast implants were first invented in 1963. Secondly, there is a growing consciousness of the rare but potential systemic symptoms related to silicon collectively called Breast Implant Illness (BII). When BII symptoms are identified, or even if on occasions, when not sure, women mostly want them out. There are various other requests for removal. These may be due to personal preference, health concerns, or frustrations with previous procedure and revisions. Finally, for vague or for even no particular reason, women may be interested in removal and just want to “be done” with implants. For all of these reasons, this procedure has gained significant increased attention and growing numbers in recent years. Therefore, Dr Romano wants you to be completely educated about the different options and techniques for removal, especially since multiple plastic surgeons will often suggest much different approaches and this can be confusing. Dr Romano will help you make sense of this and guide you through making an informed decision about what is right for you, what will meet your expectations, and what your body will allow us to do safely and predictably.
REASONS FOR REMOVAL
- Problems with Previous Surgery: There are times some women may experience hardening of the collagen capsule around the implant called capsular contracture. This occurs in different degrees of hardness and may be challenging and ultimately difficult to cure. Other times there may be displacement of the implant, irregular shape, asymmetry, or just too large or too small. Infection and rupture are nowadays very rare but may also be the cause of presentation. All of these can be addressed and often cured with a revision and new implants, but these conditions and these processes may be frustrating enough to the point where the patient desires removal.
- Breast Implant Illness (BII): We are learning more about a condition called Breast Implant Illness (BII). This has come to be identified by a spectrum of various systemic symptoms like fatigue, joint pain, and brain fog and others. Although there is not a clear science as to the cause-and-effect relationship to silicone, there are statistics enough that these symptoms are linked to the presence of implants, and removal usually cures them.
- Aesthetic Image: Over time in living with implants even with no problems, personal preferences and perspectives about body image can shift. A woman may decide that implants no longer align with her proportions, self-image, or lifestyle. Weight changes, pregnancy, and sagging implants from skin stretch and aging can also alter how implants appear over time and strongly influence the desire to have removal.
- Implant Fatigue: Implants are designed and guaranteed by the manufacturer to last forever. There is no real lifespan or time limit requiring removal. In this case the patient, not the implant, becomes “fatigued”, due to any of the above or any other reasons and the patient just simply is tired of the implants and has “had enough” and wants them out.
BREAST IMPLANT REMOVAL PROCEDURE AND OPTIONS
Breast implant removal is a not at all a straightforward procedure. The procedure and several options will greatly vary depending on your specific expectations, the size of the implant, and your anatomy. All of this introduces variables for the different options which will be discussed in detail during your consultation, and summarized below.
Basics:
- One vs. Multiple Stages: The implants can be removed, and that alone or other related procedures may potentially all be done at once. Otherwise, the implants can be removed, healing can occur, and other procedures, if any indicated, can be done later.
- Anesthesia: The surgery is performed under a very light general anesthesia with a board certified highly skilled anesthesiologist. Since the surgery is minimally invasive you will wake up in very little or no pain. It is outpatient and lasts about 2 hours and you can return home the same day.
- Incisions: Virtually always the complete surgery can be performed through your original incisions.
- Recovery: You will awake with little or no pain and this is true for your recovery as well, which is quick and comfortable. You can return to most activities the next day and full activities in three weeks.
One Stage-Simple:
- Implant Removal Only: In certain selected patients where the anatomy will allow, Dr Romano will carefully remove the implants, and in many cases, remove the collagen capsule of scar tissue (capsulectomy). The internal tissues are then heat treated to create shrinking of the implant space and in so doing, internally create some breast lifting and perkiness. The space once occupied by the implant then shrinks down in a controlled fashion and this provides some natural lift and better return to a nice shape.
- Results: When properly planned and selected, this most of times is all you will need. The breast tissues and skin will shrink down and reform the breast size and shape you had prior to breast implants. We have not burned any bridges and if you desire more size or shape or lift, a secondary procedure can be done and with a better ultimate result.
One Stage-Complex
- Implant Removal and Other: Depending on your anatomy it may be advisable to perform an added procedure at the time of implant removal. This may be indicated because of very large implants and stretched skin, or drooping breasts or thin tissues. After removal of implants, you may benefit from a breast lift (external incisions such as donut, lollipop or boat anchor) or fat grafting or a combination of these. This operation is more risky in terms of safety and cosmetic results.
Multiple Stage:
- Implant Removal and Other: In vast difference to the “One Stage-Complex” as noted above, this achieves the same result but is much safer and predictable. The first stage is to remove the implants and let the tissues and breast shrink down and remold and totally heal. Frequently this turns out to look so good most patients do not wish or need to proceed to an additional stage. Otherwise, if there is a good indication then a later stage can be undertaken, and this is much safer and predictable and satisfying. Total healing and shrinking after the first stage insures the blood supply is robust and not compromised and that total healing allows for shrinkage and creation of a new stable “canvas” upon which to craft and create the new breast shape as opposed to healing with all the variables if done in one stage-complex.
The ”Others”:
- Breast Lift: After implant removal, the breasts may sag or appear deflated, especially if the implants were large and your skin is thin. A breast lift (mastopexy) will tighten and reshape the breast for a more youthful appearance. This will involve external incisions ranging from donut to lollipop to boat anchor designs.
- Fat Grafting: In some cases, fat from another part of your body can be transferred to the breasts to add volume and improve the overall contour after implant removal. The fat can only be added to your natural breast and fat layers and never into the implant removal space, so the amount of fat and where it is placed will influence the shape and size, but there are limits to this. The surgeon will carefully remove the implants, and in some cases, remove the surrounding scar tissue (capsulectomy), especially if capsular contracture has developed. SEE DIAGRAM BELOW
- Alone or in Combination: These other procedures may be done at the first “One Stage-Complex” or as the secondary stage in “Multiple Stages” either alone or together as needed. Dr Romano will counsel you carefully about this and what is best and why.
RECOVERY AFTER BREAST IMPLANT REMOVAL
Recovery from breast implant removal is predictably comfortable and quick. This is because of the preparation, the anesthesia, and the special techniques. Since Dr Romano is using the same incision, not making any new surgical spaces, not stretching out the tissues, and not cutting through anything painful, the surgery is well tolerated, and the recovery is rapid and comfortable. The procedure will take anywhere from 2 to 4 hours depending on simple vs. complex as noted above. You will be in recovery room for an hour then go home. You can return to most light and daily activities the next day. You can return to full unrestricted activity in about three weeks.
RISKS, COMPLICATIONS AND CHALLENGES
As with any surgery, breast implant removal comes with potential risks. While these are generally rare, they are the same as with any other procedure such as infection, bleeding, scarring and others depending on the surgical procedure option chosen as noted above.
It is not the complications which are of concern after this procedure as it is the byproduct of healing and this challenges the patients and your doctor. Simply stated, it is the issue of:
- Changes in Breast Appearance: Depending on the size of the implants and the amount of skin stretching that has occurred, your breasts may appear smaller, looser, or more saggy after implant removal.
- Irregularities: When done in one stage-simple as noted above there may be an agonizing period of healing where there are irregularities, folds, bumps and dents all related to the breast skin shrinking down after implant removal. This does not occur in all patients and when it does, it virtually always resolves with time and massage. Dr. Romano will be expert in counselling you if this is likely to occur or not.
- Time to Heal: As mentioned, if there are irregularities and some internal scarring, it may take a long time (months) for massaging and healing to ultimately allow for round, smooth, natural breast shape.
- Unpredictability: Although your breasts most often return to your pre implant state, on occasions they may not return to exactly how they appeared before the implants were placed. Factors such as weight changes, aging, and skin elasticity all influence the final appearance. However, procedures like a breast lift or fat grafting can help enhance the overall shape and contour of your breasts after removal.
FINAL THOUGHTS Breast implant removal is a safe and effective procedure for women who no longer want their implants. With proper planning, a qualified surgeon, and an extensive education, counselling, and clear understanding of the process, you can safely and predictably achieve the results you desire and feel confident in your decision and a permanent result.
