Breast implant removal and total capsulectomy

Patients will choose to undergo a breast implant removal for many different reasons. There are those who will do so after pregnancy weight gain or during menopause, others will feel discomfort in their bodies, while some will opt to remove implants that are in bad condition, have aged or because of postoperatory complications. Regardless of why, it’s possible to remove the implants without reverting to a prosthesis change.

Surgical Techniques

Surgical techniques that are chosen for the procedure will depend on a series of factors, with the most decisive one being a physical examination and meeting with the patient. Normally, the incision used to remove the implants will be the same that was used for the original implant intervention.

Transaxillary endoscopic removal:

If the patient’s breast augmentation wa performed through an axillary incision, and implants are saline, I’ll usually use an endoscopic approach and remove implants through the original incision. The surgery lasts about the same time as the first intervention, and the patient is under general anesthesia. Recovery time is shorter than it was for the breast augmentation, as most patients feel very little discomfort after the removal.

Inframammary fold:

I examine the existing scar in patients that already experienced scaring below the breasts. This type of surgery can be performed with mitigated anesthesia, which means it’s regional and the patient is sedated.

Total capsulectomy:

If a patient wishes to remove breast implants because they could be the source of medical conditions (BII : breast implant illness), removing the implants won’t be enough. In these cases, I suggest a full capsulectomy, as well as an implant removal. A total capsulectomy is a procedure that removes the fibrous capsules that naturally grow around breast implants.  It’s a delicate procedure, with the ideal incision locate in the inframammary fold, which is under the breast. Performed under general anesthesia, it normally takes between 3 to 4 hours. By removing both the implants and the capsules, we increase the chances of a positive postoperative result.

The same thing applies for silicone-gel or any other textured implant. Chronic inflammation can eventually settle within the fibrous capsule which calcifies over time. This calcification of the fibrous capsule can be due to silicone gel leakage through the implant lining. Once the calcified fibrous capsule is removed, we can choose to replace the breast implants, or not.  In some cases, rather than opting for replacement implants, patients prefer to remove them for good. It’s a personal choice. If breast implants are replaced, we’ll usually use saline implants that are positioned in the retropectoral space.

The consequences of a ruptured gel silicone breast implant are yet to be confirmed as studies are still being conducted. There have been cases of silicone gel leaking towards the chest, the axilla, the upper part of the abdomen, the arm and the groin. Studies have shown that silicone gel was present in these areas. There have also been cases where silicone gel has migrated to the axillary lymph nodes, causing lymphadenopathy, even when there is no sign of a rupture.

Possible consequences of a silicone gel leakage are lesions to the nervous system, presence of granuloma, degeneration of the tissue that’s in direct contact with the silicone gel, hardening of the mammary tissues, a change of size or shape for the breasts, pain and calcification of the fibrous capsule. Obviously, if a silicone implant bursts, I’ll perform a full capsulectomy.

Because there is a correlation between textured implants (saline or silicone) and ALCL (Anaplastic Large Cell Lymphoma) or cancer of the fibrous capsule, I automatically recommend a full capsulectomy and the removal or replacement of breast implants, choosing a smooth variety this time around.

Postoperatory results

The main concern for patients that are considering an implant removal is ending up with a less than flattering appearance. It’s false to believe that patients eliminating implants will necessarily require a breast lift. Postoperatory results will vary from one patient to the next, but it takes several months, after the procedure, to visualize the final result. Wearing a compression bra is important during the healing process. If a breast lift is necessary, it’s best to wait one year between the removal of the implants and the corrective procedure.

In conclusion, any breast implant removal should be consulted with your plastic surgeon in order to make an informed, appropriate decision.