Whether for cosmetic breast augmentation or breast reconstruction, it is known that breast implants are not lifetime devices. Common reasons for breast implant removal include rupture and capsular contracture; however, recent discussions pertaining to the safety of silicone breast implants are fueling increasing demand for explantation. Rates of explantation have increased from 19,857 procedures in 2009 to 30,000 in 2018, making explantation one of the top ten most commonly performed plastic surgery procedure performed in the United States.
With any breast implant, your body creates a layer of protective scar tissue around the implant, called a capsule. In some women, this capsule can abnormally harden and tighten, causing pain and distortion of the implant. Studies report rates of capsular contracture ranging from 2.8% to 18.9% for augmentation patients. In the setting of capsular contracture, implant removal or implant exchange can be considered.
All types of breast implants can develop a tear or whole, leading to rupture. Rupture of a silicone implant is an indication for implant removal. Implant rupture rates can vary based on surgeon and manufacturer. Diagnosis of silicone implant rupture is usually achieved using MRI or ultrasound.
“Breast Implant Illness” or silicone implant illness is characterized by a non-specific and generalized constellation of symptoms. These can include malaise, fatigue, fibromyalgia, headache or other autoimmune like complaints potentially caused by a breast implant. No diagnostic test for BII currently exists.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is associated with textured breast implants. Patients most commonly present with seroma (fluid collection around the implant), pain and/or swelling in the breast, capsular contracture, and a mass or lump around the implant. In patients with BIA-ALCL, the capsule, fluid surrounding the implant, and any associated masses should be completely removed with the implants (en bloc resection). In asymptomatic patients with textured implants (without BIA-ALCL), there is no evidence that whether implant removal with partial or total capsulectomy has any effect on reducing risk of developing BIA-ALCL in the future. Lack of data creates a challenge for patients and surgeons to determine the best course of action with textured implants.
Women who are unhappy with their breast appearance due to age-related changes, pregnancy, weight gain or loss, or changes in public opinion concerning breast implants, may desire to remove previously placed implants.
Breast implant removal is a safe, reliable, and outpatient procedure. Prior to breast explantation surgery, there are two important considerations. Breast explantation will change the appearance of the breast, and procedures such as mastopexy (breast lift) and/or fat grafting can be performed at the same time as breast implant removal. Secondly, it is important to determine how the breast capsule will be managed during surgery. With any breast implant, your body creates a layer of protective scar tissue around the implant, called a capsule. The appropriateness as to whether capsule removal is indicated is not always clear and can be quite controversial based on the indication for breast implant removal.
A capsulotomy is the simplest and safest of the procedures used to manage the capsule in explant patients. During an open capsulotomy, the capsule is cut open, allowing exposure to remove the implant. The capsule remains in the patient, and the implant is removed. While safe, capsulotomies are not suitable for patients with BIA-ALCL or when calcium deposits, masses, or silicone are embedded in the capsule.
In a partial capsulectomy, a portion of the capsule is removed with the underlying implant. The part of the capsule that remains in the patient is the posterior capsule, which is often adherent to the chest wall. This remaining piece of the capsule is often cauterized to make sure that it does not pose any issues after surgery.
In a total capsulectomy, the entire capsule and the implant are removed. Total capsulectomy is the most invasive of the three approaches and carries a higher risk of bleeding and complications compared to capsulotomy or partial capsulectomy. For patients requesting the capsule and implant to be removed in continuity, the capsule and implant can be explanted as a single unit.
En Bloc capsulectomy is defined as an oncologic procedure in which a margin of normal-appearing tissue around the capsule is removed with the implant and an intact implant capsule. Currently available evidence indicates that an en bloc capsulectomy is indicated in those who have breast implant associated anaplastic large cell lymphoma (BIA-ALCL).
To learn more about Dr. Tanna's commitment to continuous research and innovation in the field of plastic surgery, click here to read a recent article that was published with thought leaders around the country on breast implant removal.