Choosing removal of breast implants is often a personal decision that can be justified by several factors. Reasons most commonly noted are weight gain, menopause, pregnancies, discomfort, implant rupture and of course, post-operative complications. Implant replacement is not indispensable since it is also very possible to refer to (exeresis) surgical implant removal.
During the physical examination, the surgeon will determine the most efficient surgical technique, based on several factors. Typically, the incision for removal is very similar to that of a breast augmentation operation.
For patients having had breast augmentation surgery by axillary method (armpit), and physiologic saline solution implants, removal of the implant is possible, using the endoscope, and the same incision point. The procedure requires approximately the same amount of time as the implant augmentation process and is performed under general anesthesia. Patients return to their regular activities shortly after surgery, since very little discomfort is noticed with this type of procedure.
For patients who have an inframammary fold scar (under the breast) the surgeon will use the same incision as the one used for an implant augmentation and this can be performed either under local anesthesia with sedation or general anesthesia.
Capsulectomy is a surgical procedure used to remove the fibrous capsule (scar tissue) that normally forms around the breast implant. Capsulectomy is complete and is generally recommended when the patient has silicone implants, cohesive silicone gel implants, textured surface implants or for patient showing signs of BII (Breast Implant Illness).
As for physiological saline implants, the fibrous capsule (scar tissue) surrounding the breast implant is usually of a normal nature (thin, translucid and not calcified) therefore total capsulectomy may not be required. On the other hand, if patient shows recurring capsular contracture, the scar envelope will likely be thick and opaque. Total capsulectomy should then be considered.
Concerning silicone implants, cohesive silicone gel implants, and all types of textured surface implants, in time, chronic inflammation of the fibrous capsule can develop, which in turn calcifies (becomes bone like). This calcification would be caused by silicone gel leakage through the implant wall. Once the calcified fibrous capsule has been completely removed, opting to replace or not to replace breast implants is possible. In certain cases, patients will choose complete removal of implant instead of a replacement, this becomes a personal decision. When breast implant replacement is decided, surgery is usually performed with physiological saline implants and inserted under the Pectoral muscle or retromammary according to the surgeon’s assessment.
Because of correlation between textured implants (both saline or silicone gel) and ALCL (Anaplastic Large Cell Lymphoma) or cancer of the fibrous capsule, I automatically recommend total capsulectomy and removal of breast implant.
This surgery is especially delicate and will require 3 to 4 hours in the operating room under general anesthesia. The ideal incision type for this procedure is in the inframammary fold area. By removing the scar envelope, and the breast implant, we can reduce probability of recurring fibrous capsule contracture. But still, the risks of secondary capsular contracture are high.
Consequences of silicone gel breast implant ruptures are for the moment unknown since studies are underway. Cases of silicone gel leakage have been reported in such areas as the chest, arm pits (axillary), the upper part of the abdomen the arms and groin. Studies have shown cases where silicone gel has migrated to axillary lymph nodes and caused a lymphadenopathy even without signs of rupture.
- growth of granulomas
- deterioration of tissue in direct contact with silicone gel
- induration of breast tissue
- change of breast size or shape
- pain
- calcification of the fibrous capsule
When a silicone fielded breast implant rupture, it’s recommended to proceed with a total capsulectomy.
BII (Breast Implant Illness) syndrome is not scientifically proven. Some patients having developed a variety of symptoms, link these symptoms to the breast implants. Patients who wish to proceed with a in-block or total capsulectomy and removal of breast implants (explant), because of BII, must be informed that there is no guarantee that the symptoms will disappear. One must understand that in-block or total capsulectomy produces a substantial amount of permanent scar tissue, and this can be a cause for pain or discomfort after the surgery. Concerning a total capsulectomy for cohesive silicone gel implants or saline implants, the incision area is usually in the inframammary fold and is performed under general anesthesia. A 3 to 4 hours procedure is needed.
The fear of obtaining poor esthetic results is patients primary concern, when breast implant removal is considered. It is wrong to believe that patients who decide to have implants removed will automatically require a breast lift operation. Post-operative results may vary from one patient to another. Final and definite results will only be seen several months after the surgery. Wearing a compressive bra is of utmost importance during the healing process. Should a breast lift operation be needed, it is preferable to wait at least one year between implant removal and this surgery. The breast lift can be done only on patient who had their implants behind the pectoral muscle, otherwise, the risks of skin necrosis are too high.
In conclusion, for your breast implant exeresis, it is recommended to consult your plastic surgeon who will help you make the right decision.
Here is an overview of before and after photos of patients who had their breast implants removed at Dr. Mario F Bernier’s clinic.
Céline Enea
24/07/2021
I had a saline breast augmentation in December 2001. It took me a long time to comment VERY POSITIVELY: throughout the process (consultation, surgery, follow-up) A1. My choice was made with Dr. Bernier's professional advice regarding my choice of implants, their size and the consequences. I was a little disappointed that I did not have much leeway on the volume. The maximum for my physiognomy was the 2nd size of the smallest implants... I was a little disappointed but so convinced when he told me "if you want bigger, I won't do them. It's about aesthetics, not size." What sound and knowledgeable advice!!! It gives a good indication of the surgeon's conscientiousness and professionalism. I have never regretted it! Thanks again Doc 🙂
Translated from French
Translated from French
Annie Olivier
08/02/2018
Breast augmentation
Clinical and surgical fees (breast augmentation without scar on breast) anesthesia fees, postoperative bra, and postoperative follow-ups. Sale taxes non-included. *Only a medical evaluation with Dr Bernier can determine if you are an ideal candidate for the surgery. **Price may vary, a medical evaluation with Dr Bernier is required.
Price upon request
Mastopexy (breast lift)
Clinical and surgical fees (3 to 4 hours surgery), anesthesia fees, postoperative bra, postoperative follow-ups. Sale taxes non-included. *Only a medical evaluation with Dr Bernier can determine if you are an ideal candidate for the surgery. **Price may vary, a medical evaluation with Dr Bernier is required.
Price upon request
Breast reduction
Clinical and surgical fees (4 to 5 hours surgery), anesthesia fees, postoperative bra, postoperative follow-ups. Sale taxe non-included. *Only a medical evaluation with Dr Bernier can determine if you are an ideal candidate for the surgery. **Price may vary, a medical evaluation with Dr Bernier is required. ***250g and less per breast (breast reduction for breasts over 250g is covered by the Régie de l’assurance maladie du Québec (RAMQ) and performed by a plastic surgeon in a hospital setting).
Upon request
Inverted nipple(s)
This surgery is only available in conjunction with a breast augmentation.
Do not hesitate to contact us for any information request or to make an appointment for the removal of your breast implants.
Translated from French