Breast Implant Removal and Total Capsulectomy
The decision to remove one’s breast implants is often a personal one, which may be justified by a variety of different factors. In our experience, the most common reasons are related to weight gain, menopause, pregnancy, discomfort, a ruptured implant or post-surgical complications. Replacing the implants certainly isn’t obligatory, and it’s entirely possible to have the implants excised (removed).
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.
The axillary method (armpit) or endoscope:
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.
Via the inframammary fold incision:
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.
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.
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.
Possible consequences due to leakage of silicone gel are: growth of granulomas, deterioration of tissue in direct contact with silicone gel, induration of breast tissue, change of breast size or shape, pain and calcification of the fibrous capsule.
When a silicone fielded breast implant rupture, it’s recommended to proceed with a total capsulectomy.