Breast Implant Removal Surgery Options and Expectations for Outcomes

There are many reasons for exploring the option of breast implant removal. Women often seek options trying to decide if they will look and feel better without implants. Some reasons are:

• Those who have had implants for many years, and now feel that their breast are too large for their lifestyle.
• The aging of their breast have become larger often due to hormonal changes.
• Their breast changed significantly after one or more pregnancies.
• Their breast became too large with some unintended weight gain.

And there are those with issues with implants.

• Their breast are unconformable because the implants have shifted down or to the side, particularly problematic during sleep and when reclining.
• Their breast are uncomfortable during exercise.
• The the implant has become too thinned.
• The implant feels cold.
• The breast implants are too firm or are too asymmetric.
• They have become unattractive when standing without a bra, or when leaning forward without clothing.
• They have had multiple operations and just cannot quite get the look and feel that they can enjoy.
• Questions or concerns about potential health impact
• No longer feel the implants match their lifestyle.

And many more reasons.

All are valid. In the best of circumstances, implants are not considered lifetime devices, and it is expected that these patients will need replacement, revision or removal of their implants at some point.

But breast implant removal conjures up feelings of uncertainty, and anxiety regarding appearance. And for those removing implants hoping to restore their health, the anxiety can be even more intense due to the unknown. There is yet to be any definitive test for breast implant illness. And yet there are many who are relieved, improved, and often thrilled to have their implants removed, and have a smaller more natural breast in return.

Breast Surgery for Implant Removal

A detailed consultation is always required before surgery. There are many more factors at play that must be considered before breast implant removal surgery (explant surgery), and the technical and artistic approach is clearly dependent on experience.

Most patients fall into 3 categories:

1. Those that can undergo implant removal and look “normal”
2. Those that may undergo removal and have the option for breast renovation
3. Those that will require surgery after implant removal to have a more normal appearance.

Breast Surgery Options After Implant Removal

Breast Lift

Consider that your breast is made of several units, the nipple and areolae and attached breast glandular tissue, and the skin envelope that holds it. After pregnancy many women have a droopy breast due to decent of the breast, too much skin, and too much breast tissue at the lower part of the breast. A bra no matter how well constructed, may have a difficult time mechanically moving the breast far enough up to make it look youthful.

Breast lift operations allow for movement and repositioning of the breast tissue to the upper chest wall where most breast tissue resides in younger breast.

After women have had breast implants for some time, the tissue often changes, with loss of volume, and thinning of the breast, particularly from the nipple areolar area toward the breast fold.

This results often in greater breast volume in the upper breast and less at the bottom. In effect, when an implant is removed, it is equivalent to having too much natural skin for the remaining volume.

Surgery to address this condition may have incisions that look like a breast lift. However, the operation is a renovation of the breast more than a lift, designed to achieve a greater balance between remaining volume of breast tissue and skin and soft tissue support.
Many women find that after implant removal where the implant weight and pressure have thinned the tissue, that some of the volume will return with time.

Capsulectomy

Any foreign object in a body will stimulate the creation of a capsule. A capsule is a layer of scar tissue that often is described as pseudo-skin. It will occur around and non-biologic implant, such as a pacemaker, implants of almost any type (breast, orthopedic, facial, neuro, spine, etc.).

When breast implants are removed, the capsules often will not resorb (disappear). The lining may be found years later on re-operation, not due to a defect, but because there is not a natural signal for the tissue to remodel.

When capsules are surgically removed (capsular contracture surgery) with implant removal, the tissue has the best chance to heal back to pre-implant conditions.

For implants placed above the muscle, this allows the breast tissue to heal back to the surface of the pectoral muscle where it was naturally before augmentation. For implants under the muscle, this may allow for the muscle to heal more naturally to the chest wall, again more anatomically. Rarely is muscle repair required. The reason that implants can be positioned under the pectoral muscle is that the muscle typically has minimal attachments there during normal function and has an origin (attachment to the area next to the breastbone) and insertion (into the main bone of the upper arm – the humerus) and functions normally this way. There are specific cases where excess detachment of the pectoralis occurred during augmentation. In these cases, if repair is done it most often requires more sophisticated approach often with a graft material to reattach to ribs. Board certified surgeons with experience in breast augmentation, breast breast lifts, and breast revision operations should be adequately trained for these operations. Those surgeons who also have reconstructive experience also should qualify for implant removal and associated procedures.

En Bloc Surgery

There is confusion as well regarding “enbloc” operations. “Enbloc” has the definition of removal of tissue with a “normal” tissue margin in tumor surgery.

“Enbloc” has been described as the removal of the breast implant as a single unit. This operation is extremely demanding and carries in some cases very significant risk of damage to surrounding normal tissue that can result in both short-term complications (pneumothorax or puncture of the lining around the lung), damage to the cardiac space, and long-term scar tissue between the ribs that can result in impact on chest wall function, as well as damage to muscle and regional nerves.

Be wary of “enbloc” experts who guarantee this outcome. Patients may expect to achieve a total capsulectomy, which may start using an en bloc technique, and may result in removal of grossly resectable capsule while preserving normal tissue.

Patients with BII (Breast implant illness) often are found to have extremely thin capsules, often “see through” cellophane thin, and require surgical expertise to remove this tissue and not damage surrounding tissue. Current published date supports improvement in symptoms after implant removal independent of capsule removal technique. It remains your decision on the approach used for capsule removal. More aggressive removal techniques are associated with higher surgical risks. Make sure you understand these factors before surgery is scheduled.

Consensus Statement on Breast Implant Capsulectomy Definitions and Management Created by Breast Surgery Collaborative Community, The Aesthetic Society/ The Aesthetic Foundation , June 8, 2024

“The FDA recently created a strategic priority for the creation of collaborative communities to bring together stakeholders in the medical device realm to solve challenges and achieve a collective betterment for patients, physicians, industry, as well as the medical community at large. The Breast Surgery Collaborative Community (BSCC), a consortium of patient advocates, board-certified plastic surgeons, the medical device industry, and others with a vested interest in enhancing breast surgery safety, was assembled to offer clarity for women seeking guidance on removal of breast implants related to health concerns. “

“The BSCC consensus statement defines four types of capsulectomy: “

• “Total intact capsulectomy: Complete removal of the breast implant capsule as a single unit.
• Total capsulectomy (total precise capsulectomy): Complete removal of the breast implant capsule, not necessarily done as a single unit or in one piece.
• Partial capsulectomy: Removal of the breast implant capsule where some capsule is left behind.
• En bloc capsulectomy: Removal of the breast implant capsule with a margin of uninvolved tissue for treatment of suspected or established breast implant-associated cancers after appropriate medical workup. “

The statement explicitly declares, “the absolute and only indication for an en bloc capsulectomy is for an established or suspected breast implant-associated cancer after appropriate medical workup.”  This decision for surgery is clearly a part of the informed consent process, and any decisions should be shared between the patient and surgeon in a formal discussion around risk assessment, benefits, and alternatives, as well as the expected outcomes. “

Patient Outcomes From Capsulectomy

Patients with capsular contracture, ruptured gel implants, and older implants, may as well have very thickened implants, and may as well have calcification, eggshell type flakes due to cell death of scar tissue, and this tissue typically is completely excised as well.

This technique of delicate total capsulectomy appears to be as effective in our patient population of approximately 1,000 implant removals when compared to data presented by the ASPS, where 88% or more reported improvement of symptoms following implant removal. There are numerous patients who state they are able to document post-operative resolution of their symptoms from facial/eye swelling to resolution of skin rashes and go on to have resolution of many other symptoms of concern in the early phases of healing. All tissue that we remove in surgery is sent to expert pathologist trained in breast and soft tissue disease diagnosis.

Breast Renovation

Breast “Renovation” is the process of restoring the breast to “life, vigor, and beauty”. Implant removal does not necessarily mean you are destined to have a misshaped breast, or an alien look. Yes, there will be volume loss. However, in many cases the resulting volume an appearance can be a significant improvement.

It is not uncommon to hear that clients love the way they look and feel, in and out of clothing after implant removal. There are certainly some who remember having minimal breast tissue, and feel the anxiety of return to that volume, with the added concern of changes that have happened to the tissue over time. And yet many of those patients can feel to be made whole again with removal.

Patient Outcomes From Breast Renovation

There are many patients who have significant health improvement with implant removal, and some, that even though they feel so much better, miss their volume. The operations and impact are real, exciting to some, anxiety provoking to others, and somewhat traumatic to a few.

There are ways to gradually change the shape and volume with techniques such as fat grafting. This option is presented on the internet as a “near magic” treatment. Patients however should carefully choose a surgeon who can demonstrate long term volume preservation with fat grafting. We typically recommend reserving this option for secondary surgery if needed to address contour issues such as depressions, asymmetries, dimpling, and contour variations after implant removal with or without breast renovation.

What is a Breast Renovation?

A Breast Renovation really means that techniques are used to help package remain breast tissue as skillfully as possible to provide the best appearance possible after implant removal. The incisions on the surface frequently appear to mirror a breast lift.

The surgery beneath the skin however is designed to maintain all viable breast tissue and in effect repackage the tissue particularly along the lower pasts of the breast into a smaller area, removing redundant skin, to support the breast shape, and provide volume support to the nipple areolar area. This is not magic. Tissue cannot be created where significant prior thinning has occurred, and there are those who simply may not feel pleased with the outcome. But most patients are often extremely surprised by the appearance, residual volume, contour, and feel of the breast.

See our Breast Implant Illness page for additional current literature references.

Request a Consultation

Exploring options for implant removal require careful, meticulous, and precise evaluation by a board-certified plastic surgeon with experience. You should feel that the consultation provides education that surpasses information on the web, and relates directly to your body, your concerns, and your expectations. Everyone is nervous the day of surgery. You should not have anxiety however that you are not at the right place, time, and facility, and with the surgeon best suited for your needs. That’s our job, to give you the information about you for you to make the best decision.

To request a consultation with Dr. Rudderman, contact us at 678.566.7200 to schedule a consultation in our Alpharetta or Midtown Atlanta offices.