Breast Implant Removal in Salt Lake City & Layton, Utah
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I am reading a lot about breast implant removal, why is this suddenly popular?
As a plastic surgeon in practice since 2003, I have seen a lot of trends and fads in plastic surgery. Breast implant removal is more popular today than it has been through this point in my career.
I had very few patients in the first 14+ years of practice inquire about implant removal, whereas today, this is requested frequently. The reasons for this are not entirely understood by me but are complex and likely multifactorial.
- Fashion trends – are women finding smaller breasts more desirable?
- Breast implant illness – covered below. Are implants making some women ill?
- ALCL – A link to a type of lymphoma (ALCL) exists for specific textured breast implants
- Social media – there have been a lot of social media posts about breast implants lately. Whether this is spreading important information or unwarranted panic is a considerable matter of debate.
What are the common reasons someone would want to remove their implants?
Through my career, the most common reason patients have asked me to remove implants is that they have gained weight and feel too large. In the past two years, the most common reasons patients request implant removal are for breast implant illness concerns and BII-ALCL concerns with textured implants.
What will my breasts look like after I remove my breast implants?
Understandably, women with breast implants are nervous about the appearance of the breasts after breast implant removal. It is often not as simple as expecting the breasts to look the same as they did before implants. For one, time has passed, and there are supposed age-related changes in volume or droop. Secondly, the implant itself can stretch tissue or cause a modification of the breast tissue or underlying rib cage shape. Generally, the larger the implant, the more the impact on the breast. Although we love 3D imaging to help visualize how a patient will look with implants, there is no such technology to simulate implant removal. Patients should expect smaller breasts, with less upper fullness and often more droop than the current breasts. Occasionally other procedures such as fat transfer or breast lift may be necessary to achieve the patient’s goals.
I am worried that I have breast implant illness, how does that change things?
Breast implant illness is challenging to diagnose as there are no well-defined laboratory tests, and symptoms vary from patient to patient. The vast majority of health symptoms that women with implants have are symptoms that women without implants get as well, at similar frequencies. For these reasons, it is essential a woman not immediately determine a breast implant is the cause of illness; other health disorders are more common. Under the direction of their physician. For the women who receive no answers, it is entirely reasonable to consider whether an individual is having an unusual response to their implant and is effecting other aspects of their health.
Women who are concerned they have breast implant illness should consider that implant removal may not improve their health if there is another, unrecognized condition. For these women, there is a lot of information on the internet. Depending on the source, this information ranges from implants pose “no risk whatsoever” to ” implants are slowly killing you.” It is hard to separate fact from bias. My opinion, based on a long career placing and removing implants, is that some women DO have unusual inflammatory responses to implants. Inflammation can lead to a “whole body” response. Similar to a medication allergy, I wouldn’t disregard the rare allergic patient because this isn’t the response of the majority of people.
Women who present to my office asking for breast implant removal can expect an honest discussion about the disorder and a few questions. Firstly, I want to be sure that other, more frequent medical issues have been looked at by a physician. Second, we will discuss how implant removal will affect the aesthetics of the breast. The patient must have reasonable expectations.
We will then have a conversation about the breast implant capsule. I find that most patients have strong feelings that their capsules must be removed as part of this process, yet have a poor understanding of what a capsule is. A capsule is the scar tissue that forms around a foreign body placed within soft tissue in the body. Capsules form around other medical devices as well as breast implants. Capsules are created by the body and are not created by the implant or added to the body. The breast implant capsule is simply the smooth scar tissue that forms around the implant and is important in implant support. There are times where this capsule becomes diseased, such as capsular contracture or with silicone implant rupture. In these cases, I recommend we remove the capsules entirely. But what about the patient who has healthy capsules? These capsules look like saran wrap and are as thin and fragile as tissue paper. They are virtually transparent, and you could read print through them. There is no evidence of inflammation or anything visible that would lead one to believe they are causing harm. According to some sources on the internet, the only way to cure breast implant illness is to remove this healthy capsule with the implant. Although the research and science behind this are lacking, I believe that if a patient wants their capsule removed, I should do it.
Here’s the tricky part. Removing an implant while leaving a healthy capsule has many advantages. The capsule itself is not a vascular structure and has virtually no nerves in it. Not violating the capsule makes it an almost bloodless, painless procedure. Additionally, if a healthy capsule is not removed, it can be used to internally lift the breast tissue to reduce the amount of droop that remains after implant removal. Financially, the surgical time required to remove the capsule can be significant, and the costs of this procedure similarly higher.
From my perspective, based on thousands of implant patients I have seen, it is difficult for me to believe that a healthy capsule could contribute to illness. However, if a patient is convinced that the capsule needs to be removed, I believe we should.
What is a breast implant capsule, and do I need to remove it as well?
There are two types of capsules, healthy and diseased. Healthy capsules are shiny, smooth, transparent, and fragile. They are the normal response to any foreign body in healthy soft tissue and entirely benign. Diseased capsules are calcified, thick, firm, and inflammatory. There are typically, but not always, physical signs of diseased capsules such as implant firmness. I recommend the removal of all diseased capsules and generally recommend against removing healthy capsules. A common reason a patient would ask for capsule removal is breast implant illness. Although evidence is scarce that healthy capsule removal is indicated, if a patient wants their capsules removed, it should be offered.
Removal of thickened capsule affected by capsular contracture
Diseased capsules, particularly when the implant is above the muscle, are easier to remove than healthy capsules. Healthy capsules are very thin and fragile and one with the surrounding tissue. There are situations where the capsule cannot be safely removed in its entirety. When the implant is under the muscle, and the capsule is healthy, there is often a portion of the capsule that sits directly on the ribs that can’t safely be separated from the ribs and underlying tissue. In that situation, removal risks outweigh potential benefits, and it is common to leave that portion behind. Plastic surgeons will often cauterize the adherent portion of the capsule, although the benefit of that procedure is unproven.
A healthy capsule surrounding a textured silicone implant. Healthy capsules are thin, fragile, and often difficult to separate from surrounding tissue without tearing.
A diseased capsule (left) thickened from capsular contracture. Explanation was en bloc with the removal of the capsule and implant as a single unit. On the back table, the capsule was opened to demonstrate the intact saline implant.
Do I need En bloc capsulectomy?
En bloc capsulectomy refers to the removal of the breast implant and capsule as a single unit. The theory is that if microscopic impurities are surrounding the implant, that removal of the capsule entirely while keeping all of the implant material inside is better for the patient. To date, this hasn’t been proven to be beneficial, but the appeal is understandable. In the event of capsular contracture or implant rupture, en bloc removal is often possible. With a healthy submuscular capsule, en bloc removal may not be possible despite adequate skill and understanding of the surgeon.
En bloc removal requires a much larger scar than would be necessary otherwise. The implant entirely contained within the capsule is less flexible than an implant by itself and requires a larger incision for the explanation.
how about a silicone implant rupture?
En bloc capsulectomy is always my preference, when possible, particularly in the face of silicone implant rupture. If ruptured, silicone material should be removed entirely, including any foreign body reactions to the material.
I have swelling around my implant, what do I need to do?
Swelling around an implant is also referred to as a seroma. A seroma can occur soon after surgery or much later down the road. Most breast implant seromas are benign, but this can be a sign of a bigger problem. Treatment will often require drainage, biopsy, or implant revision surgery. Contact your surgeon and discuss your options.
Is Fat transfer a good breast implant alternative?
Fat is a natural alternative to breast implants when a patient desires implant removal. Fat transfer breast augmentation can achieve an increase in size and restore some of the fullness lost from implant removal. In most cases, the shape is more natural, and the size smaller than can be achieved with an implant. For some patients, this is a negative and some a positive.
Will I need a breast lift after breast implant removal?
If you didn’t need a lift before implants and little time has passed since implantation, you are likely not to need a lift. If you were borderline for a lift or a lot of time has passed since breast augmentation, you may find a lift is necessary. If you are happy with the nipple position and skin envelope and the implants are conservatively sized, you will likely not need a lift. If you feel droopy or the implants are very large, you will likely want a breast lift.
Can I replace breast implants at a later date if I change my mind?
Yes. It is typically possible to re-create an implant pocket and replace new implants after breast implant removal should you change your mind.
Will insurance pay for breast implant removal?
Typically this is considered a portion of the original cosmetic procedure and would be denied by insurance. It never hurts to ask your insurance carrier, but we have seen few success stories.
How long does the procedure take?
Simple implant removal, without capsulectomy, typically takes around one hour. If capsulectomy is performed, the procedure takes closer to two hours. If fat transfer and a breast lift are performed, the procedure can take up to 4 hours.
What kind of anesthesia will I need for implant removal?
This will vary from surgeon to surgeon. In my practice, we use TIVA anesthesia for almost every procedure. Breast implant removal is no exception. Total IV Anesthesia (TIVA) is closer to general anesthesia than local anesthesia. It requires no intubation or paralysis, and patient recovery is much quicker.
How much does breast implant removal cost?
Breast implant removal costs depend on the location and experience of the surgeon. Most patients are disappointed to find that implant removal generally costs more than their original implant placement. It is simply a more complicated procedure.