Some patients considering breast implant revision decide instead to have their implants removed. The biggest advantage of this approach is that following removal or “explanation,” there is no need for future surgery. Commonly, women say they are, “over having implants.” Other patients note their native breast has enlarged and now their overall breast size is too large, especially for their age. A breast that looks good on a 35 year old can look excessive in a 50 year old. Some women are advised by their physicians to have their implants removed for heath concerns.
Appearance After Implant Removal
There are several factors that determine the appearance of a woman’s breast after implant removal.
The removal of smaller implants has less impact on the appearance of a woman’s breast than larger implants do. This is because there is less extra skin.
Implants that are under the pectoralis muscle cause less central atrophy or thinning of a woman’s breast. Following removal of sub-muscular implants, these patients will have more central breast fullness than a patient with sub-glandular implant. Women with sub-glandular implants can have central hollowing after removal.
This will vary with patient age and skin character. Some patients will have excess skin and their breast will appear flattened. Those with elasticity will contract significantly.
The Procedure of Implant Removal
Breast implant removal is almost always an outpatient procedure done under general anesthesia and takes 1 to 2 hours. A capsule or scar forms around any implant and some of this is routinely removed with the implant. Capsulectomy allows the breast tissues to more easily heal back to the chest. In some cases, a total capsulectomy is performed. Sometimes the term “en bloc” is used to describe a total capsulectomy. This is truly a misuse of the term because by definition, en bloc resection means removing a layer of normal tissue around the capsule. With submuscular implants, this would involve removing a patient’s ribs with the capsule, which is obviously unreasonable.
Total capsulectomy is easiest when the scar or capsule is thickest, and the entire scar with the implant can be removed in one piece. When the capsule is thin, complete excision results in unnecessary injury to normal muscle and other tissues. In these cases, the capsule is more reasonably removed by “sanding” the capsule off the chest. This permits complete removal with less injury.
Drains are commonly placed for a few days to prevent fluid accumulation. All of the sutures are dissolvable and showering is allowed the next day. Most patients can return to work in a few days and regular exercise can resume in about 2 weeks.
While removal alone suits most patients, some will obviously have excess skin and/or poor position of their nipple following implant removal. These patients may elect to have a breast lift or mastopexy at the time of their implant removal. This procedure can also be done at a later date if the patient wants to “wait and see” what they look like.
Some patients may be interested in fat grafting where their own fat is used to restore some shape and size to the breast after implant removal. Fat grafting is more successful when done at a later date.