What Does Breast Implant Removal Surgery Involve?
All breast implant removals are performed under general anesthesia on an outpatient basis. The precise technique will vary slightly based on factors such as whether the implants are silicone or saline, smooth or textured, the presence of thickened or calcified capsules, and whether the implants are ruptured or intact.
The quickest and easiest procedure is removal of smooth surface saline or intact silicone gel implants. A small incision is made underneath the breast, the implant is removed, the pocket is irrigated with antiseptic solutions, and then the incision is closed. Since there is very little trauma to the breast tissue, recovery is often quick with most patients feeling good and returning to normal activities the very next day.
The most complicated procedure is implant removal with capsulectomy, or mastopexy using GalaFlex mesh to help support the lift. This is a 3 to 3.5 hour procedure and requires drains, with patients typically back to work in two weeks while avoiding certain strenuous activities for four weeks.
There are multiple options between these extremes.
Do I Need a Capsulectomy?
There are certain situations in which a partial or complete capsulectomy should be performed. Capsulectomy is clearly indicated in cases of implant removal and a calcified capsule, textured implant, or significant capsular contracture. Capsulectomy almost always requires insertion of a drain for 5 to 7 days postoperatively.
The decision to perform capsulectomy should not be taken lightly. A simple implant removal becomes a 2.5 hour, far more complicated procedure with significant risk. Some women who have or believe they have breast implant illness have become convinced that they require capsulectomy from their research on the Internet; however controlled studies in the plastic surgery literature clearly indicate that capsulectomy does not alleviate breast implant illness symptoms more than implant removal alone.
Do I Need a Breast Lift?
As in primary mastopexy, the decision as to whether the patient needs a breast lift after breast implant removal varies. Some patients clearly do need a lift, some patients clearly do not need a lift, and some patients are borderline. There is some skin contraction after the weight of the implant is removed. Particularly in younger patients, the skin can contract quite a bit. The quality and age of the skin determines how much it will contract. If it is obvious that a patient is going to need a breast lift, it is done at the same time as the implant removal. Many patients are not ready to commit to an extra procedure and prefer to take a wait-and-see approach. While some of these patients will eventually get a lift, most actually will not. The decision varies from patient to patient and is a personal one.
