ABOUT IMPLANT REMOVAL
The following information regarding breast implant removal/exchange which is important to review, understand and discuss with family and/or friends before proceeding with surgery.
GOALS OF BREAST REMOVAL/EXCHANGE: The purpose of implant removal, with or without implant exchange, is to remove the existing implants along with some or the entire surrounding fibrous (scar) capsule. There may be many reasons for implant removal including the patient’s desire for implant removal, physical or x-ray evidence of loss of implant integrity (rupture/leakage), or scar formation leading to pain and/or deformity. The choice to replace old implants with new breast implants is a personal patient choice. It is the current position of the American Society of Plastic and Reconstructive Surgeons that the link between silicone gel implants and autoimmune disease is medically unproven and that implant removal may not improve symptoms in patients with a diagnosis of autoimmune disease. However, in such patients who desire implant removal regardless of the uncertainty of improvement following implant removal, the surgery may be performed. In general, implant removal is indicated to improve the physical appearance of the breast by removing deformed capsules and malpositioned implants. Often when pain is associated with the firm breast capsules, this will be improved as well. In any given patient, these goals may be only partially met.
LIMITATIONS OF THE PROCEDURE: Implants cannot be removed without a surgical procedure which carries all the risks of any operation, notably bleeding, scar formation, further deformity of the breast, infection, and other possible complications. To restore an aesthetically acceptable appearance to the breast, additional incisions may be required which will lead to new scars on the breast. If implants are removed without implant replacement, there may be significant sagging, wrinkling, or retraction of the breast tissue leading to a displeasing physical appearance. If no implants are replaced, and the breast skin is tightened to restore normal contours, the breast may be considerably smaller in volume. Internal healing from the original surgery and from the surgery to remove the breast implants will result in permanent internal scarring which may be felt, seen as visible irregularities of the breast, or observed on a mammogram. In addition, if new implants are placed, the implants may be more palpable than the previous implants or more visible due to the removal of existing scar tissue in the breast. In most women, implants cannot be removed without some decrease in breast volume with the removal of scar tissue and adherent breast tissue. Implant removal may be followed by psychological disturbances such as depression from an alteration in body image. The disturbances are generally temporary (may require psychiatric treatment), but may be permanent. Removal of the implants may not relieve any of the physical complaints or psychological concerns that the patient relates to the implants. If implants are replaced with different implants, the risk and complications related to the new implants are the same as those at the time of one’s original surgery.
ALTERATIONS TO THE PROCEDURE: In the absence of documented implant rupture (mammogram, ultrasound, MRI, or CAT scan) the implants can be left in place with regular follow-up at least every two years. Other options include (1) implant removal only, (2) removal of the implant and the surrounding scar tissue along with any other abnormal tissue in the area, and (3) implant removal with or without capsule removal and replacement with new implants. At the present time, saline implants are the only implants available for breast augmentation.
CHARACTERISTICS OF SALINE IMPLANTS: Saline implants are constructed of an outer silastic shell and filled with sterile saline at the time of surgery through a fill port. The implants have a risk of leakage of 0.5% to 1%. Leakage of the implant represents no risk to the patient, but the breast will change size as the implant deflates. This will require implant replacement and an additional operation. Because the density of saline within the implant is different from that of normal breast tissue or silicone gel, the breast may feel different or may show areas of surface rippling.
SURGICAL TECHNIQUE/ANESTHESIA/ RECOVERY: In general, implants are removed through previous surgical incisions unless the previous incisions were placed in areas that, would make implant removal difficult (armpit, nipple incisions). In some patients, additional incisions are needed to perform the mastopexy or breast lift. We attempt to remove the implant intact if it is not already ruptured along with as much of the surrounding capsules as possible. Often a portion of the scar capsule is left behind to avoid excessive bleeding or removal of too much of the patient’s remaining breast tissue. If saline implant replacement has been chosen by the patient, the saline implant may be placed in the previous implant pocket or a new pocket may be made in a more desirable location. Drains are frequently used and brought out through the corners of the incision. These are usually left in place until the drainage is less than one ounce per day. Supportive dressing such as ace bandages or bras may be used following surgery, although in some cases nothing other than a light tape dressing is utilized. The procedure is performed under general anesthesia in the operating room as an outpatient. Upper body physical activity is limited for 2-5 weeks following surgery. No driving is permitted for the first week following surgery. Most patients can return to work within two weeks and return to full physical activity within 4-6 weeks. Blood transfusions are usually not required. However, if you desire, your own blood or donor-designated blood can be collected prior to surgery.
RISKS/COMPLICATIONS: As with all surgery, some degree of pain, discoloration, and swelling will be present. Specific to this procedure, there may be bleeding within the old implant space or around the new implant, which if severe, could necessitate a return to the operating room. Infections can occur which could necessitate the removal of the new implant for several months until the infection is cleared. There may be numbness of the breast skin or nipple following surgery. This may be temporary or, in some patients permanent. It is possible that implants that have not ruptured can be ruptured during their removal, potentially leaving silicone within the breast tissue or surrounding tissue. This may be noted on mammograms. If implants are replaced, all of the attendant problems associated with implant surgery may occur, including asymmetry, nipple numbness, bleeding, infection, spontaneous deflation of the implants, scar contractor with hardening of the breast, breast deformity, wrinkling or irregularity of the surface of the skin, changes in skin color, fluid collection or lymph node enlargement. Additional operations may be required to change the implant size, shape, or position. Even though the risks and complications cited above occur infrequently, they are; the ones that are peculiar to the operation and/or of greatest concern. Any and all of the risks can result in additional surgery, time off work, hospitalization, and expense to you.
The practice of medicine and surgery is not an exact science. Although good results are expected, there can be NO guarantee nor warranty expressed or implied by anyone as to the results that may be obtained. Many factors beyond the control of the surgeon affect short and long-term outcomes, scarring, and other health factors. On occasion, secondary surgeries may be indicated or desired to obtain the optimal result. If such procedures are performed, there may be additional charges incurred by you.
Comments: If you are a smoker, you must be off cigarettes for three weeks before surgery and for three weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss, and skin loss in smokers.
If there is any item that you do not understand, please call the office. An explanation or additional information will be provided.