10 Nov Breast Implant Removal: Facts and Considerations
Barnes & Edds Cosmetic Surgery
Breast Implant Removal: Facts and Considerations
Gerald G. Edds, MD, FACS, FAACS
Having started performing cosmetic breast surgery in 1986, I have thirty-five years experience in over five thousand patients. Over that period of time, I have seen many changes in the breast implants available for use, as well as the procedure itself. Over the last 3-4 years there has been a significant increase in patients requesting removal of previously placed implants.
This article is written to discuss both the reasons patients make the decision to remove their implants and the things these patients should consider in the decision process. A large number of patients have had breast implants in place for fifteen years or longer. Here are some of the many reasons patients may consider removing previously placed breast implants.
- Life Stage – While many women in their twenties and thirties enjoy having larger breasts prior to marriage, children and “middle-age”, many women are finding themselves now to be at a different stage of life. I often hear them say, “I just don’t need or want these large breasts anymore”, and ask for their removal.
- As the number of birthdays increase, many women find that their weight increases along with the size of their breasts. The full “C-cups” that looked really good in previous years when the waistline was smaller are now DD breasts requiring larger blouses and shirts that can lend to the appearance of obesity with a definite affect on body image and perceived attractiveness.
- Physical symptoms due to larger breasts: The pull of the weight of larger breasts can contribute to neck pain, shoulder pain and notching due to bra-straps holding larger breasts up, back pain, headaches, and occasionally an irritating rash under the breasts called intertrigo.
- Concerns over “Breast Implant Illness” or Breast Implant Related Anaplastic Large Cell Lymphoma (ALCL). Breast Implant Illness is a term some use to refer to a wide range of symptoms that rarely can develop after placement of breast implants. This has been reported with all types of implants and many symptoms have been attributed to breast implants including:
- Joint and muscle pain
- Chronic fatigue
- Memory and concentration problems (“Brain fog”)
- Sleep problems
- Rashes and skin problems
- Dry mouth and dry eyes
- Hair loss
- Gastrointestinal problems
Fortunately, a very small percentage of patients with breast implants attribute these symptoms to their implants. Those who do often request removal of their breast implants along with the surrounding capsule.
Breast Implant Related Anaplastic Large Cell Lymphoma (ALCL) has been diagnosed in about five hundred patients and sixteen deaths have been attributed to ALCL. ALCL is not a breast cancer, but an immune system cancer that can usually be cured with surgery, if detected early. Patients with implants with a textured surface are most at risk and smooth surface implants are not generally associated with ALCL. As there are minimal to no benefits of textured implants, I do not use them in my practice.
- Recurrent capsular contracture: Using breast implants currently available, capsular contracture occurs in a relatively small percentage of cases. Capsular contracture is the formation of a thickened fibrous layer of tissue surrounding the breast implants. This is usually placed into classes based on its severity and are referred to as “Bakers Classifications”, after the plastic surgeon who described them.
Bakers Class I – Normal soft breasts
Bakers Class II – The breast is firmer than normal but not extremely hard or painful
Bakers Class III – The breast is quite hard and can appear quite distorted
Bakers Class IV – Same as Class III but also painful
Generally Classes III and IV are treated surgically with removal of the capsule and possible change of the implant pocket location. Some patients develop a subsequent capsular contracture after surgical removal of the capsule. In these cases, removal of the implants is an option some patients choose.
- Other: While the above issues cover most reasons patients choose to remove their breast implants, there are others as well.
There are several options available to patients who choose to remove their implants but the ultimate decision may not be as easy as it seems. First, the patient must consider what to expect in regard to breast appearance after implant removal. I often use the analogy of the abdomen after pregnancy. Most women are pregnant for about forty weeks until delivery. During that time the abdomen gradually expands with the growing baby. After delivery, the abdominal tissue contracts to varying degrees, back to close to its pre-pregnancy state. Consider for a moment what would happen if a woman remained pregnant for ten, fifteen or more years before delivery. It is highly likely that the abdominal tissue will lose its elasticity and not contract back to an acceptable appearance. The same considerations apply to breasts with implants. The longer implants are in place, the less likely the breasts will return to their pre-implant state after implant removal. The result may not be acceptable to many patients.
Most commonly, my patients choose to combine a breast-lift with implant removal. This places the nipple in a normal position, tightens and lifts the breast tissue and yields more normal, aesthetically pleasing breasts. However, every patient has options available to them, and all of these options are performed in my practice.
- Implant removal with no further procedure: Some patients may be satisfied with simple removal of their implants and choose this route, knowing they can consider having a lift or other procedures at a later date if the end result is not acceptable to them.
- Implant removal with excision of the surrounding capsule: This is a more extensive procedure taking two to three times longer than simple removal. This approach is more often indicated when there has been recurrent capsular contracture or in those patients concerned about the “Breast Implant Illness” or Breast Implant Related Lymphoma.
- Implant removal with breast-lift: This procedure takes about three hours or more and can yield much more attractive breasts. This is one of the more common procedures performed in my practice.
- Implant removal with replacement of smaller implants combined with a breast-lift: Many patients choose this approach because the placement of smaller implants can result in adequate upper breast fullness, better shape and more youthful-appearing breasts.
- Removal of implants and excess breast tissue combined with a breast-lift: this approach is usually indicated in patients with an excessively large amount of breast tissue who desire to go a good bit smaller, and where implant removal alone will not reduce the breasts to a desired size. This procedure can take three to four hours.
Every patient is different, and many will require some variation of the procedures described above. If you are interested in discussing the removal of your breast implants, please call the office to schedule your complimentary consultation.
Gerald G. Edds, MD, FACS, FAACS
Barnes & Edds Cosmetic Surgery