Removal of Breast Implants
A woman may want to have her breast implants removed for any number of reasons. There are many things to consider, and a couple of interesting options.
Reasons for removing breast implants
A women may tell us she is at a different point in her life than when she underwent her augmentation. She may have changed physically. A woman may have a new spouse/partner who feels differently about breast implants than her last spouse/partner. Others don’t want to worry about having to undergo more surgery in the future related to their breast implants.
Our health tends to decline as we age. Autoimmune disorders like rheumatoid arthritis are usually diagnosed in women in their 40’s. This is true whether a woman has breast implants or not. If a woman who has breast implants is diagnosed with an autoimmune disorder, she may wonder if her implants are contributing to it. A woman who is worried about this may decide to have her implants removed.
Breast implant illness may be a concern. This is not a defined medical problem but rather a group of symptoms that includes fatigue, chest pain, hair loss, headaches, chills, pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues, and hormonal issues. A ’cause and effect’ relationship has never been established between implants and these symptoms. However, some women with breast implants who have these symptoms note their symptoms improve when the implants are removed.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is another issue that women have questions about. Of an estimated 20,000,000 women worldwide who have had breast implants, about 600 (0.00003%) have developed this problem. It seems to be related to textured surface breast implants. About 80% of women who developed BIA-ALCL had Allergan textured surface implants. Because of this, in July 2019 the FDA asked Allergan to recall their textured surface implants. Women who have textured surface implants may decide to have them removed due to concerns about BIA-ALCL. While they may not have BIA-ALCL now, they want to minimize their long-term risks of developing it.
Just remove the implants, or also do capsulectomies?
A thin layer of scar tissue, called a capsule, forms internally around any breast implant. A capsulectomy is the surgical removal of this layer.
Removal of the implants alone, without removing the scar tissue capsules, is relatively easy to undergo. In most cases the scar tissue goes away over time. Typically no drains are required. Minimal pain, short operation, pretty uneventful recovery.
Women who are concerned about the capsules may want to have them removed. This is a little more involved than just removing the implants. During a routine capsulectomy, most commonly an incision is made in the capsule and the implant is removed. The capsule is removed once the implant has been taken out. Some women prefer to have the entire capsule and implant removed as one big piece. This is called an en bloc capsulectomy. Women who choose this may be concerned about ‘spillage’ of any contents contained within the scar tissue capsule. En bloc capsulectomies require longer incisions than regular capsulectomies, resulting in longer scars.
A capsulectomy is a bigger procedure than just removing the implants. It takes longer, adds some tissue trauma, more discomfort is involved, and it costs more. Many women select it; it’s really a matter of personal choice for most.
Do I also need a breast-lift?
Most women have their implants removed without undergoing a breast lift. However, when the breasts are bottom-heavy a breast lift may add more shape to the breasts. Sometimes a woman’s breast tissues may have drooped over the ends of the implants over time. When the nipples are low, a breast lift may reposition the nipples more centrally on the breasts as the implants are removed.
Fat grafting after removal of breast implants
Removing breast implants results in a loss of shape and fullness. Breast lifts may reposition the nipples and tighten the bottoms of the breasts. However, that does not result in fullness toward the tops of the breasts. For women who want more shape and fullness at the top of the breasts, fat grafting may be a good option. It is possible to do liposuction of the abdomen, flanks, and thighs, and place that fat in the breasts. While this does not replace all of the shape and fullness, it is an option worth considering.
surgery to remove breast implants
The surgical procedure takes place in an outpatient surgical facility. Dr. Kunkel does this with the patient under general anesthesia. Removing the implants alone may take about 30 minutes. Capsulectomies may add as much as an hour to the procedure. Breast lifts and fat grafting require additional time.
It is uncommon to have much pain after these procedures. There are some restrictions of activity for about 4 to 6 weeks. The shapes of the breasts change over 3 months or so.
Does insurance pay to remove breast implants?
In most cases insurance does not pay to remove breast implants. There are some exceptions. Some insurance plans cover removal of ruptured silicone gel implants. Removal of ruptured saline implants is almost never covered. Currently insurance companies do not cover removal of implants for women who have symptoms of breast implant illness. Insurance companies do tend to cover removal of implants for breast cancer reconstruction patients.