Breast explant surgery: What does it entail?

Explant surgery, also known as breast implant removal, involves the surgical removal of breast implants. This procedure can be performed for various reasons, from medical necessity to personal preference. While breast augmentation remains a popular cosmetic procedure, the reasons for seeking explant surgery are equally valid and important to understand. If you’re considering explant surgery, you likely have many questions – let’s address them.

Reasons for Explant Surgery

Patients opt for explant surgery for numerous reasons, including:

  • Health Concerns: Some patients experience complications such as capsular contracture, implant rupture, or breast implant illness (BII). These issues can cause discomfort, pain, and health problems, prompting the need for removal.
  • Aesthetic Preferences: Over time, personal preferences change. Some women decide they no longer desire the appearance of augmented breasts and opt to return to their natural breast size.
  • Aging Implants: Implants are not lifetime devices. The longer you have implants, the greater the chance of complications. As a result, some women choose to remove their implants after many years. Read more in our article, “How Long Do Implants Last?”
  • Breast Cancer Treatment: For patients who have undergone breast reconstruction after mastectomy, complications or changes in their cancer treatment may necessitate the removal of implants.
  • Autoimmune Responses: Some patients report symptoms like chronic fatigue, joint pain, and cognitive issues, which they attribute to their implants. Although scientific consensus on breast implant illness is still evolving, many patients find symptom relief after implant removal.
  • Implant Displacement and Distortion: Implants can move out of place over time, leading to unnatural appearances and discomfort, such as dynamic distortion when the implant moves with chest muscle flexing.
  • Infection and Rupture: Bacterial infections within the scar capsule or implant rupture and leakage can also necessitate removal.
  • Medical Necessity: Conditions like breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) or increased risks of autoimmune disorders and cancers can make explant surgery medically necessary.

The Explant Surgery Procedure

Explant surgery is typically performed under general anesthesia. The process involves several steps:

Preoperative Consultation
Your medical history will be reviewed, your goals discussed, and the condition of your implants and breast tissue evaluated. This is also the time to discuss additional procedures, such as a breast lift (mastopexy), which may be necessary to achieve your desired outcome.

Surgical Plan
Depending on your specific needs, your surgical plan may include a capsulectomy, where the scar tissue (capsule) surrounding the implant is removed. This is particularly important if the capsule is causing symptoms or concerns about implant-related health issues.

The incisions for explant surgery are often made along the same lines as those from the initial implant surgery, minimizing additional scarring. Common incision sites include under the breastfold (inframammary), around the areola (periareolar), or through the armpit (transaxillary).

The implants are carefully removed, and the surrounding capsule is excised if necessary. There are two primary methods for capsule removal:

Total Capsulectomy
The capsule is removed in pieces after the implant is taken out.

En Bloc Capsulectomy
The implant and capsule are removed together in one piece, which can be essential if there are concerns about silicone leakage, infection, or BIA-ALCL.

The incisions are closed with sutures, and the breasts are bandaged. Drainage tubes may be placed to help remove excess fluid and reduce swelling.

Recovery and Aftercare

Recovery from explant surgery varies among patients. After surgery, you will be monitored as you wake up from anesthesia. Most patients can go home the same day, although an overnight stay might sometimes be recommended. You may experience discomfort, swelling, and bruising, which can be managed with prescribed pain medication and proper care. It’s important to rest and avoid strenuous activities. Follow your plastic surgeon’s recommendations and wear a supportive bra to help aid in the healing process.

Full recovery can take several months. Most patients can return to normal activities within 4 to 6 weeks, but following your surgeon’s specific guidelines is crucial to ensure optimal healing.

Risks and Considerations

As with any surgical procedure, explant surgery carries potential risks. These may include:

  • Infection: As with any surgery, there is a risk of infection, which can usually be managed with antibiotics if caught early.
  • Scarring: While we strive to minimize scarring, it’s inevitable in any surgical procedure. The extent of scarring depends on factors such as your skin type, the surgical technique used, and your body’s healing response.
  • Changes in Breast Appearance: Some patients may notice changes in breast shape and volume after implant removal. Additional procedures like a breast lift can help address these changes.
  • Anesthesia Risks: General anesthesia, though generally safe, carries its own set of risks, including reactions to medication and respiratory issues.
  • Unsatisfactory Results: The outcome may not always meet your expectations. It’s important to have realistic expectations and communicate openly with your surgeon about your goals.
  • Seroma and Hematoma: Fluid accumulation (seroma) and blood pooling (hematoma) are complications that may occur after surgery.
  • Pneumothorax: In rare cases, the removal of the implant and capsule can cause a collapsed lung.

Benefits of Explant Surgery

Despite the potential risks, explant surgery offers several benefits:

Improved Health
For those experiencing complications or breast implant-associated illness, explant surgery can significantly relieve symptoms and improve overall health.

Natural Appearance
Many women enjoy returning to their natural breast size and shape. A breast lift can enhance the aesthetic outcome, resulting in a youthful contour.

Peace of Mind
Removing implants can alleviate concerns about potential long-term complications and reduce the need for future surgeries related to implant maintenance.

Enhanced Comfort
For some, implants can cause physical discomfort, especially during physical activities. Removing them can lead to increased comfort and a more active lifestyle.

Is Breast Implant Removal Right for You?

Deciding to undergo explant surgery is deeply personal and should be made with careful consideration. Here are some steps to help guide your decision:

  • Research: Educate yourself about the procedure, potential outcomes, and recovery process. Reliable sources such as the American Society of Plastic Surgeons (ASPS) and peer-reviewed medical journals provide valuable information.
  • Consultations: Schedule consultations with board-certified plastic surgeons. Discuss your concerns, goals, and any symptoms you may be experiencing. Multiple opinions can help you make a more informed decision.
  • Medical Workup: Before surgery, ensure you are in good overall health. This includes managing any underlying medical conditions and maintaining a healthy lifestyle.
  • Support System: A strong support system can significantly impact your recovery. Friends and family can provide emotional support and practical assistance during healing.

What to Expect During Surgery

Breast implant removal requires general anesthesia and can take one to three hours, depending on whether one or two implants are being removed and whether additional procedures like aesthetic flat closure or flap reconstruction are performed.

Before surgery, your surgeon may recommend imaging studies such as MRI or ultrasound to check for implant rupture or evidence of illnesses like BIA-ALCL. In addition to removing implants, explant surgery may involve procedures to remove the scar tissue around the implant, known as the capsule.

Types of Capsulectomy

Total Capsulectomy
Removes the breast implant first, then the capsule in pieces.

En Bloc Capsulectomy
Removes the implant and capsule together in one piece, preventing potential contamination if there is a rupture or infection.

Post-Surgery Recovery

Recovery from explant surgery is similar to recovery from mastectomy and can last from two to six weeks or longer. Follow your surgeon’s instructions for post-operative care, including keeping incisions clean, taking prescribed medications, and avoiding certain activities. Drains may be placed to remove excess fluid, and wearing a supportive bra may be recommended.

Insurance Coverage

The out-of-pocket cost of breast implant removal can be several thousand dollars, however, if you are having complications with your breast implants, your insurance company may cover the surgery. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires group health plans that pay for mastectomy also to cover reconstructive procedures, including breast implant removal if deemed medically necessary. Ensure your insurance plan understands the medical necessity of your surgery.

Finding the Right Surgeon

It’s crucial to find a plastic surgeon experienced in breast implant removal, particularly for those who’ve had reconstruction with implants. The surgeon should address all your concerns, explain the procedure, and discuss benefits, risks, and complications. Consider consulting multiple surgeons to find the best fit for your needs.

Considering an Explant Procedure? Book a Consult in Arizona Today

If you have any further questions or would like to schedule a consultation, please do not hesitate to contact our office. Your health and happiness are my top priorities, and we are here to support you every step of the way.

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