Breast implant removal involves removing the breast implant itself, as well as the capsule or scar tissue surrounding the breast implant. This is the same for both silicone and normal saline breast implants. San Francisco plastic surgeon Miguel Delgado, MD is a breast implant-breast augmentation revision specialist. He has performed thousands of breast surgeries and has a special interest and expertise in breast implant revision surgery. Dr. Delgado also has a dedicated breast revision website: breastrevisionsanfrancisco.com.
What Are the Most Common Reasons for Implant Removal?
- Capsular Contracture – The breast implant is recognized by the body as foreign. Consequently, the body immediately walls-off the implant with a capsule, which is composed of scar tissue. This scar tissue formation can be paper thin and pliable or very thick and constricting. The science shows that a “bio-film” surrounding the breast implant causes the thick capsule formation. The bio-film is seeded with bacteria, causing a low-grade inflammation that results in increased scar formation. This low-grade inflammation is local to the breast and does not affect the whole body, so no illness results.
- Breast Implant Rupture – As a general statement, the rupture rate is 1% per year beginning after five years.
- Breast Implant Removal and Replacement – A patient may want to increase or decrease her breast size, which is done with the removal of old and placement of new breast implants.
- Breast Changes After Pregnancy – A breast lift with breast implant exchange is common.
- Unwanted Implants – As a patient ages, she may become restricted by the implants with activity, and the body fat content may increase in the breasts to the point that the breasts become too large.
- Breast Implant Illness (BII) – Some women feel the implants are causing unwanted changes to the bodies.
What Are BIA-ALCL & BII?
BIA-ALCL is the acronym for Breast Implant-Associated Anaplastic Large Cell Lymphoma, and BII is the acronym for Breast Implant Illness. Please refer to the respective sections below for information about each.
BIA-ALCL is an extremely rare, highly treatable type of lymphoma which develops arounds the capsule of the breast implant. This is mostly associated with textured-surfaced breast implants. Despite its association with the breasts, BIA-ALCL is not breast cancer—but rather a cancer of the immune system that is usually curable.
There are women with breast implants—either silicone or normal saline—who self-identify a variety of symptoms, believing them to be caused by their implants. They refer to these symptoms as Breast Implant Illness (BII). The symptoms vary, including brain fog, tiredness, fatigue, headaches, chills, hair loss, chronic pain, body odor, anxiety, depression, sleep disturbance, neurologic issues, and hormonal issues.
Are there any tests to diagnose the connection between breast implants and BII?
Unfortunately, there is no diagnostic testing for BII.
Is there any scientific data to link breast implants to BII symptoms?
This issue has been investigated by the Institute of Medicine Committee on the safety of silicone breast implants, which dates back to 1999. The thorough review of the available studies concluded there was no clear link between silicone implants and systemic sickness. There have also been studies looking at the link to autoimmune disease, and again, no link has been determined. So, the symptoms of patients with silicone implants have displayed no laboratory abnormalities to define a distinct sickness.
Will breast implant removal cure or improve the symptoms for women who have been diagnosed with medical illnesses like an autoimmune disorder?
A variety of studies show different degrees of temporary and permanent improvement of symptoms. There are no studies that show which symptoms may or may not be improved with implant removal with or without capsulectomy. The lack of evidence does not mean that patients with breast implant symptoms are not real. Some patients have significant concern about a potential link between symptoms and breast implants. Further research is needed.
What should a plastic surgeon do when a patient complains of Breast Implant Illness symptoms?
These patients need to be taken seriously. The symptoms that they experience are real, and whether the symptoms are related to the breast implants is not relevant since it cannot be proved or disproved.
There are a variety of options that a patient can consider. One option is a thorough medical work-up, possibly including a consultation with a Rheumatologist. Another option is to wait and observe the symptoms over time. The surgical options would include: remove the breast implant without taking out the capsule, remove the implant with a capsulectomy, or removal with en bloc capsulectomy.
Patients with BII have symptoms that cannot be defined into any disease entity. These patients require a full medical evaluation because they have real symptoms. The available options need to be discussed to determine the best alternative until more research is available to answer these issues.
What is the chance of developing Breast Implant Illness?
There are no known risks because there is no obvious link between women’s symptoms and implants, and there is no viable testing. Many of the symptoms described by patients with breast implants are seen in the general population with implants or without. This is not to say that there is not a connection, but one has not been established at this time. However, patients should be informed about BIA-ALCL and the symptoms associated. As described above, this is a lymphoma and not a cancer of the breast tissue.
How Is the En Bloc Breast Implant Removal Procedure Performed?
The goal of an en bloc resection is to remove the breast implant and the scar capsule in one piece. To accomplish this, a larger incision is required, so treatment cannot be performed through armpit, areola, or belly button incision methods.
How Is the En Bloc Breast Implant Removal Procedure Performed?
The goal of an en bloc resection is to remove the breast implant and the scar capsule in one piece. To accomplish this, a larger incision is required, so treatment cannot be performed through armpit, areola, or belly button incision methods. By taking the implant and capsule out as one contained piece, there is no spillage of the content inside of the capsule. This must be performed very carefully because the scar capsule is in contact with muscles, ribs, and the space between the ribs that is in direct contact with the lungs. Once the en bloc removal is complete, a drain is placed and the incision is closed.
What Is Recovery from Breast Implant Removal Like?
Breast implant removal—such as an en bloc—does require some recovery. The body is rid of the entire scar capsule, so there is a large amount of raw tissue that needs to heal. The pain and discomfort will depend on the damage to the remaining tissue, so it is different for everyone. The drain will be removed when the fluid output reduces so it will not build up inside. This usually takes about three to seven days. Depending on your type of work, you may return in 10–14 days, and you will likely be able to resume exercise after approximately four weeks or so.
How Will My Skin Look After Breast Implant Removal with En Bloc?
This is the most often asked question for a woman who wants to remove her breast implants altogether. The answer depends on the following:
- Age of the patient
- Breast size
- How long the breast implants have been in place
- Whether or not the patient has had kids since the implants
- Whether there has been any significant weight gain or loss
- Location of the implants—over or under the pectoralis muscle
It is difficult to predict how the skin will respond after the breast implants are removed. The older you are—and the more stretch marks and sun damage there are—the less skin contraction properties you will have.
The larger your breasts and breast implants, the more effect gravity will have on the skin.
The longer the implants are in place, the more your skin is stretched. This is called “tissue expansion.” The skin will thin as it stretches.
If you have had children, the breastfeeding cycles stretch the skin on a permanent basis. The more children that you have, the more the skin will stretch.
Weight loss and gain can stretch the skin as well, and also reduce the contractility qualities of the skin.
If the breast implants are on top of the muscle, this will have much more effect on the stretching of your skin. The submuscular placement of the implants holds the implants’ position with reduced effect on the skin.
How Much Does Breast Implant Removal Cost?
The exact cost of breast implant removal depends on what exactly is being done. For strictly en bloc removal without replacing the implant or doing a breast lift, the surgery fee at our San Francisco and Marin County practice is about $5,000–$6,000. The surgery center and the anesthesiologist combined is generally another $3,500–$5,000.
Contact Dr. Delgado
For more information about breast implant removal, or if you are interested in scheduling a consultation with Dr. Delgado to discuss your options, please contact our practice today.