Who requests removal of breast implants?
Patients request removal of their breast implants for a variety of reasons. Most frequently, breast implants are removed following breast implant rupture or problems with significant capsular contracture (causes hardening of the breasts and/or change in breast shape). Some patients (who often have put on weight in later life) decide that they want to have smaller breasts and request breast implant removal. Rarely, there are breast implant related safety scares such as with PIP breast implants or Allergan breast implants where patients are advised or request to have their implants removed. Some patients may feel that they are suffering from ‘Breast implant illness (BII)’ and may also request removal of breast implants. With advancing medical knowledge conditions that are related to breast implants become identified such as BIA-ALCL (Breast implant associated anaplastic large cell lymphoma – a form of cancer) and although these conditions are very rare some patients request removal of breast implants for peace of mind.
Removal of breast implants – procedure
Mr Morritt frequently removes breast implants at the Spire Claremont Hospital and the Thornbury Hospital in Sheffield. Breast implant removal is performed under general anaesthetic (patient is asleep). It is usually performed through a scar in the crease under the breast. For patients with and existing scar in that location the scar is simply widened. For patient whose implants were inserted through a periareolar incision, a new scar is created under the breast (inframammary scar). The patients subcutaneous tissue (fat and breast tissue) is then surgically peeled off the implant capsule. For patients where the breast implant capsule tissue is thin, the breast implants are removed and a sample of the breast implant capsule is taken for analysis (capsule biopsy). For those who have significant breast implant capsule formation (this means a thick or calcified capsule), a capsulectomy procedure is performed. A capsulectomy procedure involves removing the breast implant capsule tissue and this is then sent for detailed analysis. When performing a capsulectomy, Mr Morritt prefers to undertake ‘full capsulectomy’ to remove all (or as much capsule tissue as can be removed safely without causing significant damage to the internal tissues). He is sometimes asked to perform ‘en-bloc capsulectomy’ where the capsule is removed as a whole piece of tissue (the capsule is not opened to remove implant) around the implant and this requires a larger incision than the more frequently performed capsulectomy procedures.
If the breast implants have ruptured, Mr Morritt will then clean out any visible silicone from inside the breast. It is not always possible to removal all the silicone as some of it will be inside tissues such as the chest muscle and lymph nodes and is not visible to the surgeon during surgery. In fact, it may only become apparent that there is residual silicone when patient’s start having mammograms for breast cancer screening.
The wound is then closed in three layers with internal absorbable stitches (there are no stitches to remove). Mr Morritt does not routinely insert drains for this breast implant removal procedures but they are sometimes used in rare cases.
Patients generally stay in hospital overnight after the removal of breast implants and if surgical drains have been used they are usually removed before patients go home.
Photograph showing breast implants which have become hard over time due to ‘calcification’ (this is the white material on the implants). This can cause discomfort and the breasts can be extremely hard, painful, and sometimes patients are aware of a cracking sensation within the breast on pressure. In this case the implants were removed with total or full capsulectomy which is preferred as it means that all of the calcification is removed from the patient’s body.
Breast implant removal under local anaesthetic
Mr Morritt also offers breast implant removal under local anaesthetic for suitable patients. It is not possible to remove the whole breast implant capsule when surgery is performed under local anaesthetic so this option is reserved for patients who just want their breast implants to be removed or who are not fit for general anaesthetic. Patients are counselled regarding an increased chance of developing a chronic seroma after surgery (this is because the implant capsule is not removed).
Breast implant removal and insertion of new implants
Mr Morritt frequently replaces breast implants when implants have ruptured or when patients wish to change the size or shape of their breasts. Patients generally need to increase the size of their breast implants by a minimum of 10% and up to one cup size to fill the loose breast skin. If patients do not wish to increase breast size, they generally will need a mastopexy (breast lift) procedure to tighten the skin of the breast around the implant.
To read more about breast augmentation – click here
To read more about breast uplift – click here
Removal of implants and breast uplift
Mr Morritt frequently undertakes breast uplift (mastopexy or breast lift) following the removal of breast implants. These operations can either be performed at the same time as the implants are removed or, the implants can be removed and the uplift performed at a later date. It is necessary to have a reasonable amount of breast tissue to obtain a good cosmetic result from uplift surgery so in cases where it is not clear whether or not there will be adequate tissue Mr Morritt often recommends taking the implants out first and then allowing the tissues to settle before deciding whether or not the uplift will be worthwhile.
Case1: Photos showing appearances before and after the removal of breast implants, breast uplift with auto augmentation technique (the lowest part of the breast was tucked internally to increase the breast projection. This lady had her breast implants inserted 15 years earlier (teardrop implants placed under the chest muscle). After having children her breast tissue increased in volume. With time the breast tissue drooped over the breast implant (waterfall deformity). The patient was unhappy with her breasts before surgery as the breasts were too large, heavy and droopy so requested implant removal and a breast uplift.
Click here to read more about breast uplift (mastopexy)
Case 2: Photos showing appearances before and 6 months after removal of breast implants. This lady had breast augmentation which were inserted through a cut under the areola 20 years previously. She suffered from recurrent capsular contracture (hardening of the implants) and ultimately decided to have the implants removed which was done through a cut in the breast crease. Surgery was performed under general anaesthesia, and included removal of the capsule (capsulectomy). Although relieved to no longer have breast implants she did find that it took time to come to terms with her new appearance. Thanks to my patient for giving permission to show these images.
Case 3. Photos showing appearances before and 6 weeks after removal of PIP breast implants. Having had her breast implants for a number of years this lady in her 50’s decided that she simply no longer wanted them. She did not have any details about her implants so was slightly shocked to find out that they were 335cc PIP breast implants! Thankfully the breast implants were still intact when they were removed so there should be no long term problems. Patients undergoing breast implant removal frequently worry about whether their breasts will end up more droopy but as you can see when the patient has a good amount of natural breast tissue and good skin there is frequently very little difference in appearance. Thanks to my patient for giving permission to show these images.
Case 4. Photos showing appearances before and 6 weeks after removal of breast implants, capsulectomies and breast lift (auto-augmentation technique). Having had breast augmentation 15 years earlier (300cc high profile implants), this lady became unhappy with the size of her breasts as with time they had grown and become too big and heavy. The breast tissue also drooped over the breast implants giving rise to a ‘waterfall’ deformity. Her implants were removed, nipples lifted and the lower part of the breast rotated internally to augment the shape and projection of her breasts. Thanks to my patient for giving permission to show these images.
Case 5. Photos showing appearances before and after removal of Allergan breast implants (340cc). In the years after her breast augmentation surgery, the patient developed capsular contracture which ultimately caused pain in her breast. She had also developed a ‘waterfall deformity’ where the natural breast tissue droops over the breast implant. The red line shows how much her breasts lifted after removal of the weight from her breast implants. The surgery was done through the preexisting scars in the breast crease. Thanks to my patient for giving permission to show these images.
Case 6. Photos showing the appearances before and after removal of 305cc Silimed breast implants (under the muscle) for breast implant illness (BII). With time the patient has developed some ‘waterfall deformity’ where the breast tissue droops over the implant. Removal of the breast implants and breast implant capsules (total capsulectomy) has improved the cosmetic appearance and also had the benefit of improving the patient’s symptoms from breast implant illness. Thank you to my patient for giving permission to show these images.
Removal of implants and breast enlargement with fat injections
Mr Morritt frequently undertakes breast enlargement with fat injections (lipofilling) when implants are removed. Lipofilling can be performed at the same time as breast implant removal or at a later date. Patients should be aware that the amount of boost that can be obtained in one stage with fat injections is relatively limited (less than one cup size). In order to obtain a significant boost in volume an average of 2-3 separate lipofilling procedures are necessary (usually staged a minimum of 2 months apart).
Click here to read more about lipofilling (fat injections)
PIP breast implant removal
Mr Morritt has never inserted PIP breast implants but frequently removes them. PIP implants were made in France and were approved medical devices however at some point the manufacturer changed the silicone fill of the implant from ‘medical grade’ to a lower grade industrial silicone fill. When the PIP implant shell ruptured the lower grade silicone contents caused intense inflammation resulting in large fluid collections, breast swelling and the enlargement of lymph nodes in some patients.
If you have PIP implants you should contact the clinic (or surgeon) where you had your breast implants inserted to find out details about your implants and to take advice as to how to proceed. The advice will vary depending on which production batch your implants are in. Generally patients should have an ultrasound or MRI scan to determine whether the implants are intact or have ruptured. If the PIP implants have ruptured then they should be removed as soon as possible.
When I remove PIP implants I always perform a capsule biopsy or partial capsulectomy when the capsule is thin and implants are intact. When the capsule is thick and/or the PIP breast implants have ruptured my preference is to perform a full capsulectomy where possible.
Allergan breast implant removal
Mr Morritt frequently undertakes Allergan breast implant removal or replacement. Allergan textured silicone breasts implants have been found to carry a 6x higher risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) than implants from other manufacturers. There are also anecdotal reports of a higher risk of double capsule formation with Allergan textured implants (this can cause teardrop shaped implants to rotate causing visible shape changes in the breast). For these reasons, Allergan textured breast implants have recently been taken off the market in a number of countries including Australia, Canada and France. If you have Allergan breast implants the current advice in the UK is that you do not need to have them removed unless you are having problems. Having said that many women have decided that they do not want the Allergan breast implants in their bodies and are either requesting that they are replaced with new implants from other manufacturers or that the Allergan breast implants are removed and not replaced.
Breast implant removal – risks
Scar – the scar from the surgery is likely to be similar in appearance to the preexisting scar but wider. Rarely, scars can become raised, red, thick, painful or stretched and this can be permanent. Sometimes the scar will not be perfectly located on in the crease.
Bleeding – this can happen following removal of breast implants and frequently occurs after over exertion. For this reason, it is important that patient’s allow enough time to recover before undertaking strenuous exercise. Mr Morritt recommends allowing at least 6 weeks before undertaking any strenuous exercise after breast implant removal.
Infection – a very rare complication. Would generally require antibiotic treatment. In exceptional cases the wound may need to be reopened to clean out the breast.
Seroma – this is an accumulation of tissue fluid (much like blister fluid) in the breast. It happens in most patients following the surgery and rarely causes a problem as the fluid is absorbed by the body spontaneously. Rarely, some patients produce large quantities of the fluid and this can cause swelling of the breasts (this is more common when patients undertake too much activity after surgery). This may require treatment with aspiration (a needle is used to remove the fluid) or further surgery in exceptional cases.
Asymmetry or breast size, shape and nipple position – after the removal of breast implants it is common for asymmetries of the breasts and nipples to be noticeable. Many of these differences are preexisting (were present before the implants were inserted) and are normal variations within the female population.
Altered sensation – this can affect the nipples or the skin of the breast or both. Sensation could be reduced (numbness) or increased (hypersensitivity). It usually improves with time but can be permanent. Chronic pain after breast implant removal is rare.
Residual silicone – it is not always possible to remove all of the silicone from a patient’s breasts when the implants themselves have ruptured. This is sometimes because it has integrated into the tissues themselves and can’t be seen during surgery. This residual silicone can sometimes cause ‘granulomas’ but these do not frequently cause problems. Sometime this silicone will be visible on mammograms.
Failure of symptoms to improve following breast implant removal – some patients decide to have their breast implants removed because they have symptoms of breast implant illness. In some cases these symptoms may improve when the breast implants are removed, in others there may be no improvement in symptoms.
Unhappiness – some patients may be unhappy with their appearance following breast implant removal as their breasts are smaller, uneven or more droopy than they would like. This may affect their confidence. They may decide after time to have more breast implants or an uplift procedure.
Poor cosmetic appearance – the appearance after breast implants are removed depends on multiple factors. Patients with more of the own breast tissue who do not have significant excess skin will generally get a better cosmetic outcome than those patients who do not have much breast tissue and have skin excess. With time, breast implants can compress the breast tissue meaning that there appears to be less tissue after breast implant removal than there was before the implants were inserted. Also, in some instances the breast implants themselves can cause indentation of the ribcage which is noticeable after the breast implants are removed (the lower part of the breast will therefore not project forwards as much as it once did). Some patients will have had a number of previous breast operations and the internal scarring created from these procedures can result in uneven appearances even when implant removal is combined with a breast uplift or skin tightening procedure.
Pneumothorax – a rare, potentially life threatening complication of breast implant removal. May require a ‘chest drain’ for treatment.
Anaesthetic complications – this procedure involves general anaesthetic and so patients are at risk of the complications from general anaesthetic. Death is exceptionally rare.
DVT/PE – deep vein thrombosis (DVT) and pulmonary embolism (PE) are very rare complications that following breast implant removal.
Frequently asked questions
Can I have my breast implants once they have been removed
I’m afraid that hospital policy means that it is not possible to have your implants after they have been removed. Mr Morritt can take photos of the implants (and capsules) for you should you desire (you will need to let him know). In situations where an implant has ruptured and surgery is being partially funded under the manufacturer’s breast implant warranty then the breast implant can be sent back to the manufacturer (the patient needs to tell Mr Morritt that this is required so that the necessary arrangements can be made).
Links
Click to read more: NHS information on PIP breast implants