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 breasts/change in 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 where patients are advised or request to have their implants removed. Some patients may feel that they are suffering from ‘Breast implant sickness’ and may request removal of implants. With advancing medical knowledge conditions that are related to breast implants become identified such as BIA-ALCL (Breast implant related anaplastic large cell lymphoma) and although these are very rare, some patients request removal of breast implants for piece of mind.
Removal of breast implants – procedure
Mr Morritt frequently removes breast implants at the Claremont private hospital and BMI Thornbury hospitals in Sheffield.
Breast implant removal is a relatively simple procedure that is performed under general anaesthetic (patient is asleep). It is usually performed through the preexisting scar although if the implants were inserted through a periareolar incision (areolar scar), it is often better to create a new scar in the breast crease (inframammary scar). 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. For those who have significant breast implant capsule formation, a capusulectomy procedure is performed. A capsulectomy procedure involves removing the breast implant capsule tissue and this is then sent for analysis. When performing capsulectomy, Mr Morritt prefers to undertake ‘full capsulectomy’ to remove all (or as much capsule tissue as can be removed 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 (is not opened to remove implant) around the implant and this requires a slightly 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 free silicone.
A surgical drain is then inserted into the breast and the scar is then closed in three layers with absorbable stitches (no stitches to remove).
Patients generally stay in hospital overnight after the removal of breast implants and the surgical drains are removed before patients go home.
Breast implant removal and insertion of new implants
Mr Morritt frequently undertakes replacement of breast implants when implants (frequently ruptured) are removed. Patients generally need to increase the size of their breast implants by about one cup size to tighten the loose skin of the breast. 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.
Removal of breast 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 or the implants can be removed and an uplift performed at a later date.
Click here to read more about breast lift (mastopexy)
Removal of breast implants and breast enlargement with fat injections
Mr Morritt frequently undertakes breast enlargement with fat injections (lipofilling) when implants (frequently ruptured) 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).
Click here to read more about lipofilling (fat injections)
Mr Morritt has never inserted PIP breast implants but has experience in removing them. PIP implants were made in France and were approved medical devices however at some point the manufacturer changed the silicone content of the implant from ‘medical grade’ to an lower grade fill. When the implant shell ruptured, the lower grade silicone contents caused an intense inflammatory reaction resulting in large fluid collections, significant 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.
Breast implant removal – risks
Scar – the scar from the surgery is likely to be similar in appearance to the preexisting scar but slightly wider. Rarely, scars can become raised, red, thick, painful or stretched and this can be permanent.
Infection – a rare complication
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.
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 it is absorbed by the body spontaneously. Rarely, some patients produce large quantities of the fluid and this can cause swelling of the breasts. This may require treatment with aspiration (a needle is used to remove the fluid) or further surgery.
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. It usually improves with time but can be permanent.
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.
DVT/PE – deep vein thrombosis (DVT) and pulmonary embolism (PE) are very rare complications that following breast implant removal.
Failure of symptoms to improve following breast implant removal – some patients who decide to have their breast implants removed may have problems with pain in the breasts and other symptoms that do not improve following breast implant removal.
Unhappiness – some patients may be unhappy with their appearance following breast implant removal as their breasts are smaller or more droopy than they would like. This may affect their confidence.
Anaesthetic – this procedure involves general anaesthetic and so patients are at risk of the complications from general anaesthetic.