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 sickness’ and may also request removal of 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) 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 Claremont Private Hospital and the BMI Thornbury Hospital 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 capsulectomy procedure is performed. A capsulectomy procedure involves removing the breast implant capsule tissue and this is then sent for analysis. When performing a 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 (the capsule 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 the silicone as some of it will be inside tissues such as the chest muscle and lymph nodes.
A surgical drain is then inserted into the breast and the scar is then closed in three layers with absorbable stitches (there are 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 around the implant.
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 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.
Click here to read more about breast uplift (mastopexy)
Removal of breast 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).
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 fill. When the implant shell ruptured the lower grade silicone contents caused intense inflammation 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. Generally patients should have an ultrasound or MRI scan to determine whether the implants are intact or have ruptured. If the implants have ruptured then they should be removed.
Allergan breast implant removal
Allergan textured silicone breasts implants have been found to carry a higher risk of breast implant associated ALCL (BIA-ALCL) than implants from a number of 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 shape changes in the breast). For these reasons, Allergan 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. Mr Morritt frequently undertakes Allergan breast implant removal or replacement.
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.
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.
Infection – a rare complication
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.
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 e.g. pain in the breasts. Whilst in some cases these symptoms may improve, in others there may be no improvement in symptoms once the implants are removed.
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.
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 implants themselves can cause indentation of the ribcage which is noticeable after the 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.
Click to read more: NHS information on PIP breast implants