Explantation (Breast Implant Removal)
The request for breast explantation has increased over the past few years for a variety of reasons. Explantation is simply the removal of the breast implants. There are additional items to consider when removing the breast implants.
Breast Implant Outside Shell
The silicone gel is surrounded by a thin medical grade plastic that does contain silicone. This is made by chemically cross-linking of the silicone gel. This creates the silicone elastomer, which is a solid form of silicone which is flexible and rubbery.
The body forms a thin layer of scar tissue to essentially wall off the breast implants from the body.
The breast capsule can become inflamed for a variety of reasons. The more common ones are:
- Bleeding around the breast implant at the time of surgery.
- Slight infection of the breast implant. This can occur at the time of surgery or later with a systemic infection or even after a dental procedure. This can leave a biofilm around the breast implant so that if the Capsular Contracture was removed, using the same implant would have a high rate of return of the Contracture.
- Silicone Gel Breast Implant leak or rupture. The silicone gel can cause a local inflammatory response leading to a Capsular Contracture. The silicone gel remains contained within the breast capsule. This keeps the silicone gel locally and prevents it from “traveling” away from the breast area. Rarely a tear in the capsule may allow a small amount of gel to escape the capsule and lead to a Silicone Granuloma. This may be felt from the outside as a tender lump.
Reasons for Breast Implant Explantation:
Patient desires removal of her breast implants for several different reasons.
She may be having some issues with the implants.
- The breast implants may have become noticeable, with visible rippling or folds.
- She may have some discomfort from the breast implants and feel that this may improve after removal.
- She may have issues with the weight of the breast implants and desires to have less weight for back, neck and shoulder comfort.
- There may be a breast implant leak which will require a surgical intervention of some sort.
- She may be having symptoms that she feels could be related to having her breast implants or Breast Implant Illness.
She just may be ready for a change. Some women just get to a point when they are just ready for a change. They’ve had the implants for some time, and most enjoyed having them in the past. They are just now ready to have them removed and get back to what they used to be.
Leaking Silicone Gel from Breast Implants
If a Silicone Gel Breast Implant has developed a breakdown of the outside shell covering the silicone gel, the silicone gel may leak and become in contact with the capsule. This could lead to inflammation of the breast capsule. An inflamed capsule can thicken and contract or squeeze around the implant, as in a capsular contracture. A capsular contracture can begin to make the breast implant feel hard or firm. This can cause the implant to rise up and have excess fullness of the upper breast. The symmetry of the breasts will be less. The breast can become tender as the scar tissue begins to pull on the nerves and distort the breast.
Considerations when contemplating an explantation of her breast implants.
A Deflated Breast Implant:
Saline breast implants will either be intact or deflated. If deflated, the saline will have been absorbed. Solutions could be simply removing both breast implants or replacing the implants with the same implants or a different style or size.
For Silicone Gel Breast Implants, the silicone gel will have migrated outside of the implant shell or covering. In addition to simply removing or exchanging the breast implants, this extruded silicone gel will need to be addressed. A capsulectomy will be necessary to remove as much of the silicone gel as possible. An attempt to remove the capsule intact to remove all the gel and the implant at the same time is usually the goal. Sometimes, despite the best effort, some gel does leak from the capsule during this surgery. Vigorous irrigation and use of gauze can be used to remove as much gel as possible.
En Bloc Capsule removal with Breast Implant Explantation
There is a lot of chatter on social media in groups discussing Breast Implant Illness that the Silicone Gel Breast Implants and the Capsule need to be removed “En Bloc”. This is described above, and is the removal of the entire intact Breast Capsule the surrounds the breast implant in one piece and without any spillage of its contents. This will require a larger incision, and sometimes is just not possible.
Need for drains:
When electively removing intact breast implants there will be a couple of choices. First is to leave the breast capsule or remove the breast capsule. Removing the breast capsule will allow the pocket to close. This will give better support to the remaining breast tissue in the future. When the breast capsule has been removed there is now a pocket with two raw surfaces that can heal closed. Any fluid which collects into this space will prevent this pocket from closing. The addition of a drain to remove this fluid, as well as external compression, to keep these raw surfaces together will increase the chance that this pocket does indeed close.
Need for a breast lift:
When removing the breast implants, the final appearance of the breasts will also need to be taken into consideration. There are several factors that will affect the final shape. The size of the breast implant that was removed, the tone and elasticity of the overlying skin and breast tissue, and the beginning shape and position of the breasts prior to the implant removal. Often a breast lift will be in order to return or keep the breasts in the proper position and re-tighten the skin after implant removal.