Breast Implant Removal

Introduction

Removal of breast implants

Breast implant surgery is the most common type of cosmetic surgery carried out on women in the
UK. Breast implants can be used for two purposes:

• Cosmetic – to enhance the size and shape of the breast
• Reconstruction – to reconstruct the breast mound following a mastectomy (the surgical removal of
  the breast often used to treat breast cancer)

How long do breast implants last for?

Breast implants are a long-term commitment. After having breast implant surgery, about one in three women will require further surgery within 10 years of their initial operation. The implants may need to be replaced if problematic, for example: rupture, hardness, and change in shape.

The length of time that implants last is not defines and varies depending on an individual’s personal factors. Generally, they can remain in place for 10 years or more if you are not experiencing any problems.

Reasons for Implants removal

This may be simply patient choice, or following complications or for medical reasons. Some of the more common reasons women choose to have their breast implants removed include:

• Rupture – This is a breach in the breast implant, and is variable in extent. Rupture does not necessarily create a medical problem. In the majority of cases of silicone gel filled implants, the silicone gel will hold its shape within the capsule formed by the body and can be
  removed when the ruptured implant is removed. As the silicone is a cohesive gel it does not tend to ‘spill out’. Silicone can spread outside the capsule into the breast or lymph nodes in the armpit and result in enlarged lumps. These may give rise to local symptoms such as tenderness. In a small number of cases the gel has been found in other tissues, for example,
  the muscles under the breast, the armpit or (rarely) in the nerves into the arms. If any symptoms such as excessive pain, a burning sensation, lumps, or aching occur and cause concern, you should contact your surgeon or ask your GP to refer you to a specialist breast unit.
  There is no evidence to suggest that flights for travel cause strain or rupture to an implant.
• Capsular contracture – The body forms a wall of scar tissue (fibrous capsule) around any implanted foreign material and breast implants are no exception. As the scar tissue shrinks it
  becomes noticeable as an apparent hardening of the breast. This is a common complication and happens in approximately 1 to 20% of patients, although modern implants have a
  textured silicone shell with a lower incidence of capsular contracture. If capsular contracture occurs and causes symptoms such as tightness or pain, you may need further surgery. The implant may have to be removed, along with the capsule, and replaced with another implant if required.
• Rippling and creasing – The implant capsule may develop creases, kinking, vertical ripple folds and rippling in the breast. These are commonly seen in women with little or no breast tissue cover.
• Appearance, symmetry and asymmetry – Some women may feel their breast implants are the wrong shape or size. Over time they may have moved into the wrong position because of weight loss, weight gain or pregnancies. Shifting of the implant can also be caused by factors such as gravity, trauma, or capsular contracture.
• Pain – Some patients have described chronic pain, fatigue, lethargy and joint pain associated with their implants. Others experience constant pain around the nipple areola. An increase or decrease in the feeling in the nipple and/or breast has also been reported and can vary in
  degree and may be temporary or permanent.
• Lymphadenopathy– swollen or enlarged lymph nodes in the armpit can be associated with implants. It can be caused by transportation of silicone particles to the regional lymph nodes
  leading to siliconoma or a foreign body reaction may produce local swelling of the involved lymph nodes.
• BIA-ALCL – Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) which is a rare type of immune system cancer is linked to silicone breast implants. ALCL is a lymphoma and not cancer of the breast tissue. In women with breast implants, ALCL has been found adjacent to the implant itself and contained within the fibrous capsule. The most common sign of this condition is a collection of fluid around the implant which presents with swelling of the breast (late onset seroma). The usual treatment is removal of the implant and the capsule with any lumps or scar tissue around the implant (capsulectomy) and some cases will require chemotherapy. Breast implant associated Anaplastic Large Cell Lymphoma (BIA-ALCL) remains a rare condition, believed to be in the order of 1:24,000 (some figures show 1 in 10,000) in the UK and this is regularly updated.

Who is breast implant removal for?

If you have any of the features described above you can contact your GP or the clinic where you had your implants inserted. You may be referred to a specialist breast unit for further investigations in the form of Ultrasound scan or MRI scan (and/or mammogram to check the breast tissue).

Depending on the condition identified you may be offered removal of implants. The NHS does not provide replacement implants for cosmetic purposes.

Surgery

Breast implant removal surgery is performed under general anaesthesia and usually takes between one to three hours.

Depending on your recovery, you may be able to go home on the same day of the surgery.

Incisions are usually made in the same place as where the breast implant surgery was
performed.

If you are suffering from capsular contracture, the hardened capsules will be removed as well to accelerate the healing process as per your discussion with your consultant. If there is capsular formation this will be removed for pathological assessment to determine BIA-ALCL.

Recovery

Whilst recovery from breast implant surgery varies from person to person, it is usually smoother than the initial breast implant surgery.

Most women are able to return to work in five days and report experiencing minimal discomfort after the surgery. If you’ve had the breast implants removed due to capsular contracture, there may be more discomfort and the recovery time will be longer.

Breast implant removal scars typically heal very well and are often inconspicuous.

It’s important to note they heal in stages with the process taking three to four months. While the scars will fade, they will never disappear entirely.

You will need to avoid lifting anything over five kilograms or exercising excessively for the first six weeks after your surgery. While you will usually be able to resume normal activity after six weeks, your breasts will take several months to settle into their new position.

Please follow the instructions given to you regarding:

• Avoiding certain activities- Strenuous exercise should be avoided for 2-6 weeks.
• Wearing compression garments – Wear post-operative support bra for 2-6 weeks (24/7)
• Taking pain medication as prescribed.
• Drain insertion – This may be required and will be determined by your surgeon.

Complications

Every cosmetic surgery procedure can bring complications of anaesthesia, which your Anaesthetist will outline. It is important to note that risks and complications with regards to implant removal can include:

• Infection – This may require regular dressings and antibiotics.
• Bleeding – If excessive may result in a blood clot called haematoma and this may require return to operation theatre to resolve this.
• Fluid collection – This a common effect as there is a cavity where the implant has come out and this usually resolves on its own.
• BREAST DEFORMITY AND SAGGING – This is inevitable: it is important to understand and realise that removal of implants results in an empty cavity and the overlying tissue has been
  stretched such that removal of the implant will cause the lax tissue to sag. You may consider uplift surgery simultaneously and can discuss this with your surgeon. Uplift surgery will require further scars as the excess skin is removed. Some patients choose to have their implants removed and wait and see how the tissue reacts. It is possible to have uplift surgery later.
• Thick scarring – This depends on your body’s healing process. The resultant scar may be wide, red, dark, pale, thickened, raised. If the scar is unsightly you may use bio-oil or gels which may help
• Pain – Medication can be taken as needed.
• Breast sensation – Altered breast or nipple areola sensation may occur.
• General anaesthetic –
  • reactions to medication
  • Deep vein thrombosis (clots on the legs) or PE (lungs)
  • Covid 19
  • Nausea or vomiting

What results can you expect from breast implant removal surgery?

Once you have had breast implants removed, your breasts will initially look deflated. They might appear ‘caved in’ initially. Later they may appear swollen or enlarged due to fluid collection. The upper pole of the breasts may look quite flattened. Following your breast implant removal surgery, your breasts will not look the same as before you had the original surgery. This is because the breast implants stretch the tissue over time and cause changes in the breast shape.

Obviously, the choice is yours. You need to be comfortable with your decision.

Please consider carefully your decision to remove breast implants. Discuss any queries with your surgeon. We are happy to help you.