Breast implant removal has become a more popular procedure these days. There are a variety of reasons for implant removal including; problems with the original implants, the effects of aging, weight changes or pregnancy on the breast appearance, discomfort from the breast implants and even concerns about breast implant illness.  Dr. Lyle answers a few frequently asked questions about breast implant removal.

1. Do my implants have to be changed every 10 years?

No.  There is no reason to automatically consider removal of implants after 10 years.  Most of the newer generation of implants have data supporting that leakage rates at the 10 year mark are below 10% of women having breast augmentation so why would you overtreat 90% of women that do not have a leak?  I do think it is wise to consider imaging as you approach the 10 year mark to look for signs of potential rupture.  Although an MRI is the best test, it is expensive and not covered by insurance.  High-resolution ultrasound is a great alternative and a good screening tool.  Although breast implants are not designed to last a lifetime, newer technologies should allow for more longevity.  Silent rupture is a term used to describe women who have no symptoms or signs that have evidence of an implant rupture so even if you are breast implants feel normal you should consider periodic ultrasounds or MRI.

2.  Do I need a breast lift if I have my implants removed?

 Although no one “needs” a breast lift it may be desired.  Generally, if the nipple is sitting above the fold of the breast and the skin tone is reasonable- breast implant removal usually does not result in the need for a breast lift.  If the breast tissue is hanging off of the implant  and the nipple is at the lower portion of the breast, as the implant is removed it creates more breast sagging or ptosis, and a breast lift is generally recommended.

3. What is a capsule, and do I need it removed?

A breast capsule is a normal finding and represents your own body’s healing processes which creates a thin layer of scar tissue around the implant.  It is not part of the breast implant itself but how your body isolates a foreign body. The vast majority of breast implant cases, this normal structure does not create problems but in patients with a capsular contracture, it can cause firmness, change in shape, distortion and pain and in those instances the capsule should be removed.  A normal capsule however does not need to be removed and in fact sometimes plastic surgeons use it to hold sutures in place internally or to adjust the breast shape.  Unless a breast implant is ruptured or heavily covered with a thick capsule, there is no need to remove the entire capsule -in fact complete removal in some circumstances may result in more injury to the chest wall and surrounding structures like nerves and blood vessels.

4. Can I have my own fat to replace the breast implants?

Fat transfer after breast implant removal can be a very useful procedure overcoming  some of the volume loss from the implant.  However fat transfer alone usually will never make up the entire volume of the implant removed.  For one thing, the fat is not placed where the implant used to be- i.e in the pocket.  To do so would result in a large deposit of fat with no blood supply causing it to turn hard and die in a situation called fat necrosis.  

When fat is transferred after implant removal, it is specially processed and delivered through small multiple injections throughout the subcutaneous tissue and therefore is never the same as a breast implant.  Limitations of transfer exist -too much fat can overburden the tissue and can lead to resorption of fat, oil cysts, calcifications and lumps which can cause problems with interpretation future mammograms.

5.  Is the procedure complicated?

Breast implant removal can be a complicated procedure especially when there is the need for extensive capsulectomy as this can cause injury to the chest wall.  Removing a breast implant and doing a mastopexy can  also be quite challenging.  Because some of the blood supply to the nipple has been compromised by breast implantation, risk of nipple loss or  necrosis is higher with implant removal  and mastopexy. This is especially true if someone had a prior mastopexy. This is why it is  critical to choose  a  Board certified plastic surgeon with plenty of experience in breast implant removal.