Implant Removal & Replacement

Breast augmentation is the most common of aesthetic/cosmetic surgical procedures carried out in the United Kingdom to date. The use of silicone implants is the most recognised, widely used and time tested method of breast enhancement. Implants are instrumental to increase the volume of the breasts, but they also bring certain issues related to the probability of wear and tear and in some cases, rupture. Due to the fact the silicone implant is identified as a ‘foreign body’, the surrounding breast tissue will form a ‘protective’ fibrous capsule around the silicone implant. Sometimes this capsule thickens and contracts. This effect is known as “capsular contracture”. If the capsular contracture is severe, it can change the shape of the breast and sometime causes pain or discomfort in one or both breasts. Although uncommon, a long- standing capsular contracture can cause calcification within the fibrous tissue.

Many times a woman may decide to remove the breast implants because of discomfort or dislike without issues related to rupture of the implant or capsular contracture. Therefore it is important to fully understand the aesthetic effects following the removal of implants.

When the breast implants are removed there will be a significant loss of breast volume and variable degree of sagging of the breast. If small sized implants are removed in a young woman within a short time following a breast enhancement, then sagging of the breast is not generally common.

However, the removal of large implants many years following breast enhancement is almost certain to leave the empty and saggy breasts. The sagginess is further compounded with poor skin quality, multiple pregnancies, breast feeding and relatively large breast tissue in women who continue to smoke.

Removal of breast implants is carried out either with short general anaesthetics or under local anaesthetic or sedation as a day case procedure. In younger age women, a Breast-Lift (Mastopexy) may not be required. However, it can be combined with removal of the implants in women who are left with sagging or droopy breasts.

Removal of implants and mastopexy is generally performed as a day case. However, it may require an overnight stay in certain circumstances.
Mastopexy (Breast-lift) involves trimming loose skin from the lower pole of the breast and the nipples are moved upwards to improve the shape as well as the consistency (Feel) to simulate youthful breasts. The breast -lift is associated with a variable degree of additional scarring around the nipple and a single scar runs between lower ends of the nipple extending into the fold of the breast.

Rupture of a breast implant is not uncommon and it may be interesting to know that there may not be any significant change in the shape of the breast if the implant has ruptured within the capsule. However, if the silicone gel has migrated outside of the capsule then it may cause an alteration in the shape as well as size of the affected breast. Sometimes the situation is also associated with capsular contracture with or without calcification and then there are inevitable indications for further surgery.

If the implant has ruptured, a decision to remove the ruptured implant with or without replacement will have to be carefully evaluated. If there is a significant degree of capsular contracture, particularly associated with calcification then it will require removal of the capsule (Capsulectomy).

There are many ways to deal with capsular contracture. It may require partial or complete removal or release of the capsule depending upon its thickness and location. Replacing the implants rather than using the existing implants are advisable in order to minimise the incidence of recurrence of a capsular contracture. The implants are re-positioned into a different plane, either in front or preferably behind the muscle with a view to minimise the recurrence capsular contracture as well as improve the long- term aesthetic outcome.

At this time it is important to have a clear understanding of the surgical options and realistic expectations of the agreed procedure. This may involve more than one consultation with your surgeon and investigations in the form of an ultrasound, mammogram or MRI to identify the intactness of the implant/s, severity of capsular contracture and presence of calcification.

The revision surgery may be more complex than the initial procedure of a breast augmentation.

This is a short overview regarding possible implications of breast implants and a summary of possible solutions. The understanding of the behaviour of silicone implants together with it’s interaction with breast tissue is an on-going evolving subject, with many international debates, discussions and even disputes regarding the overall management policy.