Frequently Asked Questions About Breast Implant Removal
- A capsulectomy is removal of all the scar tissue from around the implant.
- An En bloc capsulectomy is used to describe removal of the implant with the intact capsule still around it.
- A capsulotomy is partial removal of the capsule and opening of the capsule.
A capsule is scar tissue that has formed around an implant. This is your body’s normal reaction to having something foreign in it. Every patient with an implant has some capsule, which is quite normal and expected. Your body will form a capsule around any implanted device and does so around breast implants, artificial joints, and even pacemakers.
A capsular contracture is when the scar tissue around the implant becomes tight and deforming to the implant.
The majority of patients who have had breast implants over 5 years will have some amount of loose skin. How much that will bother the patient is very different from patient to patient. Dr. Rai can discuss if he would recommend a breast lift for you. It can be done at the same time safely and therefore would limit the need for a second operation.
Fat grafting is a good tool to fill out certain areas of the breasts. In general, fat grafting will never replace the volume of the implant. It is good for filling certain areas (the upper part of the breast) and trying to correct some depressions. Dr. Rai ideally prefers to stage this operation 3 months after your initial explant but it can be done at the same time if the patient desires.
This depends on many factors such as the patient’s age, the size of the implant, how long ago the implants were placed, how much loose skin is present, and how much natural breast tissue is left. The biggest factor seems to be the amount of natural breast tissue and how long the implants have been in place. Certainly, where patients will notice the difference the most is in the upper pole of the breasts. This is where the implant is providing fullness and this is the most noticeable area where you will lose volume after explanation.
Absolutely! A lot of patients have secondary cosmetic procedures done at the same time as breast implant removal. This includes but is not limited to liposuction, tummy tucks, and facial procedures. All can be done at the same surgical setting and generally don’t add to the recovery time.
Most insurance companies have exclusions for any procedure involving implants that were placed for cosmetic reasons. Implant removal can be covered if it is after reconstruction for breast cancer, a significant grade IV capsular contracture (deforming breast), or rarely a proven ruptured silicone implant. Dr. Rai does not file with insurance but can provide his patients with all their notes and codes they would need if they want to try to file themselves.
Fluffing is a word used by a lot of women to describe softening and smoothing of the breasts after surgery. This is a very normal reaction after every surgery. Immediately after surgery the breast tissue is tight and firm due to edema or fluid in the soft tissue. After several weeks the fluid leaves the tissue and the breasts begin to soften and smooth out. The breasts will change significantly for the first several months after surgery. Cupping are devices some ladies choose to use to try to get the breasts to fill out a little more.
Breast Implant Illness is a term used to describe breast implant patients who have been suffering from various symptoms including but not limited to joint pain, muscle pain, fatigue, brain fog, thinning of hair, migraines, nerve pain, and memory loss. Often these patients have seen many different doctors and had many different tests without being able to identify any specific cause of the symptoms. These patients are concerned the implants could be contributing to or causing these issues and often this is the reason for wanting to remove the implants and capsules.
Leaks in saline implants are easily detected because the body re-absorbs the saline fluid and the breast is noticeably smaller in size. With silicone implants it is much harder to tell if there is a rupture. The gold standard for detecting a ruptured silicone implant is an MRI. Even on physical exam it is difficult to tell as the silicone usually is still contained within the scar capsule around it.
Questions about the Surgery:
The procedure involves an incision on the bottom of the breast crease (generally the same incision used to put the implants in). The implant is then left covered in its capsule and the whole capsule is dissected free from the muscle and ribs. The goal of the surgery is to remove the entire capsule with the implant still inside it (“en bloc”).
For patient’s that had their implants placed through an incision on the bottom of their breast crease the same incision can be used for removal of the implants. But to remove the capsule as well in one piece will require the scar to be longer than it typically is for a breast augmentation. The scar will need to be roughly 8cm in length. For patient’s that had their implants placed through an incision around their nipple or in the arm pit a new scar will have to be made in the breast crease to allow for complete removal of the implants and the capsule.
The surgery is performed in our AAAASF surgical facility in the office. Our office operating room meets the same stringent accreditation criteria as a hospital or surgical center operating room. The only difference is it is much more convenient for our patients and we can often schedule surgery Monday through Friday.
Yes, the surgery is performed under a general anesthetic. This means you will be asleep during the operation.
Because the capsule needs to be removed from the ribs and muscle it is generally more painful than a breast augmentation. Most patients state there is two days of a deep muscle burning that typically starts to improve after the second day. Dr. Rai does use a nerve block at the end of the surgery that will help with the pain.
After the procedure you will be wrapped in an ACE wrap for compression. You can leave this in place for two days then remove all the dressings and shower normally with any soap you like.
You will get a dose of IV antibiotics at the time of the operation. Most patients will not require antibiotics after the surgery. The exceptions would be patients with diabetes, immunocompromised, active smokers, or patients with a history of breast reconstruction.
Yes you can get your implants back at the end of the operation.
Dr. Rai will take photos of the implants and the capsules at the time of surgery which all patients are welcome to.
The pectoralis major muscle is the muscle that is cut during most breast augmentations. A lot of surgeons don’t repair the muscle after the implant is placed. Because the muscle is no longer anchored to the breast fold overtime it tends to shorten and window shade up on the chest. Because of this even though your implants were placed under the muscle, at the time of explant only the top ½ or 1/3 of the implant is still covered by muscle. If the muscle is still low on the chest then Dr. Rai will repair it back to the original fold where it was. If it has shortened and risen too high on the chest then Dr. Rai will tack it down to the chest.
The main limitation is no heavy lifting. Dr. Rai will ask you to not pick up anything too heavy for several weeks. This will decrease your risk of injuring yourself or causing any healing issues with the incisions. You will be in an ACE wrap for 2 days and then can shower normally and go into a bra. You can expect some bruising to the breasts and some soreness than can last several weeks. You should be able to drive after 1 week. You can resume upper body activities at the gym usually around 4 weeks.
Dr. Rai does leave one drain in each breast after the operation. After the implant is removed and especially during a capsulectomy there are a lot of raw, oozing tissue. This can lead to issues like a seroma or a hematoma (blood caught under the skin). Dr. Rai leaves a drain to remove all of this fluid from the breast. Typically, the drains will stay in place 3-5 days. Dr. Rai will show you how to care and record the drain output. When they are ready to be removed you will see Dr. Rai in clinic for removal. This will not take more than 5 minutes.
Dr. Rai typically sees patients at 3-5 days for the drain removal, a week later for suture removal, and then 2 weeks after that. He will make a plan for each patient based on the distance they need to travel and their comfort level taking care of the incisions.
Dr. Rai uses dissolvable sutures to your body will break down overtime. He does not use permanent sutures.
There are several things Dr. Rai will discuss with you including moisturizer and massage to help minimize the scar.
Questions about Testing and Imaging:
The capsule will be sent to pathology to be tested for any type of breast cancer cells or something else unusual. CD30 staining can be done looking for ALCL.
Breast implant associated anaplastic large-cell lymphoma (ALCL) is a rare type of lymphoma that has been associated with breast implants. It typically presents with a sudden and large amount of fluid around a breast implant (a late seroma). If you have noticed one breast is much larger than the other suddenly then it is a good idea to see a plastic surgeon. If during the time of the operation fluid is noted around your breast implant, then Dr. Rai will collect it and test for ALCL.
These studies are optional if the patient wishes to have the testing run. However, the majority of time the implants, saline, and capsule look very normal and there is a low likelihood of finding any bacterial growth. It is easier to draw these studies in patients that have saline implants because the saline can be withdrawn from the implants and sent for testing.
For anyone over the age of 40 Dr. Rai does recommend a mammogram or ultrasound prior to surgery looking for any masses or tumors. It is not mandatory but highly suggested.