By Dr. Constance M Chen
According to the American Society of Plastic Surgeons, about 400,000 women in the United States had breast implant surgery in 2016. About three-quarters of breast implants were placed for cosmetic breast augmentation and the rest for reconstruction following mastectomy. Studies by implant manufacturers, however, have shown that within seven years about half of all implants need to be removed.
Breast implants do not last a lifetime. While some may last for decades, most are removed well before that. Implant manufacturers understand this, which is why implants have a 10-year warranty.
What kind of problems can implants cause? Implants are foreign bodies that provoke a natural response in which the body creates a barrier of scar tissue around the implant to wall it off and protect any foreign substance from penetrating other parts of the body. This barrier, or capsule, may be soft, flexible, and barely noticeable, or it may become hard and painful, like a shell that develops around the implant. This uncomfortable condition, known as capsular contracture, is among the most common reasons for implant removal.
Other reasons for implant removal include infection, caused by bacteria that proliferates because the implant has no blood supply to fight back; rupture, in which the saline solution or silicone gel that fill the implant leak into the surrounding tissues; and extrusion, in which the skin erodes and the implant pushes through the skin.
The FDA is also collecting data to determine whether or not there is a link between a rare cancer of the immune system called anaplastic large-cell lymphoma and breast implants, particularly implants that have a textured surface. Capsular contracture, infection, and rupture are the most common reasons for implant removal. They cause implants to look unnatural or asymmetrical, and they also cause implants to feel hard. As a result, over time women may want their implants removed because do not like how their implants look or feel.
It is important that each woman understands the various procedures for removing an implant. A complete capsulectomy is a time-consuming and meticulous procedure that involves removing not just the implant but the entire capsule that surrounds it. In some cases, this requires removing capsular material that may be attached to the chest wall or ribs, which can be adherent to the thin covering around the lungs. An en bloc capsulectomy removes the implant and the capsule in one piece. A capsulotomy involves making incisions in the capsule to break it up and soften it without removing it. To save time and reduce risk of lung injury, many surgeons remove only some of the capsule, leaving part of the material behind, or they remove only the implant while leaving the entire capsule behind.
Many women want to remove the entire capsule. The capsule may include fragments of silicone, bacteria, inflammatory cells or it may be hard and calcified. Women worry that the capsule can cause problems if left in the body. The capsule can form a biofilm where bacteria and other organisms are embedded.
When implants are removed, it may be necessary to perform additional procedures such as a breast lift, fat transfer, implant replacement, or even natural tissue free flaps to help recreate a breasts that looks attractive. If a patient has very little or no breast tissue and proportionally large implants, however, it may be difficult or even impossible to restore their breasts to a normal appearance without another implant or natural tissue breast restoration.
Before they decide to remove their implants, patients should understand that in some cases their breasts can look empty or even deformed without further procedures. Women with large breasts and small implants may look fine with implant removal alone. For women with small breasts and large implants, however, simple removal of the implants without adjusting for the loss of volume can end up looking like an empty collapsed pillowcase with the stuffing removed.
Whatever the reason for implant removal, the procedure should be performed properly. The important distinction in implant removal is whether some, all, or none of the capsule around the implant is removed. In an en bloc capsulectomy, the surgeon cuts carefully around the capsule, keeping it intact, and removes it with the implant. In my practice, I favor a complete and thorough en bloc capsulectomy. By removing the implant and the entire capsule, the healthy tissues are able to heal completely so that a woman's health and vitality can be restored.