Breast Implant Removal in New York City

What is Capsular Contracture?

All breast implants heal with scar tissue encasing them, and the scar tissue wrapping around the breast implant is called the breast implant capsule. The capsule forms because the human body is trying to create a barrier to protect itself from the foreign body (ie. the breast implant). Scar tissue that forms after the placement of an implant can be soft or it can harden, causing significant discomfort. Over time, the breast implant capsule can shrink and contract, causing painful capsular contracture. In addition, the breast implant capsule is not impermeable, and heavy metals, silicone, and other substances can leak through from the breast implant shell. Capsular contracture is one of the most common reasons to have the implants and scar tissue removed.

What is Breast Implant Rupture?

All breast implants are made with a silicone shell, which can wear out over time. The silicone breast implant shell is either filled with saline – the same salt water that is used in intravenous fluids – or silicone. Both saline and silicone implants can rupture. When a saline implant ruptures, it is usually obvious as the implant simply deflates, and the breast appears smaller and deflated. In addition, the saline that spills into the tissues is considered safe, as saline is the same fluid that is used intravenously to rehydrate the body or in contact lens solution. When a silicone implant ruptures, however, it is usually silent and the patient may not realize it. Silicone is supposed to be inert, but the ruptured silicone gel can leak out and cause irritation to the surrounding breast tissue. Instead of deflating the breast, as a silicone leak progresses a ruptured silicone implant can actually lead to the breast growing larger due to inflammation of the surrounding breast tissues.

Both ruptured saline and silicone breast implants should be removed and/or replaced. In the operating room, removing a ruptured saline implant is relatively straightforward. Removing a ruptured silicone implant, however, is more challenging because the thick sticky gel can be difficult or even impossible to remove entirely. If the silicone gel spills into the tissues, it may be necessary to resect some breast tissue. This can leave breasts appearing dimpled, wrinkled, sagging, and otherwise deformed, and the remaining breast tissue may not return to its original shape. Over the years, Dr. Chen has developed a meticulous technique to remove the spilled silicone gel while preserving as much breast tissue as possible in order to avoid/reduce postoperative changes. If a ruptured silicone implant is replaced, there may be a higher risk of complications compared to the first time. Sometimes, it’s safer to avoid replacing the implant immediately to minimize the risk of infection. If an implant is ultimately not replaced, however, it is sometimes necessary to perform other procedures to recreate the breast shape.

What is Breast Implant Infection?

Breast implants are at higher risk for infection than living breast tissue without breast implants because implants are a foreign body without a blood supply. If the breast or breast implant becomes exposed to bacteria, the implant cannot bring white blood cells and other natural defenders of the body to fight the infection. If the breast with a breast implant infection is limited to the skin only, such as redness from cellulitis, then it may be possible to control the infection with antibiotics. If a breast implant itself becomes infected, however, because bacteria is seeded on the implant, then it needs to be removed. An untreated infection from a breast implant can lead to systemic infections, which is the only true medical emergency associated with breast implants requiring immediate attention. Infection from breast implants can occur any time – days, years, and even decades – after the breast implant is placed. For this reason, patients with breast implants should take prophylactic antibiotics when undergoing invasive procedures such as teeth cleaning and colonoscopies to minimize risk.

What is Breast Implant Malposition?

Breast implants are placed under breast skin or muscle to either create a larger breast or to recreate a breast that has been removed. Over time, the breast implant can shift position. This is especially true if the breast implant is placed underneath the pectoralis muscle, because the action of the pectoralis muscle runs from the top of the arm near the shoulder to the middle of the chest. Every time the pectoralis muscle is flexed during arm movement the muscle can squeeze the implant into the armpit area. Gravity, weight gain, and trauma can also cause the breast implant to move over time. For patients who have breast implants placed due to a need for breast reconstruction and who also undergo radiation therapy, the breast skin will shrink over time and push the breast implant higher on the chest wall. Since breasts are intended to be a symmetrical pair, malpositioned breast implants that cause breast asymmetry may lead a woman to want their breast implants removed and/or adjusted so that her breasts appear more symmetrical.

What is Breast Implant Extrusion?

Breast implants create pressure against the breast skin from the inside. Occasionally, this constant pressure leads to erosion of the breast skin so that the implant starts to push through the skin. When the breast implant pushes through the skin, this is called extrusion. Extrusion is most common among women who have undergone radiation treatment for cancer. This is because radiation therapy damages the skin, and makes it more difficult to heal. Extrusion is not limited to radiated skin, however, and patients with thin skin and/or little breast tissue can also suffer from extrusion. Sometimes, the breast implant can push through a weak spot in an incision or healed scar. If a breast implant extrudes through the skin, it is considered contaminated no matter how clean it looks, and the breast implant needs to be removed. If the patient wants to replace the breast implant after extrusion, it is usually prudent to use a smaller size breast implant.

What is Breast Implant-Associated Squamous Cell Carcinoma?

Breast Implant-Associated Squamous Cell Carcinoma (BIA-SCC) is an even more rare but potentially aggressive epithelial-based cancer that appears to be associated with breast implants. Like BIA-ALCL, BIA-SCC also appears to come from the scar tissue around the breast implant, known as the breast implant capsule. At this time, there are so few reported cases of BIA-SCC that it is not possible to determine what factors increase patient risk. The FDA is only aware of 19 cases of BIA-SCC in the breast implant capsule.

What is Breast Implant Illness?

Breast implant Illness (BII) encompasses a constellation of autoimmune symptoms that includes chronic fatigue, brain fog, joint aches, food and drug allergies, skin and hair problems, and many other issues that affect women with breast implants. While BII is not recognized by insurance companies as a covered medical diagnosis, people who suffer from BII report developing problems after breast implants are placed; once their breast implants are removed, the symptoms resolve. Typically, people who suspect that their symptoms are due to BII have consulted with numerous healthcare practitioners who are unable to pinpoint the source of their problems despite a wide array of laboratory, radiological, and other tests. Ultimately, BII becomes a diagnosis of exclusion after all other known causes of the physical symptoms are ruled out.

While insurance companies may not recognize BII as a medical diagnosis, there have been numerous studies that show a higher association of autoimmune problems in patients with breast implants. For example, a 2019 study published by the University of Texas MD Anderson Cancer Center looked at long-term outcomes of almost 100,000 women with silicone breast implants and found up to 8 times the normal population rates of rare diseases like rheumatoid arthritis, scleroderma (a connective tissue disease), and Sjögren’s syndrome (an autoimmune disorder), as well as three to four times the incidence of stillbirth and melanoma. In 2018, an Israeli study compared 25,000 women with silicone breast implants to 100,000 women without implants and found that there was a 22 percent higher rate of risk of autoimmune or rheumatic disorders among the women with implants. While these studies do not prove a cause-and-effect relationship between breast implants and autoimmune issues, the association has caused concern among many women with breast implants – especially those whose unexplained symptoms only developed after getting breast implants. With BII, symptoms resolve almost immediately after breast implants are removed.

What is Breast Implant-Associated Anaplastic Large Cell Lymphoma?

In 2016, the World Health Organization determined that there was an association between breast implants and anaplastic large cell lymphoma (ALCL). ALCL is a rare type of non-Hodgkin lymphoma (NHL), cancer involving the cells of the immune system. Recent statistics on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) places the incidence as approximately 1 in 450 women with textured breast implants or 0.2% of women with textured breast implants. The pathognomonic signs of BIA-ALCL are a capsular mass and/or fluid around the breast implant, with CD40 markers on pathologic or cytologic analysis indicating ALCL. For early stages of BIA-ALCL, removal of the breast implant with complete en bloc capsulectomy is curative. For more advanced stages of BIA-ALCL, chemotherapy or radiation therapy may be necessary. According to the United States Food & Drug Administration (US FDA), BIA-ALCL has a mortality rate of 5%. As of March 2023, 59 patients have died of BIA-ALCL worldwide.

BIA-ALCL is extremely rare, and it is not a breast cancer but instead, it is a cancer of the scar tissue or capsule around the breast implant. Thus, women with breast implants may have a very small but increased risk of developing ALCL in the scar capsule surrounding the breast implant. There is currently no trend of implant type (saline vs silicone) or implant reason (aesthetic augmentation vs reconstruction) associated with a smaller or greater risk of ALCL. 91% of BIA-ALCL cases were in textured breast implants made by Allergan, which were taken off the market worldwide in 2019. There have, however, been rare reports of BIA-ALCL in smooth breast implants. When ALCL occurs with breast implants, it is identified most frequently in patients undergoing implant revisions for late-onset, persistent seroma, which is a fluid collection that develops around the implant. ALCL can also be visualized as a capsular mass on the breast implant capsule – not in the breast tissue itself. In either case – periprosthetic fluid or a capsular mass – the fluid or mass can be biopsied to obtain a diagnosis of ALCL prior to surgery. The FDA does not currently recommend prophylactic breast implant removal in patients without symptoms or other abnormalities.

What to Expect on the Day of Breast Implant Removal?

On the day of your surgery, you will be met by a nurse, an anesthesiologist, and Dr. Chen. Your surgery will be performed under general anesthesia so you will not feel anything during surgery. 

Dr. Chen will then almost always use your current scar to remove your breast implant. In rare cases, she may need to extend your current scar if it is extremely small or make an additional incision to gain access to the breast implant. Dr. Chen will remove the implants and any scar tissue through this incision, which is then closed with dissolving sutures.

Breast Implant Removal Recovery

Once you are finished with your surgery, you will be able to return home and begin your recovery on the same day. You may be wrapped in a compressive dressing, and you should avoid heavy lifting over 5 pounds for 6-8 weeks. If you have drains, they are usually removed in the first 1-2 weeks. You will be prescribed pain medication for any postoperative discomfort.