Implant Removal Birmingham (explant)

Breast Implant Removal surgery

There are a number of reasons why a woman may no longer wish to have breast implants. These include: 

• No longer wanting bigger breasts
• Breasts have become bigger with age (and weight gain): for some women who had a breast augmentation when they were young and had small breasts, their breasts may have naturally become larger due to hormonal changes, or weight gain. The implant can be removed to leave a natural, smaller breast.
• Some patients dislike the fact that there is a ‘foreign body’ in their breasts
• Some women have become mothers since having breast implants, and as they are a ‘role model’ to their daughters, they want to embrace their own natural bodies
• Some never ‘got on’ with their breast implants: some women find that having bigger breasts did not meet their expectations, or find them uncomfortable, and decide that they would prefer to be without the implants.
• Recurrent capsular contracture: a small group of patients will get recurrent capsular contracture, and after several breast augmentations, accept that their body will just keep rejecting the implants.
• Concerns over silicone: there are some patients who have experienced a range of non-specific symptoms such as ‘brain fog’, lethargy, loss of concentration, generalised aches and pains and feel this could be related to their silicone breast implants – the so-called ‘silicone syndrome’. There is no good scientific evidence to support this; large studies have shown that these symptoms appear to be as common in women without breast implants as they are in women with silicone breast implants. However, some women have found that their symptoms have improved, sometimes dramatically, once their implants have been removed.

What should I consider when removing breast implants?

There are two considerations when removing an implant: Firstly what should be done with the capsule which has formed around the breast implant?; and secondly, what can be done to improve the shape of the empty breast?

Managing the Capsule

When a breast implant is first inserted into the breast, the body responds by forming a flimsy wall of scar around the implant. This wall of scar is called a capsule, and this capsule can be left alone or removed with the implant. You should discuss the pro’s and cons of each of the below approaches with your surgeon to ensure that you have chosen the best option for you:

• Simple Explantation (removing the breast Implant). This is the simplest and safest option, which involves opening the old scar and removing the implant. However, this option leaves the capsule in place. Flimsy capsules tend to re-absorb spontaneously. However, if the capsule is a little thickened, and is left in the breast after explantation, it may be possible to feel lumpiness in the breast after surgery, or the thickened capsule may show up on subsequent mammography – leading to further investigations and even surgery.
• Explantation and piecemeal capsulectomy: This can be done through the same small scar that the implant was inserted through, by first removing the old implant and then cutting out the old scar from the lining of the empty pocket.
• Explantation and En-bloc capsulectomy: this removes the capsule and the old implant as a single block of tissue. It is generally considered safer to undertake an en-bloc capsulectomy, to avoid opening the scar tissue and spilling any contents of the capsule into the breast cavity. Furthermore this method gives the surgeon the best chance of removing the entire capsule. However, this requires a bigger scar to remove the en-bloc capsule and implant together (because this hard block of tissue cannot be squashed to get it out through the original small incision). 

Reshaping the empty breast

There are a number of options for dealing with the empty breast after explantation. This should be discussed with your surgeon before you proceed with implant removal. Sometimes the breast can be reshaped at the same time as the implant is removed, in other cases it is better to wait for the tissues to settle fully before deciding on how to modify and improve breast shape. Options include: 

• Leaving the breasts smaller and empty: some women choose not to have implants re-inserted. In these cases the shape of the final breast is a little unpredictable but can be very acceptable. The final shape depends, to some degree, upon the amount of natural breast tissue and the size of the original implant. See the above gallery for examples of patient’s explanted breasts.
• Fat grafting – it is possible to augment the empty breast by taking fat from the tummy or thigh area and injecting this fat into the breast. There is a limit to how much fat can be transferred, and it may require several episodes of fat grafting to achieve a fuller breast. I generally do not advocate fat grafting at the same time as the implant is removed as the fat could migrate into the old implant pocket and fail to survive. Usually fat grafting would be undertaken 6 months after explantation.
• Mastopexy – to reshape the breast. This is generally more successful for larger breasts, where there is more tissue to manipulate into a pleasing breast shape. The benefit of a mastopexy should be discussed on an individ

What will my breasts look like if I take the implants out?

There is an understandable fear that the breasts will be ’empty bags of skin’ or resemble ‘spaniel’s ears’ if the implants are removed. In my experience, following explantation the breasts still look like breasts, but are generally smaller and a little more droopy than before the implant was placed.

A number of factors can influence breast appearance following explantation. These include:

• The amount of natural breast tissue present: the more natural breast tissue there is, the better shape the breast will be 
• The size of the implant; the bigger the implant that is being removed, the more ‘stretching’ there will have been on the breast and skin
• The quality of the skin and breast tissue; some women have great skin with good elasticity and in these patients the breasts tend to spring back to a very decent shape
• The number of previous pregnancies; previous pregnancy tends to have a negative effect on breast tissue and a greater risk of breast droop (ptosis) 

Take the first step

Use the form to the right to ask further questions or book your initial consultation for breast implant removal surgery performed by me in a local Birmingham hospital.

Mr Guy D. Sterne
MB, ChB, FRCS, MD, FRCS (Plast)
Consultant Plastic Surgeon