Removal of Breast Implants and Capsules
Breast implants are relevant and appropriate for many breast cancer patients who undergo mastectomies. They are also widely used by women purely for cosmetic reasons.
Occasionally, some patients encounter problems from having breast implants. These include:
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Capsular contracture: the body naturally forms a layer of scar tissue around the implant. This scar tissue is called a capsule. Capsular contracture occurs if/when the capsule starts to contract around the implant. This may cause discomfort and reduce arm mobility. Surgically removing the implant, along with the capsule will resolve capsular contracture.
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Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): certain textured breast implants (which have since been recalled) were found to lead to an increased risk of developing BIA-ALCL (1 in 4,000 women). When detected early, surgical intervention is usually sufficient to treat BIA-ALCL. The Therapeutic Goods Administration advises that unless there are symptoms (pain, swelling, or a lump around the breast or armpit), removing the implants is not recommended. If symptoms exist, medical advice should be sought.
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Breast Implant Illness (BII): BII is the term used to describe a wide group of unexplained persisting symptoms that some women with breast implants experience. These symptoms may include aches and pain, chronic fatigue, brain fog, rashes, hair loss, and gastrointestinal discomfort. Studies are still being conducted to understand the link between implants and these symptoms. Some women report that symptoms progressively resolve after their implants are removed.
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Implant Rupture: while implants are designed to be resistant to rupture, they do occasionally rupture, leading to their contents leaking out of the shell. Implants are usually filled with silicone or saline, both of which are considered non-toxic. However, if a rupture occurs, the removal of the implant is advised.
Removing breast implants, along with the entire capsules, are at times medically indicated. Women with implants are recommended to speak with a surgeon to determine if implant removal is appropriate for them.
Frequency Asked Questions
I have breast implants. My breasts have started to hurt recently. What should I do to investigate this? The first step is to see your family doctor (GP). Your GP should examine you and may send you for some imaging scans to help determine the cause of your pain. Regardless of implant health, your GP might then refer you to see a Breast Specialist.
My GP sent me for a scan and I have a ruptured implant. What are the common side effects of having a ruptured implant? How urgently should I remove it? Sometimes patients do not notice any side effects even after their implants have ruptured. Other patients will experience pain and possibly a deflating of the breast. The impact of silicone leaking out of an implant is not fully understood. It is recommended that patients who have ruptured implants minimise the delay to the surgical removal of the implants.
I have been experiencing an increasing tightness around my breast implants and it is causing discomfort. I am also unable to take deep breaths of air. Is this related to my implants? It is likely that the sensation of tightness around the implants, decreased ability to take deep breaths, and possibly also limitation of arm movement is related to the contracting of the scar capsule that forms around the implant. While it is normal for the scar capsule to form around the implant, when it starts to contract (known as capsular contracture), this can cause discomfort and may even affect arm movement and breathing. Medicare provides rebates towards the removal of breast implants if there is capsular contracture. The surgeon will be able to help determine if there is capsular contracture. Where a person’s breathing is impacted, seeing a GP and possibly a heart/lung specialist may be appropriate.
Over the last few months/years, I have been unwell. I have been experiencing many different symptoms. My GP has run multiple blood tests and scans and has not been able to determine the underlying cause of my deteriorating health. Could my health situation be related to my breast implants? If you experience a number of symptoms and tests requested by your GP do not provide clues as to their cause, then it is possible that you are suffering from Breast Implant Illness (“BII”). BII is not well understood, and studies are still being carried out to establish the link between these symptoms of illness with breast implants.
What is Breast Implant Illness? How much evidence is there out there concerning Breast Implant Illness? Breast Implant Illness (“BII”) is a term used to describe a group of unexplained symptoms that some women with breast implants experience. While the link between breast implants and these symptoms is still poorly understood, the US Food and Drug Administration (FDA) has recently begun to recognise these symptoms and their link to breast implants.
What causes Breast Implant Illness? The specific cause of BII is currently not fully known. It has been suggested that BII is a bodily immune response to a foreign object, where the body mounts an attack on the foreign object found (i.e. the breast implants/silicone).
What is the appropriate treatment for Breast Implant Illness? If after the series of tests ordered by the GP are unable to determine a cause of symptoms, and where it has been concluded that these symptoms are likely linked to the breast implants, the only known solution to BII would be the surgical removal of the implants. It is the view of Sydney Oncoplastic Surgery that both the implants and the capsules surrounding the implants be removed entirely where possible to minimise the presence of any residual reaction-causing material.
After removing the breast implants, how quickly can I expect to become better? Based on the observations of past patients, it is suggested that patients can expect to experience improvements to their symptoms anytime from a few days to 6-months after explant surgery. The speed and extent of improvement in health varies widely across individual patients. Most patients see improvements within weeks of implant removal (“explant”) surgery. It is important to note that while we observe improvements in the health of most of our BII patients, improvements and resolution of the symptoms are not guaranteed. A published study that examined the improvements in BII patients' health after explant surgery determined that the majority of patients saw significant improvements in their symptoms after explant surgery. (Wee CE, Younis J, Isbester K, Smith A, Wangler B, Sarode AL, Patil N, Grunzweig K, Boas S, Harvey DJ, Kumar AR, Feng LJ. Understanding Breast Implant Illness, Before and After Explantation: A Patient-Reported Outcomes Study. Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S82-S86. doi: 10.1097/SAP.0000000000002446. PMID: 32530850; PMCID: PMC7294749.)
What are the various ways to remove breast implants? Is one way better than the other? Broadly, there are four ways to remove breast implants. These are listed in ascending degrees of duration and surgical difficulty: 1. Simple explant: this procedure involves making an incision along the bottom of the breast through the scar capsule, and then removing the implant. The scar capsule is left in its original place and the incision is then closed. 2. Explant and partial capsulectomy: this procedure involves making an incision along the bottom of the breast, cutting through the scar capsule, and then removing the implant. Portions of the capsules are also released from the cavity and removed. Usually just over half of the capsule is removed, with a portion of the remaining capsule being the part that is adhered to the chest wall. 3. Explant and full capsulectomy: this procedure involves making an incision along the bottom of the breast, cutting through the scar capsule, and then removing the implant. The remaining capsule is then separated from the body and removed entirely, leaving no portion of scar capsule in the body. 4. En bloc explant and capsulectomy: this procedure first involves making an incision along the bottom of the breast. With the implant still situated within the scar capsule, the capsule is carefully separated from the overlying and underlying tissue. Care is taken to minimise damage/tears to the scar capsule, as well as the tissue surrounding the capsule. While it requires more time to perform, this procedure’s key feature is the containment of implant material within the capsule when it is removed which significantly reduces the risk of implant material (e.g. silicone) being left in the chest cavity.
The en bloc explant and capsulectomy is a longer and more costly method of implant removal? If my imaging scans show no rupture has taken place, do I need to have my implants removed this way? There is no established "best method" of implant removal. Where implant rupture has taken place, it is advisable that the implant and capsule be removed as one piece (en bloc) to reduce the risk of silicone being left at the implant site. Interestingly, imaging scans are not 100% accurate in excluding implant rupture. Amongst our patients whose imaging scans exclude implant ruptures, following explant surgery, pathology examination finds silicone on the surface of the capsule in about 30% of the cases. This suggests that microscopic ruptures can still occur and go undetected (by imaging). Consequently, Dr Nagy commonly recommends patients have their implant removal performed as en bloc explant and capsulectomy.
My implants were placed beneath the pectoral muscles. Does that affect the way my implant removal surgery should be done? Typically, when breast implants are placed beneath the pectoral muscles, sections of the pectoral muscles are lifted off their normal anatomical position to accommodate the implants. Dr Nagy’s observations so far have led her to arrive at the conclusion that this often impacts function where common complaints include loss in strength and function (e.g. to perform pushing motion). Similarly, when the pectoral muscles are repaired/restored and placed back into their original anatomical position, over time function and fitness is regained. Consequently, it is the recommendation of Dr Nagy that the muscle repair be at the same time as subpectoral (beneath pectoral) explant surgery. Dr Nagy also believes that the repair of the pectoral muscles will help to reduce the amount of breast tissue that adheres to the chest wall after explant surgery - this is thought to lead to the occasional complaint of having a second horizontal breast crease under the nipple line (also known as the window shade effect). The repaired pectoral muscles will also reduce muscle animation. Together, these two results lead to better cosmetic outcomes. (Dr Kocak and Dr Tiwari from Midwest Breast and Aesthetic Surgery provide a helpful discussion here: https://youtu.be/IfSB1RDVrNs)
Would I need a breast lift after the implants are removed? “Ptosis” is the word used to describe how droopy or saggy a breast is. Medicare provides financial rebates towards breast lifts (also known as mastopexies) only if a patient’s breasts are severely ptotic (droopy) and very clear measures are specified by Medicare in order to qualify for the rebate. If these measures are not met, then technically a patient does not need a breast lift. For a number of patients, a breast lift would not provide much benefit to the patient after implant removal; these patients tend to have a fair amount of breast tissue without much ptosis. Other patients may gain (cosmetically) from a breast lift after implant removal. Dr Nagy will be able to provide her recommendations during the consultation.
How large are the scars likely to be after the implants are removed? The incision for explant surgery is placed at the crease at the bottom of the breasts. This is known as the inframammary fold (“IMF”). Typically, the scar will extend along a substantial portion of the inframammary fold. Where implants are placed under the muscle, the scar is longer as the process of removing the implant and the muscle repair require a larger incision. Scars are expected to fade over time.
Can I just opt to have the implants removed, and leave the capsules in place? You may choose to undergo just the explant surgery without the full capsule removal. We do not provide this specific form of treatment, but your GP will be able to refer you to a specialist who does.
Will I be able to breastfeed after implant removal? Whenever surgery is performed on the breasts, there are risks and no guarantees can be made to exclude the risk to breastfeeding. Implant removal surgery itself is not expected to affect the ability of a patient to breastfeed. However, a breast lift or mammoplasty performed after explant surgery may impact the ability to breastfeed.
How long does implant removal surgery normally take? Implant removal surgery duration depends on multiple factors. These include (but are not limited to): •Whether the implants are above or below the muscles •Whether the implants are ruptured •Whether a muscle repair is performed •How attached the scar capsule is to the chest wall •Whether a breast lift is performed after the implants are removed Consequently, implant removal surgery duration can range from three to eight hours.
How long would I need to stay in hospital after surgery? This largely depends on how the patient recovers from surgery. The minimum stay in hospital is one night. Most patients stay between one and two nights in the hospital. Some patients who struggle in their initial recovery may stay three or four nights in hospital.
How long would I be away from work? This depends on the nature of the work the patient does. Deskbound office type jobs can be resumed as soon as two weeks after surgery. Physically demanding jobs may only be resumed four to six weeks after surgery. We recommend patients be attentive to their own recoveries to determine when they are ready to return to work.
How long before I can drive? Patients who undergo muscle repairs are asked to avoid driving for four weeks after surgery. Patients who do not undergo muscle repairs may resume driving three weeks after surgery. We recommend patients start off slowly when returning to routine activities.
How long before I can shower or swim? Patients should avoid swimming and baths during the six weeks after surgery. During the two weeks after surgery, patients can shower normally from the waist down, with a clean wet towel used to clean the upper body during this time. After these two weeks, patients can shower as per normal.
What are the expected costs of surgery? The cost of surgery depends on multiple factors, including: •Whether the patient has Medicare •Whether the patient has a Health Fund with Hospital Cover •Whether the implants are ruptured •Whether the patient requires a muscle repair •Whether the patient undergoes any breast lifts after the explant is performed The total cost of surgery (out-of-pocket) may range from $8,000 to $28,500.
Will I need to have drains after surgery? Drains help to remove fluid that collects in the surgical site. This reduces the risk of discomfort and infection. Patients typically have drains for three to ten days after surgery. When the drains are no longer collecting significant quantities of fluid each day, they may be ready to be removed. The practice will make arrangements for your drains to be removed at the hospital where the patient had surgery, and instructions will be provided to the patient to facilitate this.
Are there any dietary supplements I can take to help in my healing? We request for patients to stop all vitamins and supplements two weeks before surgery. If any medication or supplements are required to be taken before surgery, please inform the practice of this and ensure this information is included in the Anaesthetic Questionnaire (to be filled when booking in for surgery).
Can I have fat transfer after the implants are removed? It is recommended that fat transfer not be done at the same surgery as explant surgery. This is to allow for a more straightforward recovery for the patient after a surgery as long as explant surgery. While it can be considered 6-months after explant surgery and is something that Dr Nagy performs routinely for reconstruction patients, many patients find that fat transfers are not required after their wounds have healed and settled down.
How long before the final cosmetic results are seen? Six months.
Are there other health care providers whom you’d recommend for me to see before/after my surgery? Some patients may choose to see an integrative doctor to provide guidance on how to “reset” their bodies after explant surgery. As these doctors are typically very busy, we recommend patients book in to see these doctors early. Our practice is able to provide names of doctors in this field. Patients may also consider seeing a physiotherapist to provide instruction and guidance on preparing for surgery and post-surgery rehabilitation. The physiotherapist may also provide treatments including laser treatment, cupping, and massage therapy.
Can I get pictures taken of the implants after they are removed? Yes, pictures are taken of the implants (and their capsules) after they are removed.
Are the implants and tissues sent off to be tested? Yes, the implants and scar capsules are sent off to Pathology for analysis and testing.
I’ve heard of scar cream, silicone sheets and laser treatment for scars. Which of these should I use? The practice does not recommend any one specific method of scar care. Many of our patients have benefitted from the use of a scar balm, a silicone gel, or silicone sheets. We only recommend for patients to start using these products six weeks after surgery. Scar balm: Nokori (discount code: scarbalm10 or scarkit100). At times, we stock samples of these scar balms – ask us. Silicone gel: Strataderm Silicone sheet: Cica Care Spot test a product before use and stop use immediately if any reaction occurs. Some patients have also mentioned that they have benefitted from laser treatment to their breasts, particularly their scars. Patients may speak to a physiotherapist about laser treatment.
When are the follow-up appointments after surgery? Follow up appointments are typically two to three weeks after surgery. The practice will send you an email after your discharge to provide follow up appointment details.
Do I need to have blood tests or scans done before surgery? Typically, patients will have a number of tests done before surgery: •Breast abbreviated MRI •Chest X-ray •Blood Test & ECG Dr Nagy will provide request forms for these tests. We recommend that these scans and tests be done two weeks prior to surgery.
Can I see some "before and after" photos of patients who have undergone explant surgery with Dr Nagy? Dr Nagy will be able to show you de-identified photos of patients before and after their explant surgery at your consultation. Sydney Oncoplastic Surgery expresses its gratitude to the many patients who have volunteered their photos for this purpose.