Remove capsule? Drains? Local?
Seeking safest simplest way to remove 6 yr old under muscle through underarm, 275 saline implants?
Doctor Answers (4)
Removal of implants
Your operating surgeon might well feel comfortable removing your implants through the armpit. However, if you have a capsular contracture which also needs to be removed (capsulectomy), or if you need other procedures done, such as adjusting the position of the implant, it may be difficult to do through the armpit. In this situation, or if a new implant might be put in, it might be necessary to use a different incision.
I don't think local would be very comfortable, since the old tunnel from the armpit to the implant pocket has closed off, and would need to be made again. I wouldn't use drains unless I did a capsulectomy where there was a lot of bleeding during the operation.
Breast Implant Removal Concerns?
Although precise and meaningful device would require in person consultation, some general thoughts may be helpful to you. If at all possible, it is usually best to use a previous incision to remove breast implants. However, it is significant amount of work needs to be done around the breast implant, an infra axillary incision may not be the best choice.
Generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, there is no indication to have them removed. On the contrary, capsulectomy can expose you to additional risks, such as bleeding and minimal size loss.
Having said that, I often remove a small segment of capsule tissue when removing breast implants with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.
What your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.
Patience is definitely indicated after removal of breast implants; it will take many months for the skin to “bounce back” and for you to see the final appearance of the breasts.
I hope this, and the attached link, helps.
Removing saline implants through the arm pit incision
If the implants feel normal and there is no significant capsule present then removing them from the armpit incision should be very easy and straight forward. It is true that the IMF or crease incision allows the most direct access for treating complications and issues arising during surgery but don't feel you have to have that incision just because its the only one offered by the surgeon. Many surgeons only perform the procedure through one or two different incisions as they may have been train in residency to perform. You need to follow up and see someone with a large experience with all five approaches ( IMF, NAC, Transaxillary , TUBA, TABA ) or at least the one you had to truly get the best advise.
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Removing saline-filled breast implants
Ease of removing breast implants is one reason to place them through the inframammary crease to begin with, but if the original was done through another approach, the removal will still be best done through the inframammary crease. If there are no problems with the capsule that require it to be removed, the simplest and safest is a 2 cm incision in the center of the inframammary crease with a simple closure, no drains and can be done with local anesthesia. Silicone gel implants require a larger incision for removal and it may not be a simple removal if they are ruptured. Removing capsule would also require a larger incision and more than simple local anesthesia -- at least IV sedation and more full scale operating conditions.
I offer my patients (where I did the original surgery) a single, reduced fee for simple removal of saline implants through the inframammary crease incision they already have with local anesthesia alone.