Breast Implant Removal: Stories

I did a lengthy review under Breast Implants, so anyone interested in why an implanted woman like me would HateMyImplants, you can check out my other review. Here I am going to try to keep it to a review of Explantation.

A little info: I'm 35, had implants 12 years. They are smooth, round, mentor saline implants. I believe they are 360cc 'overfilled' to 400cc. My incisions were inframammary. I was a cute 36A before surgery. Post surgery a bulging 36C, and after 2 kids settled at small 36D. Capsular Contracture in my Left. It's developed along over the past 4 years, and now is really noticeable and intolerable. I'll be looking to get these implants removed through my existing under-breast scars and capsulectomy. I am currently planning no lift. My goal is to have (relatively) symmetrical breasts again. Capsular contracture has really made the Left distort and move, and I'd just love to have a small matched set again.

I'll update when as I go through consultations and each step of the explant process. TTYS, girls.

Hope all you ladies enjoyed your holidays. After much research, I've narrowed down my top picks for potential surgeons to remove these implants. I am now scheduled for 3 consultations, and I hope to choose my surgeon by the end of this month and get a surgical date ASAP. I'm nervous, not about the aesthetic results of the explant - just nervous about going under general anesthesia and having surgery. I want these stupid foreign objects out of my body, but to get that done I have to let someone cut me open and fiddle around with my body... So it's sort of a mixed feeling.

Had an excellent consultation yesterday. The PS and his staff were wonderful, and they listened to me first - then gave me options for my explantation. They NEVER tried to push me toward replacement implants or a lift! I really appreciated this, and felt they respected my wishes as a potential patient. What they DID do, after my breast exam, was explain different techniques and options for the explant - local vs general anesthesia; capsulotomy vs capsulectomy vs leaving the capsules in; what would necessitate use of drains or not; option of leaving the fibroadenoma in vs removing it; and how these different options would each effect both my recovery time as well as the price of the procedure. I am extremely pleased with the tone and thoroughness of this consultation. I felt the surgeon did not try to steer me toward what he wanted, but rather tried to respond to what I want (explant) and explain how his skill and medical expertise could be used to achieve my goals. I give the guy an A+, I actually chose him from extensive regional research. The only thing holding me back from signing up for the surgery date is that I have 2 more consultations scheduled next week... But I would be extremely comfortable using this surgeon, so I have at least one option! I will see what the other 2 have to say and what their demeanors are next week, and I think I will know for sure who to pick by then.

OH YEAH!!! This was in my review for 'breast implants' but I think I failed to mention this so far here in my 'implant removal' review: in December 2012 I was diagnosed with a 2cm fibroadenoma. This is a common and benign breast lesion. Radiologist said I have the options of leaving it in place and getting mammograms every 6 months to monitor it for changes, or that I could get an excisional biopsy (where it is removed and sent for pathology) at the same time as my explant if the surgeon is willing to do so. This is why I have this added element in my explant consults - to find out each surgeons' opinion of either removing the fibroadenoma or leaving it in place.

So, last Wednesday I had 2 more consultations scheduled. One of the PS cancelled on me day of, and flew away on a plane :( The other surgeon I saw (interestingly a female one) emphasized to me over and over again how flat, floppy, deflated and deformed I'd be... How I'm "not burning any bridges" and should expect to come back for a lift and/or smaller/silicone/under muscle implants in a few months. She went on and on as if she were trying to talk me out of some horrific self-mutilation for my own good. I just don't think she got what I was telling her about not wanting implants and thinking small natural boobs are just fine. And after about 20 min of this I was worn out and pretty much wanted to punch her in the mouth. And she quoted me over double the price of the first surgeon I saw who was supportive. Yeah, I had enough of all that. I'm going to Dr #1.

My only hesitation is that he believes my capsules should be left in, and that removing them could lead to distortion or permanent asymmetry because of how little breast tissue I have, and how my skin has thinned due to the stretching of the implants. I had really been thinking I'd have a complete capsulectomy, especially since I have CC, but the Dr was very against that surgical plan for me personally. He said since I have saline (no chance of free silicone leaked into the capsules) that the removal of capsules would be more for the sake of avoiding seroma in the short term during healing. He also thinks my CC is Baker grade 2, even though that boob rides high, by the 'squeeze' test he did not think the capsule is very thick, it's just contracted. My mammogram did not show calcification of the capsules. So, basically the capsules (even the CC one) can stay in and the CC asymmetry will resolve just from removing the implants. If I go with a simple explant, no capsule removal, then he will do my surgery under local anesthesia -- which appeals to me both because I'm scared to death of general anesthesia and because it lowers the cost by +/- $2000 (I'm paying for this out of pocket). If I am adamant about the capsule removal, he will do it under general anesthesia. This particular Dr is a dual specialist - he is a board certified plastic surgeon, and he also did a special fellowship in breast surgery (oncology, etc), so I think his surgical plan probably has more medical merit than mine. I have seen quite a few women on here who did not have capsulectomy and others who thought they were going to have a capsulectomy and then surgeon decides in the operating room not to do one. So maybe this is ok.

I was going to ask a question about capsulectomy / capsulotomy and what happens to the pocket after explant if you don't remove the capsules... But it looks like another (understandably) confused patient beat me to it. The consensus of the Drs who answered sounds very similar to what my surgeon told me, so I think he is spot-on.

http://www.realself.com/question/breast-pocket-breast-implants-removal

In my case I have thinned skin (from stretching in pregnancy) and essentially no breast tissue over my implants (I can clearly feel both valves through my skin) and digging out the capsules could cause more distortion, damage and trouble than it is worth... Now, if I had silicone implants or calcifications then the distortion and damage to my already non-existent breast tissue might be worth it weighed against the migration of free silicone to lymph nodes etc. Also, if I had more breast tissue, it could be worth sacrificing a bit of it to dig those capsules out. In my personal case, it seems other surgeons might advise me the same as the surgeon I've chosen, so I feel better. Again, this just proves that 'one size fits all' approach to explant doesn't work - we all need individualized plans based on our personal situations. I am coming to believe there is no 'perfect' surgery - it is a matter of weighing one set of risks and possible complications against the other. In my case, I'm going to be looking out for a seroma, in order to spare what pathetically little breast tissue I have. I'm ok with that.

***ABOUT MY SURGERY***
I had essentially 2 seperate procedures done at the same time. I had a simple explant - no lift, no internal stitching, no capsule removal. I also had a lesion removed from under my left areola - this was an 'excisional biopsy' due to a lump in my left side which was probably a fibroadenoma (waiting on pathology to find that out for sure). Dr Gabriel did the biopsy immediately after the explant. I did all of this under local anesthesia, with just a 2mg Lorazapam pill (no IV sedation). I am an extremely calm patient, and preferred to NOT have general anesthesia (losing consciousness scares me) so I would not recommend it for everyone but in my case it was preferred. I walked into the surgical suite, was strapped down, draped, cleaned up, and then had injections of local anesthetic. They sting for a minute. Then Dr Gabriel began by cutting in my existing inframammary scars, he was able to make the incisions smaller than the existing scars as he drained the saline implants before pulling them out. You feel pressure, tugging, warmth and cold - but no pain. The only time I felt pain was a couple of times when the electrocaudery devise zapped me where I wasn't numb - felt like hot splattering bacon grease, really no big deal. After the bags were removed, it felt like Dr Gabriel used some sort of suction in the pockets, almost like what they use at the dentist office - I could feel the vacuum internally which felt odd, but again it was not painful. To finish up, he artfully stitched my under breast incisions closed, layer by layer. I should end up with a very small, fine scar. That is it for the $1500 local anesthesia explant. Took about 40 minutes total.

Separately, after my explant, my L areola was cleaned, injections of local anesthetic, small peri-areolar insicion and Dr Gabriel went to work removing my probably-fibroadenoma breast lesion. Again, I could feel warm/cold, tugging, and pressure but no pain. The lesion was directly under the skin, felt like a marble. If it were deep in the breast tissue this excisional biopsy would have probably had to be under general anesthesia, but I am so thankful to get both thigs done at once. After about 12 minutes of digging Dr Gabriel had removed the lump - about the size of a small grape. He took longer stitching the lumpectomy incision, explaining that he does each layer of tissues individually, and the lumpectomy went deeper into the fat layers and needed deep stitches to make sure it heals beautifully. I will have a separate charge for the pathology etc for the biopsy, not part of the $1500 explant BUT I didn't have to pay any additional operating room fees or fees for local anesthesia etc. I was on my feet and walking out of the operating suite after about 1 hour, feeling fine.

**** ABOUT MY PICS ****
Please ladies do NOT let my pics scare you! I know the 1 minute post-surgery pic looks like Snoopy's ears. I went through a lot with my implants - 2 pregnancies and breast feeding where they ballooned to ginormous proportions, plus I have almost no real breast tissue. My lack of breast tissue is part of why my surgeon didnt want to remove my capsules. I have stretch marks from my babies, thinned skin from pregnancies with over-muscle implants... And I am still hopeful that things will improve with time for me. So please, pre-explant ladies, especially those who never had babies with implants in, do not look at my 1 minute picture and grow faint of heart. I think they will improve, and will post weekly pics over this month, and then monthly pics over the next 6 months. Luv you girls. Xoxo

I feel great. ZERO pain, besides an occasional momentary 'shooting zinger' through my left side that had more work. Almost no bruising (faint) all 3 incisions are nice and dry and haven't been painful or oozing at all - not even nipple incision where the biopsy was done. I am sleepy and nap for hours, LOL. But other than being tired I feel fine.

When I changed the bandage I took a look and they have improved already in just 2 days. I am keeping on TIGHT binding... Double bras (tight sports bras x2, or genie bras x2) 24 hours a day, and ace bandage binding them over top at night. I plan to do this for a week - 2 weeks, and then graduate down to 1 bra.

I have wonderful news! I had a post-op appointment and got my pathology back today. The lump was in fact an approximately 2cm fibroadenoma - no cancer cells, just a textbook 'normal' benign breast lesion. Yeah! I never in my wildest dreams thought I would be excited to have a tumor, but when you find out FOR SURE that the lump in your boob was a benign tumor and NOT CANCER you get really excited about having 'just a tumor'. Hope the grape-like thingy doesn't grow back, but for the moment I am lump free, cancer free, and implant free. I am feeling like a million bucks.

My neck and spine inbetween my shoulder blades feel AMAZING. I had no idea that the constant aches, pain and tension was the weight of my implants, but apparently it was. My boobs might look 20 years older, but my spine feels 20 years younger so that is awesome.

I cannot say enough about my awesome doctor! Through all this craziness that is one thing I am 100% happy about - I really think I chose the absolute best surgeon in my region for this. His surgical technique is meticulous, he is really a breast specialist, and I could not be any more happy with everything about the way my surgery was planned and executed - even his medical opinion of me leaving my capsules in has been absolutely correct (for my case personally). For how much he had to do, especially on my left breast, there is essentially no pain, no swelling, no bruising, no bleeding... And that scar placement for the lump removal in the nipple crease instead of the edge of the areola - genius. It is going to heal and be zero visible, and yes I have complete sensation in that nipple despite him squeezing a grape-size tumor out of that delicate incision (while pleasantly carrying on a conversation with me, LOL). The guy has skill and talent.

Of equal importance though has been his bedside manner and that of his staff (many of whom have implants!). Never have any of them made me feel bad about explanting - never have they tried to suggest replacement implants or a lift, I have been treated with absolute dignity and respect. I was given fair warning about thinned skin, stretch marks, sagging - but never told I'd be 'deformed' nor was I insulted, nor did I experience the dreaded 'scare tactics' that some PS seem to fall back on when faced with an explanter. They somehow toed the fine line between clinical honesty and still being positive and respectful of my body and choices. In retrospect I can understand why many plastic surgeons sort of 'freak out' or act weird toward explanters - we are essentially rejecting what they do, their life's work of 'cosmetically improving' people. The choice to be 'natural and imperfect' could be taken as an insult to some individuals in this profession. I really feel that Dr Gabriel has such a good character as a physician and never loses sight of his primary job as a healer, and that his staff is very well trained and professional. Today he told me my incisions are healing great and he also welcomed me to let them know if there is anything else he could help me with in the future, beyond the scope of what a good bra can do. haha. I go back in 10 days, and 6 months.

*About Recovery*

I think you can see pretty clearly in my pics what was going on (especially watch how my R boob changes) , but anyway... immediately post-explant there is a concave area we all talk about. Best way I can describe it is that over the years the implant pushes all your breast tissue to the edges and when your implant is removed you are left with a "doughnut" shape breast tissue - a ring of breast tissue with a nice center hole of nothingness (where the implant used to be) that caves into your ribcage. It is distressing. I had a few cries about it. Over time somehow things "knit" back together and the body starts closing that hole in the center. I will be very happy to be FLAT, and not to have concave "spoon" shaped breasts. We will see.

Week 1: Exhausted. Don't try to do anything. I was not in pain but I was SO tired and needed lots of sleep.
Week 2: Itchy. Internal itching. Incisions itching. Steri-strips itching. Dissolving stitches itching. Toward the end of week 2 I had resumed most of my daily activities (office work and children) but with needing extra rest than usual.
Week 3: Aches like I am going to lactate. Diffuse swelling, and localized bruising (which I had only where fibroadenoma was removed) have resolved. Daily routine is once again as easy as its ever been.
Week 4: Pretty much feel normal - so this is about the time I am tempted to "over-do it". I don't want any last minute complications so I am holding out on being lazy for the full 6 weeks.

I am still taking it easy. I have had a few rounds of crying and freaking out - during the first week. Overall I am thrilled to be rid of those implants. Currently I am OK with my results. The overall size is fine, even the droopiness is fine with me. My issue is that I have severely damaged stretch marked skin on my boobs. I may look into a Benelli-type breast lift in the future, mostly for the sake of removing the damaged skin. But, I am not going to seriously consider this for at least 6 months, and likely will not end up doing it. I would NEVER again consider prosthetic breast implants of any sort... so... regardless of what my future holds I am so happy to be natural and rid of those implants.

I am still in recovery.

Week 5: I began a 12 week course of Mederma treatment on my stretch marked boobs. I am only lightly rubbing the stretch mark cream into the superficial skin layers. Some of you ladies start deep tissue massage right away, but I am just not ready yet.
Week 6: I forgot to take pictures, it was one of those weeks I didn't feel much changed. Boobs feel a little less "jello".
Week 7: When I crop these pictures to standard dimensions week after week my editing tool comes up as a grid. I have watched the nipples go from CC cockeyed on completely different lines of the grid to even and on the same line. It is official as of today the nipples are the same height, even though the boobs are not 100% symmetric and never will be this is a huge thing for me. Yeah! To me this is the point I can truly say I have recovered from the CC.
Week 8: the ridges and valleys of my stretch marks seem smoother. I was skeptical going into the Mederma treatment. It worked well on my stomach when I had fresh "new" stretch marks... But these ones on my boobs are the silvery/white "old" stretch marks. It even says that it won't work in old stretch marks.... Well, it DOES, at least for me. I am pleased with the results so far and will do a full 12 weeks.
Week 9: FINALLY I feel OK about a deeper tissue massage. The last of my dissolvable stitches "spit out" like little whitehead pimples. There has also been a sudden firmness change in my tissue, I believe this is what all you girls refer to as the "fluff fairy". Check out my pics - radical change in just one week between weeks 8-9. I have carefully palpated around where my "capsules" would be an I can't feel anything. My implants were over the muscle so I should be able to feel that capsule tissue if there was anything alarming but there isn't. I don't think I could tell the difference if I didn't know my capsules were left in place.

Finally, I am no longer thinking about any more surgery. I am dealing with my stretch marks through non-surgical techniques and once my 12 weeks of Mederma is over I will probably move on to things like Retinol, hyluronic acid, tca peels, and other things like that. I will keep you girls posted. As it stands now I am at 2 months post op and completely satisfied with my current result. If I didn't change any more at all I would still be happy! Great thing is I am still seeing huge changes :)