Breast implants: Placement and Removal


     When a woman elects to have breast implants, she must also be briefed and accept that other operations may be in her future, including explantation or removal.  The reasons why women choose to remove their implants is as varied as those which led to choose them and serves to illustrate that perceptions of beauty, value and health are always changing.  Undoubtedly, many of our aesthetic ideals are predicated on the distinct historical and socioeconomic time, in which we live, but in my experience, my patients research, go on multiple consults and confer with trusted friends, prior to proceeding.  Most patients state that the barriers against proceeding include financial, knowledge and trust, However It is primarily the financial commitment, which is heavily weighted, as the results must be "maintained", as  women's breasts change with weight gain/loss, pregnancy, menopause and illness. Yes, it is a PS' obligation to divulge that the passage of time may produce changes, which were not originally  anticipated and may trigger a "call to action".  

Revision may take the form of breast implant exchange (different style, size, replacement of saline for silicone or for deflation); mastopexy (breast lift with original or "new" implants); capsulectomy (removal of deforming scar around the implant); capsulorrhaphy (placement of sutures and/or ADMs, acellular dermal matrices to correct implant malposition or symmmastia); removal.  Fortunately, not every woman will experience these conditions, which require the investment of money, expectation and exposure to another surgery.  For those who "opt out", they should be aware of the consequences, which can include but are not limited to: Positives: elimination of further surgeries, improved mammographic surveillance (?), reduction of variables contributing to the aging breast.  Negatives: change in the body image, possible need for additional procedures, at time of explantation, including mastopexy, (which will result in additional scars and possible delayed wound healing, hematoma, seroma),  capsulectomy, etc.  While this may seem onerous to disclose to a potential explantation candidate, they are essential subjects to raise in order to render Informed consent.  Unlike the pre-augmentation patient, who can literally "size" up with a variety of lingerie props, the pre-explant patient is literally "going back in time", if her breast form hasn't been overly thinned out, nipple inferiorly displaced, etc.  The patient's anatomy has great relevance on what surgical plans will be proposed.

     I have taken care of women who remarked that they "never made friends" with their implants, despite having objectively "good" results (soft, mobile breasts, without ptosis).  These lucky ladies can have "simple" explantation and "shrink" back to baseline.  Others who have hard, misshapen breasts will require, at minimum, capsulectomy (scar removal) and possibly mastopexy (lift).  Post-op pain is significantly less than the original surgery and the motivated patients rarely express dissatisfaction.  The "adjustment" period is variable but I am gratified to report that to date, I haven't had any explant patients request augmentation.  One even quipped that the happiest day of her life was when she had her breast augmentation and the second happiest was when she removed them.  Ultimately, the outcomes will be favorable if the decision making is sound.  







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Orange County Plastic Surgeon