Some of the "drivers" for breast implant removal

by

I continue to be amazed by the number of women seeking explantation of their breast implants. Since 2013, I have removed 50 sets of implants, two of which were mine.  One was a young woman who had recurrent capsular contracture, was recently married, starting a family and didn't want to nurse with a firm, tender breast.  The other had breast reduction, elsewhere and was tempted to have a small, 200cc, implant for upper pole fullness.  Although she had no problems, she elected to remove them because they didn't feel like "hers".  I believe that the reasons why some choose explantation are as diverse as those who choose augmentation but ultimately are deeply personal and reflect the fact that breasts epitomize femininity, youth and beauty, so perceptions are continuously changing.The unique historical era in which a patient lives, where she is in her family cycle, her favorite sports and the influence of significant others are just some of the factors, which may contribute. Change is inevitable and requires the input of energy and the abandonment of security.
Breast explantation can be "simple", if the extent of capsular contracture is minimal,  the breast skin not excessively "stretched out" and the nipple at a satisfactory position.  Too often, younger women comment that that they asked for a full B but were advised by their PS that they should choose larger volumes.  More complex cases may involve capsular contracture or deflation in middle aged women who frequently choose to explant rather than revise because of financial concerns.  The most technically difficult cases involve post-menopausal patients, who have maximum challenges, CC, deflation, major ptosis or excess breast tissue. Operative strategies may require not only capsular procedures but also mastopexy/lifts.  
Apart from the standard operative risks, there are physical and psychological considerations for explantation patients, which  bear recitation.  Seromas or accumulation of fluid in the space previously occupied by the implant can occur after procedures, designed to remove scar capsules.  For this reason, I routinely place drains, in explantation with capsulectomy and/or mastopexy.  "Buyer's remorse" has occurred rarely and the overall satisfaction is very high. Elective surgery is precisely that.  Our collective role is to understand the patient's objectives, analyze her health and suitability for surgery, be nonjudgmental and be prepared for any contingency.  Will the trend continue?  I'm not sure, however the surge has certainly expanded my informed consent statement.  Now I counsel patients that among the reasons for future surgery are 1. implant failure; 2. capsular contracture; 3. patient initiated: (volume change, filler change - saline to silicone, shape change, or request for explantation). 
Article by
Orange County Plastic Surgeon