Unilateral or Bilateral Explantation?

Question

Hello Doctors - What are the pros and cons of unilateral vs bilatral explantation of breast implants when one side of the breast is fine?  If I have the implant removed from the problematic breast, I may not be able to have the same size inserted again but a smaller implant, right? Right now I am seeing rippling with the same size implant (275cc after multiple surgeries on the same breast even with silicone under the muscle). Would I achieve better results if I leave it out for a year and let things heal up?

Otto Joseph Placik, MD · Answer

The main issue appears to be the relative lack of tissue. You could consider higher profile implants with lower tendency for rippling, lipoinjection to cove r and disguise the ripples, Alloderm to diminish tendency for capsular contracture and enhance thickening of the tissues, complete implant removal with downsizing and replacement wtih smaller implants or volume restoration with autologous fat grafts.

Raffy Karamanoukian, MD, FACS · Answer

Correction of the problematic breast implant should be performed with possible explantation and correction of the deformity.  Explantation and delay is reserved for rare cases of infection.

Trevor M. Born, MD · Answer

Dear Imadvice
The rippling may be a result of thin breast tissue or capsular contracture.  The best solution i have seen is doing micro fat grafting to the breast to increase the soft tissue coverage.
If you have a capsular contracture then other remedies are indicated- open caapsulotony or oral singulair to release/soften the capsule.
 
With Warm Regards,
Trevor M Born MD

Farbod Esmailian, MD · Answer

I would not say that is the solution to your problem. It sounds like you are having problems with inadequacy of soft tissue coverage of your implants.

	What you need is better coverage and adjustment of your implants, in size perhaps. Alloderm or other such products are helpful in that they add soft tissue coverage to persons like your self to help with rippling affect.

	Make sure you see a board certified plastic surgeon that does breast revision work.

	Good luck.

Shahram Salemy, MD, FACS · Answer

Replacing both implants is probably your best bet, as you will have a better chance at achieving symmetry.  In terms of the rippling, another option to help hide the rippling would be to use a product like Alloderm.  Alloderm is human skin which has been treated-- what is left is a collagen matrix, and it comes in sheets of different thickness and sizes.  At the time that the implants are replaced, I would suture the Alloderm in the pocket, between the implant and the skin in the area of rippling.  While it does not 100% guarantee that you will not see any rippling, I think it would be your best chance.
Good luck,
Dr. Salemy

Unilateral or Bilateral Explantation?

Answers (8)