Should I get breast implant removal? (Previously tuberous breast to capsular contracted breasts with implant) (photo)

Several recent publications have estimated the risk of developing anaplastic large cell lymphoma (ALCL) in individuals with textured breast implants. The FDA reports that ALCL may develop in 1 in between 3,817 to 30,000 women with textured breast implants.  As of this date, the risk appears to be very small. The FDA has not recommended removal or replacement of textured breast implants or tissue expanders in asymptomatic patients.
An MRI can be performed when an ultrasound or mammography fails to provide adequate information. The most common test for ALCL is to take a biopsy of an enlarged lymph node and check it for lymphoma cells. In most cases, ALCL is found in the scar tissue and fluid near the implant but can be widespread.Consider all the pros and cons of removing the textured breast implants and replacing them with smooth ones.  Your board certified plastic surgeon and results of imaging can help you make the best decision for your mental health and genetics.

Hi, thank you for your story and picture. Tuberous breast deformity is usually managed with augmentation and mastopexy or breast lift surgery and whilst your special circumstances may have resulted in the approach taken in your surgery, you will benefit from clinical assessment and examination by an experienced surgeon regarding breast implant revision and mastopexy surgery. While there is no evidence that the risk of breast cancer is increased by textured nor smooth breast implants, the risk of Breast Implant Associated Anaplastic Large Cell Lymphoma is estimated at approximately 1:2000. Given your underlying tuberous breast deformity, you may be eligible for a medicare rebate to assist with part of your costs of revision breast surgery. I hope this is helpful.

Considering removal of breast implants can be a difficult decision.  Predicting the appearance of breasts after the implants are removed can also be difficult.  There are many factors that I take into consideration when seeing women for explant surgery.  The main factors include:
The size of the implants - the larger the implants (in relation to your body size) the bigger the change to your breast appearance after removal.
Skin quality - insertion of implants stretches the skin. The better quality your skin is, the more it will retract well after implant removal and your breasts may look fairly similar to prior to implant insertion.
Your expectations - in my experience, women who wish to have their implants removed have very different goals from when they were inserted. The more realistic your expectations, the more satisfied you will be after explantation.
Based on your photos (which is never as accurate as assessment in person), you may benefit from a breast lift (including an areolar reduction) at the time of explant, if you choose to go ahead. Currently there are no recommendations to remove textured implants, however as the absolute lifespan of an implant is unknown, many Plastic Surgeons would recommend removal +/- replacement at 10 years.  With a capsular contracture, Medicare will contribute to your surgery, however having valid private health insurance will cover a larger proportion of the cost of this surgery.    

The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Dear Bella4920,
It is hard to tell for sure without an examination but based on your photos, it looks like you might need implants removal and probably breast lift or implants exchange.. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If you are concerned about having textured implants, then consider having then exchanged for smooth implants. With the capsules, I would suggest removing the capsules and going somewhat smaller. Implants do not cause breast cancer, and the lymphoma (not breast cancer) from the textured implants is rare. Medicare will not cover removal or exchange since this is cosmetic surgery.

Based on your photo and description I think you would benefit from a revision to your breast surgery.  You can consider either removal or exchange of the implants along with a lift.  I encourage you to visit with a board certified plastic surgeon near you to discuss your concerns and learn more about your options.

Ultimately, whether or not to remove breast implants altogether (as opposed to undergoing revisionary breast  augmentation surgery) will be a very personal decision only you can make after considering the pros/cons associated with each option. Having said the above, based on your physical and mental concerns, you may be best off undergoing breast implant removal; breast lifting survey will likely also be indicated.  Also, you will be best off undergoing breast surgery once you have achieved your long-term stable weight if you are not there already.My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well.   I find that the use of goal photographs and computer imaging are very helpful during this communication phase. Working together you will come up with a good plan to achieve your goals.  Best wishes. 

If you have textured implants and/or wish to remove as much of the possible silicone, I would recommend an enbloccapsulectomydotcom and this I usually do through incision under the breast. This has become my specialty. This is removal of the breast implant together or en bloc wit the surrounding capsule so there would not be contamination of the remaining tissue. The main down side is that your breasts will probably sag more and be less full depending on the size of the implants removed but I usually do a breast reconstruction and possible fat grafting which I usually do at same time!There are several types from just a small uplift to a full anchor scar type. The larger the implant and saggier your breasts, the more scars compared to someone with small breasts and implants. If I do an en bloc procedure, I usually use drains which stay in for about 3-5 days.