Would 2 separate procedures be best to remove my implants?

Question

I am planning to explant textured under the muscle for back / neck pain reasons and not wanting ALCL. Would it make sense to just remove implants first then capsules later? I have a 4 month old at home and would have to hire help to care for her during recovery if I went ahead and did the whole procedure at once. My understanding is that removing the implants is very easy and recovery is as well vs a complete explant with enbloc?

Jed H. Horowitz, MD, FACS · Answer

Good day! Generally after explantation, the shape and size of the breast will be unpredictable. Yes, it will be smaller and possibly sag. Result varies between patients and it will largely depend upon their age, duration and size of the implant, or previous state of their breasts like existing anatomy, deformity, previous surgeries, underlying personal and family medical conditions, nicotine use, pregnancy and other factors. That's why it is suggested to wait for explantation results to show before deciding for a lift, but yes, you may also do the lift with the explantation to save time and money. Do not hesitate to contact your surgeon about this and discuss realistic goals and expectations. Best of luck! #RealSelf100

Eric Wright, MD · Answer

If you want both the capsule and implants removed, I would recommend having them at the same time.  Recovery for the en bloc is typically a week.  It does depend on whether your implants are placed in the submuscular position.  This can be a little more uncomfortable during the initial recovery.  As well, it depends if any muscle is sutured at the time of the en bloc.  All of these questions can be addressed during your consultation with a plastic surgeon.  Good luck with your surgery.Dr. E Wright

Gary M. Horndeski, MD · Answer

If
you are having neck and back pain and concerned about ALCL, the implants should
be removed.  Whether the capsules need to
be removed or not is determined by the surgeon at surgery.  Removing the capsules creates more bleeding
and damage to the remaining tissue.  The
majority of patients who undergo explant only are dissatisfied with the
appearance and require a lift later.  However,
a lift can be done at the same time, if desired.  The technique I recommend is explantation
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
and the ability to breast feed are maintained, if not injured during your
previous surgery.  At the same time or
later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear vinyasabutterfly,recovery process is not that much different after implants removal and implants + capsules removal. 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

Nelson Castillo, MD · Answer

Thank you for sharing your question.  If your implant capsule is amenable to being left behind, a two stage procedure can be performed.  That said, recovery from an en bloc procedure is not significantly different and most surgeons would recommend having both performed at the same time.  Hope this helps.

Kenneth Hughes, MD · Answer

Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.ALCL is diagnosed by testing the fluid (seroma) that collects around the implant.  Seroma is usually not caused by ALCL.  Even when ALCL is in the breast, it is not breast cancer, but rather a cancer of the immune system.  Most breast implant-associated ALCL has cancer cells within the fluid inside the scar capsule. That ALCL can be treated by removing the implant and the surrounding scar tissue - a capsulectomy.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Connie Hiers, MD, FACS · Answer

I would suggest removing the capsules with the implants in one procedure. Every surgery has risks, and this can all be done with one surgery and one downtime.

Nandi Wijay, MD · Answer

If the capsule is firm and painful, we recommend removing the implant and the capsule at the same time. 
The advantages of 1 stage procedure is that you only have to have general anesthesia once!   The advantage of 2 stage procedure is that you can see how the breast settle after implant removal. Then weeks later you can perform the lift.  Also, in a 2 stage procedure you can "delay" this skin flaps which may provide a safer breast lift.  
  In regard to the capsule, if the capsule is firm and painful we recommend removing the entire capsule.  If the capsule is soft, we can sometimes preserve the capsule and use the capsule to our advantage.

Jeanette Padgett, MD, FACS · Answer

I don't think it is necessary to have 2 separate procedures.  I would recommend that you remove the implants and the capsules in one surgery.  That way you only have one recovery period, one surgery and generally less expense.   If you decide to procedure with a breast lift, I would wait several months until your breast tissue has settled.  It will be more apparent at that point if you need or desire a lift.  Best wishes.

Gregory Sexton, MD · Answer

I would remove implants and capsules at the same time. Recovery should not be bad, and no sense in doing it twice.good luck,Greg Sexton, M.D.Columbia, S.C.

Would 2 separate procedures be best to remove my implants?

Answers (17)

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