Breast implant removal advice (Photo)

Question

Hi, I’m 26 years old - no children. I’ve had 325cc high profile textured implants under muscle placed 4 years ago, I feel like they don’t suit my frame and feel a little too big for me. For past 2 years I feel i my posture has been so bad because they feel uncomfortable sleeping or when exercising. Some surgeons advise leaving capsule in, others say I might need muscle repair. How will my breast look after? I’m terrified

Jeffrey M. Darrow, MD · Answer

Thank you for your photos.  First, if you don’t feel your implants fit your frame then removing them will correct that.  If you have not put on weight since your augmentation, removal of your implants should return your breasts to their appearance before your augmentation.  At 26 years of age, your skin has excellent elasticity and should snap back to it’s prior contour.  Although rare, textured implants are associated with a very rare type of tumor, called anaplastic large cell lymphoma, and removal should eliminate any concern of that in the future.  The current recommendations from the American Society Of Plastic Surgery is that, unless there is a high degree of capsular contracture and calcification of the capsule, removal of the capsule is of no benefit and is unnecessary.  I don’t have the benefit of an examination so I can’t speak to whether you would need a repair of your pectoral muscle or not. A review of your prior operative note would tell if your prior surgeon divided your muscle or not.  So to summarize, removal of your implants, without the need to remove your capsule, and the possibility of a small repair of your muscle should return you to your preoperative appearance.  Best wishes.

Alan Gonzalez, MD, FACS · Answer

Hi @wowowi, thank you for your question. From my practice and experience, I consider that the capsule should be completely removed, since this being an inflammatory tissue, it is not reabsorbed and can generate immunological problems in the patient. Additionally, a breast implant removal should be combined with an immediate breast reconstruction to reposition the breast tissue and improve the projection of the upper pole and medial areas through the BRALAN Technique (Breast Reconstruction Anatomical Lift Augmentation) since the results will be adequate in terms of aesthetics and will have a minimal L-shaped scar. If you are thinking about breast augmentation, consultation with a plastic surgeon with experience in this procedure is essential to ensure optimal results. Best regards.

Alan Gonzalez MD, FACS. Member of the American Society of Plastic Surgery (ASPS), Member of the International Federation for Adipose Therapeutics and Science” (IFATS), Member of the Colombian Society of Plastic Surgery (SCCP).

Alan Gonzalez MD, FACS. Member of the American Society of Plastic Surgery (ASPS), Member of the International Federation for Adipose Therapeutics and Science” (IFATS), Member of the Colombian Society of Plastic Surgery (SCCP).

Yucel Sarialtin, MD · Answer

Hello,
thank you for your question.
At 26 with good skin quality and no pregnancies, you’re likely to have a favorable outcome after explant, though some breast deflation or mild sagging may occur depending on your tissue and implant effects. If your implants feel too large or uncomfortable, removal is reasonable, and your breasts may return close to your pre-op shape over time. Whether the capsule should be removed or muscle repaired depends on symptoms and intraoperative findings. A lift or fat grafting can improve contour if needed, but many young patients heal well without additional procedures.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

I understand your concerns. This really depends on what implants you have in and on an examination to determine whether you would benefit from capsule removal and how much breast tissue you will have remaining after implant removal. If you are concerned about being too small following removal, you could consider having a smaller implant placed, or some fat transfer to boost your breast volume.

Daniel Barrett, MD · Answer

Dear wowowi,
it is hard to tell for sure without an examination. Generally speaking, if your capsules are thin there is no need for their removal. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Shaher W. Khan, MD · Answer

Hello, thank you for your questions. It's completely understandable to feel anxious about the prospect of undergoing surgery, especially when it involves your body and aesthetics. Let’s break down your concerns regarding your breast implants, potential surgery options, and what to expect in terms of appearance and recovery in the attached video. Deciding to undergo breast surgery is a personal choice that requires careful consideration and planning. It’s important to weigh the pros and cons, seek professional advice, and choose a surgeon you trust. Your comfort and confidence in your body are paramount, and with the right approach, you can achieve a result that aligns with your goals while addressing the discomfort you’ve experienced. Take your time to make the best decision for yourself, and know that you’re not alone in this journey!

Gary M. Horndeski, MD · Answer

325 cc implants are about an average size. However, after removal, your skin will hang. An alternative to consider is doing fat transfers at the same time with a donut mastopexy. The donut mastopexy can take care of the excess skin and the fat transfers will give more volume. In your pre-op photograph, you look like you were asymmetrical in volume. One side will need more volume than the other.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

If your capsules are thickened or are causing issues they should be removed along with the implants.  If they are thin you can elect to remove just the implants and leave the capsules behind.  You will lose the volume of the implants and have some loose skin after surgery.  You will have some degree of skin retraction, which will be aided by the fact that you are young and have moderately sized implants.  One option if you like implants, but don't want them as large is to exchange them for a size that you feel better matches your frame.

Connie Hiers, MD, FACS · Answer

I would suggest removing the capsule and going down in size. The lateral pockets can be tightened if needed. You were not happy with your breasts prior to surgery and may not be happy once removed. You feel that they are too large, so going down in size might be your best answer.  You might like 200-255 cc implants which should drop you down about a cup in size.

Mats Hagstrom, MD (license on probation) · Answer

Before deciding to remove your implants, you should be certain that you don’t want implant augmentation in the future.
The worst scenario is having the implants removed, then changing your mind that you want to implants.
The number one indication for a capsulectomy is if the capsule has thickened.
If the capsule is very thin, then it becomes technically very difficult to remove the capsule.
In these instances capsule removal is also not indicated.
Failure to properly remove the capsule with the removal of implants when the capsule is thick can lead to the breast, looking distorted afterwards,
 if that’s the case, removing the capsule after evidence of disfigurement becomes much more difficult from a technical perspective.
There’s also the decision if a drain should be placed.
If the capsule is left, then there is a better indication for using drains.
When in doubt drains should probably be used.
As with almost all plastic surgery procedures, provider selection is by far the most important variable.
In the hands of the right provider correct decisions will be made.
Best,
Mats Hagstrom MD

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