Ruptured Allergan textured implants - what is the best removal method?

Question

Hello, I've recently discovered I have a rupture via Ultrasound, and potentially mild grade 1-2 CC in the other breast (suspected by visual examination only). My question is what is the best and most suitable removal method? I initially hoped for the least invasive option, but now don't think that's possible due to my situation. Is capsulectomy the best option? Will an MRI give a clearer picture of how thick capsules are, and the full extent of the rupture? Thank you

Zoran Potparic, MD · Answer

Only at the time of surgery your surgeon will be able to decide whether capsulectomy is needed. I do not think that we came to the conslusion, yet, that after every textured implant remova full capsulectomy should be routinely performed? In cases like yours, if capsule is fine and thin, we would perform biopsies at 1-2 sites and send capsule for citohistology evaluation. You should didcuss this issue with your surgeon and possibly seek a second opinion consult. Good luck.

Alan Gonzalez, MD, FACS · Answer

Hello @Mish85, thank you for your question. Regarding the best removal method for ruptured implants, the most important thing is implant removal and total capsuleptomy. Although an MRI can help assess the implant capsular contracture, surgery may be the only way to fully understand the extent of the problem. In the end, it's usually necessary to do a complete capsulectomy to remove all capsule material and any affected surrounding tissue. The specific technique used for implant removal depends on the plastic surgeon's surgical approach. I always perform this surgery with a L shape incision. This allows me to remove the capsule and implant and reconstruct immediately with the BRLALAN esthetically adequate option would be immediate reconstruction with the BRALAN technique (Breast Reconstruction Anatomical Lift Augmentation) technique. Whether the implant and capsule can be removed en bloc or separately depends on the specific case. In cases where en bloc removal isn't possible, we remove the whole capsule to avoid any possible inflammation process in the future.  I link a video to shed more light. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),   International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Randal Haworth, MD, FACS · Answer

I'm sorry to hear about your situation. The best removal method for a ruptured breast implant and/or capsular contracture can depend on several factors, including the severity of the rupture, the type of implant, and the extent of the capsular contracture. In general, the treatment approach may involve removing the ruptured implant and surrounding capsule (capsulectomy) and replacing it with a new implant.

If there is suspicion of capsular contracture in the other breast, additional diagnostic tests such as an MRI may be recommended to help determine the extent of the contracture and whether surgical intervention is necessary.

An MRI can provide a clearer picture of the extent of the rupture and the thickness of the capsules. It can also help determine if there is any leakage of the implant outside the capsule. This information can be important in guiding the surgical approach.

Ultimately, the decision regarding the most suitable removal method should be made in consultation with your plastic surgeon. They will be able to assess your individual situation and recommend the best course of action based on your specific needs and goals.

Best of luck !

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Daniel Barrett, MD · Answer

Dear Mish85,
it is hard to tell for sure without an examination. 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 question. Total capsulectomy, in the EN BLOC fashion, is the best and ONLY option to remove your entire implant, capsule, and all inflamed tissue to ensure there is no spillage of silicone into the chest. This will be a catastrophe to manage. Please go to a reputable explant surgeon who only explants, and who has a track record of removing ruptured implants in EN BLOC fashion. MRI is always helpful to define the extent of silicone spread.

Richard A. Bartlett, MD · Answer

Further imaging may be indicated to assess the possible rupture. I suggest reaching out to your original implanting surgeon to discuss further imaging and a physical examination.

Connie Hiers, MD, FACS · Answer

You do not need a MRI. The best surgery is to remove the implants since you have a rupture and remove the capsules since you have a capsular contracture.

Ahmad H. Ahmadi, MD · Answer

Capsulectomy may not be needed if you don’t have any symptoms and the capsule is thin.  However, textured implants tend to stick to the capsule, thus necessitating capsulectomy.  Regardless, You should have a board-certified plastic surgeon examine you for further recommendations.

Camille Cash, MD · Answer

From your description you will want to consider en bloc implant removal.  With this approach the implants and capsules are removed as one unit.  You can elect to have the implants replaced at the same time if you want.  Visit with a board certified plastic surgeon near you to learn more.