I was advised explant under local with no capsule removal or muscle repair - is this standard?

Question

I have no issues with my implants and have only had them for roughly 4 months. I just don't like how they feel in my body. I was advised explant under local with no capsule removal or muscle repair. Is this standard? What happens to my capsule? Will it cause my breasts to scar oddly?

Alan Gonzalez, MD, FACS · Answer

Hello @Feelinglost16 thank you for your question. It is not safe, since local anesthesia has peaks that can generate inconveniences in very high doses. The most important thing is always the patient's safety. Carry out an adequate surgical plan in order not to have to deal with bad results derived from a bad practice. Is important in a breast explant to not only to completely remove the capsule but also to reconstruct the tissue. It is best to consult one or more board certified plastic surgeons to get more information and options tailored specifically to your situation. Best wishes! Alan Gonzalez MD FACS

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

Kristopher Day, MD, FACS · Answer

It would depend on the reason for explantation. If it is for capsular contracture, one of the most common complications of breast augmentation, then the capsule should be removed, and this is generally done under general anesthesia. If it is for breast implant-associated illness (BIA, not BIA-ALCL), then removal of implant does not require removal of the capsule. This could be done under local, moderate, or general anesthesia. So it really matters why you "don't like how they feel." As long as it's not because of a problem with the capsule, then the capsule should be reincorporate by you body not unlike a scar on the skin is reincorporated into the surrounding skin.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs, told us your bra size or your implant size. If your implants are large, you may have stretched your skin and the skin may sag after removal. However, it is possible to removal implants under local. The capsules usually do not need to be removed and usually resolve by themselves. If the muscle was cut during initial augmentation then the muscle cannot be repaired because it has retracted. Most patients will need a breast lift after implant removal.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Feelinglost16,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Stephen Brown, MD, FRCSC · Answer

It's unfortunate that you've had this surgery but aren't comfortable with the way your breasts feel. I agree with the recommendation that you have been given. There is likely a very thin capsule at this time which does not need to be removed and over time, without the implant in place, should disappear. If the implants are in a submuscular position, the muscle will adopt a normal position after the implant is removed and I would not suggest repairing these fibres. Your existing breast shape will not change after the soft tissues recover from the stretch of the implant which could take a couple of months. I hope that information is of some reassurance. Best of luck.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your breast augmentation.  When having your implants removed if you are having issues with the capsule, such as it being thickened or causing pain then it should be removed.  Otherwise it is an option.  Since you've had your implants in for such a short time it is likely that your capsules are very thin and can be left behind.  General versus local anesthetic is usually based on patient or surgeon preference and should be decided individually.

Connie Hiers, MD, FACS · Answer

Your implants can be removed under local anesthesia if you want. Your capsules are not yet fully formed and may slowly absorb over time. They are probably very thin  and can be left in place.  The muscle will probably just settle back down, but you still may see some amination when flexed.  Your tissue has been stretched with implants so you may have some sagging. You might consider going smaller since you were not happy before getting implants. Perhaps yours are just too big. Your pockets can be tightened internally if you choose to go smaller.

I was advised explant under local with no capsule removal or muscle repair - is this standard?

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