Should I get my implants removed now or wait until after having kids?

Question

Six months after surgery my dr. said I had Bilateral CC. They do not hurt me anymore, but I just am uncomfortable with the size and want them out. I’m about to start a job as a nurse that will require me on occasion to lift objects possibly greater than 5-10 lbs. I want Hto get pregnant in about a year. Would it be worth it to get them removed before? Also, would I HAVE to have a capsulectomy? What’s the recovery time like? Also, will this affect BF at all with children?

Jed H. Horowitz, MD, FACS · Answer

hello acarter13  This surgery is not known to interfere with pregnancy.  If you are planning a pregnancy, your breast skin may stretch and undermine the results of surgery.  You may have more difficulty breastfeeding after this operation. #recovery #capsulectomy

Anita Patel, MD, FACS · Answer

If you are uncomfortable with the size now, you may be better off having the implants removed now. The breasts will grow during pregnancy, and this will stretch your skin and increase your breast size even more, so if you are uncomfortable now, imagine being larger, heavier, and more stretched. Also, capsular contracture when left untreated tends to get worse over time, and the breasts can develop more hardening, breast distortion, and even pain. You do not have to get the entire capsule removed, though typically part of it is removed if you have some degree of contracture. Implant removal without capsulectomy would not be expected to negatively impact breastfeeding ability, though if there is aggressive capsulectomy and breast tissue is also removed, there is a greater chance of affecting it. The bottom line is any breast surgery can theoretically affect breastfeeding ability. The recovery from implant removal is typically much easier than for implant placement, though often drains are placed that stay in 3-5 days on average.

Benjamin J. Cousins, MD · Answer

Thank you for your question and post. Generally, if the implants are not causing you any problems, then you can keep them. And this is also a personal decision about whether you want to have them or not. When the implants are removed, the capsule is removed as well. If the scar/ early capsule is very thin and immature, not thickened, not causing pain, not contracted or causing other problems, it does not have to be completely removed with the implants (en bloc) as this may cause unnecessary bleeding, pain and muscle/tissue trauma damage and injury to the breasts/chest. Be sure to see a Board Certified Plastic Surgeon who can examine you in person and take time to answer any and all questions you may have. 
  
Sincerely, 
  
Dr. Benjamin J. Cousins MD Board Certified Plastic Surgeon Miami/Miami Beach FL

Camille Cash, MD · Answer

You do not need to wait until you are finished having children to have your implants removed.  The removal should not interfere with your ability to breast feed.  You will likely need to have the capsules removed, but an examination is needed to give a more definitive opinion.   I encourage you to visit with a board certified plastic surgeon in your area for a consultation and to learn more.

Jeanette Padgett, MD, FACS · Answer

Thank you for posting your questions.   If you are uncomfortable with the size of your implants and want them out, then go ahead and have them out now.  You will have time to heal before a future pregnancy.  More than likely, it would be best to remove the capsule if you have capsular contraction.  The recovery time would be 3-4 days if you have a desk type job with lifting restriction of 5-10 pounds for a month.  Once healed, you should be able to breast feed.  Best wishes with your surgery.

Brian K. Brzowski, MD, FACS · Answer

It's really up to you to decide whether to wait to have your implants out or to do it later. Of course, if you go ahead now, the issue you're having with heaviness will be improved more immediately. That said, if you wait until you're done with kids you'll have an even better idea what size you'll be without them - it's definitely possible that you'll lose more breast volume with the next pregnancy and wish you had some volume from an implant still.You didn't say whether you had saline or silicone, but if they're saline, you might consider a pre-explantation deflation (emptying the implant with a needle under local anesthetic) to see even more accurately what your breast size will be if you just took them out.I'd definitely plan on removing the capsules. If they are just tight, they could be left behind, but the residual tissue is always present. Furthermore, you're at more risk for a fluid accumulation in that slippery, moist pocket. You'd especially want them out if they are thickened or calcified (an intraoperative finding).Recovery is generally pretty quick: desk work in 2-3 days; full activities in 2-3 weeks provided you're healing well. Breast feeding shouldn't be affected unless the implants are on top of the muscle and you have a lot of dense scar tissue/capsule that is adherent to the gland and must be removed.Lastly, you may have some other options to help you with the heaviness besides just taking out the implants. For example, liposuction is often helping along the edges to reduce that boggy, heavy sensation. I will admit that most patients who decide to remove their implants are happy with that choice. Just be sure you're fully informed and have been adequately counselled about your options by an experienced board certified plastic surgeon.Best of luck, and thanks for going into nursing. We surely need great nurses: "any amount of great doctoring can be undone by bad nursing". Good on ya :)*This is an original answer authored by Dr. Brzowski. No staff members created this document, and this reply is not cut and pasted from previous answers.*

Connie Hiers, MD, FACS · Answer

Since you were not happy with your breasts prior to surgery, and pregnancy does often change the way your breasts look, I would suggest waiting until you have had all the children you want.  Then, consider what size you want and if you need a lift. The fewer surgeries you have on your breasts, the less scar tissue is present, and the risk of interfering with breast feeding is less.

Tom J. Pousti, MD · Answer

OUltimately, timing for this type of surgery will be a very personal decision.  On the one hand, there is no urgency to have the procedure performed, especially given that you are no longer in pain.  Waiting until you have completed pregnancies will  potentially minimize the number of breast operations you undergo (for example, it is possible that you may choose to have an operation such as breast augmentation or lifting done after completion of pregnancies, depending on how your breasts change with pregnancies). Given your history, I would recommend a capsulectomy when you undergo breast implant removal surgery. Most patients are able to breast-feed after this type of surgery. Best wishes.

Chad Robbins, MD · Answer

Hello and thank you for your questions.   It sounds like you want them removed now and that's fine, especially with capsular contracture.  Yes, you would have to have a capsulectomy when they are removed.  If you can keep your lifting , pushing and pulling to no more then 8 lbs or so,for three weeks post surgery.

Robert Whitfield, MD · Answer

If you have capsular contractors then I would typically perform a capsulectomy on both sides and check each side for bacterial infection.  I have found several patients to have infections.  I would go ahead and get the implants and capsules out prior to pregnancy. It should not interfere with your ability to breast feed.

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