How can you tell at a consultation that breast implant removal will be simple removal vs a capsulectomy?

I have 18 yo mentor (I think 450-500cc) silicone implants under the muscle. No problems with the implants (no hardness or pain, etc) - have been wanting them removed for last 5+ years. ( I was a 34A before sx - currently 36C) What criteria makes a lift necessary?

Doctor Answers 7

Your Breast Shape and Your Expectations

The position of your nipple will determine if a lift would be desirable.    If your nipple is above the level of the folds, a lift in all likelihood will not be necessary.    If your nipples are right at the fold, options will have to be discussed with your surgeon prior to surgery.

Implant Removal

Good morning and thank you for your question concerning the implant removal process. This answer is best decided during an in person evaluation. At that time, the surgeon will physically examine by palpation to check for hardness and current implant location. You will also be asked questions about pain or tenderness in or around your breasts. Sometimes, an ultrasound of the breasts will be ordered to check for rupture just so the surgeon will have a better idea of what to expect during the surgical process. As for the lift, that depends on how you want to look after surgery. Even without examination or photos, I can tell you that by just removing the implant alone and closing up, you will left with loose, sagging breast tissue. These are all things that you can discuss at your consultation with a board certified plastic surgeon. Good luck to you!

Michael K. Obeng, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 46 reviews

How can you tell at a consultation that breast implant removal will be simple removal vs a capsulectomy?

Thank you for the question. Don't be surprised if you receive a variety of differing responses. Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en block removal of breast implants is a good procedure. On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity. Recently I have become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy is always necessary and undergo unnecessary surgery associated with additional morbidity and unnecessary expenses.
Careful physical examination will be key when it comes to determining whether or not you will benefit from breast lifting surgery. In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt (allow for about six months to pass after breast implant removal) before deciding whether breast lifting would be beneficial.
I hope this, and the attached link (dedicated to breast implant removal surgery concerns) helps. Best wishes.
 

18 year old implants

After 18 years of having your skin stretched out by your implants and gravity pulling on your implants you will require a breast lift following implant removal. This is a tricky surgery and requires a modification of routine lift techniques to ensure avoidance of nipple areola loss. Please see examples below.

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 44 reviews

How can you tell at a consultation that breast implant removal will be simple removal vs a capsulectomy?

Hi and thanks for your question. If the capsules are firm then removal of the capsule or capsulectomy may be required. With such large implants it is quite likely a breast lift will be needed if you decide to either downsize the implant volume (say from 450 cc to 350 cc) or not replace the implants. The final decision may have to be made by your surgeon at the time of breast surgery. My advice is to seek a surgeon who is certified by the American Board of Plastic Surgery, a member of the American Society for Aesthetic Plastic Surgery, and very experienced in revisionary breast surgery. That's my recommendation after 30 plus years performing aesthetic plastic surgery. Best of luck!
Richard Chaffoo, MD, FACS, FICSTriple Board Certified Plastic Surgeon

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.7 out of 5 stars 17 reviews

Removal of implants... What to know

First, when your submuscular implants are removed you need the muscle repaired. This is important in order to avoid a pec flex ion deformity. That muscle was cut from the ribs when the implants were placed and it needs to be put back. Next, some people need a capsulectomy too, but most don't. Capsules are YOUR tissue that wraps around the implant, and I only remove it if it is abnormal, like some capsular contracture or ruptured silicone etc. finally, needing a lift depends on you. You know how some women look great after pregnancy, others are all stretched out? Same with boobs. Generally speaking, if you look like you need a lift already, once the implants are out you will definitely need a lift. Big implants that are in longer are usually worse, i.e. over 400 cc. Also good to know is surgeons can cheat the breast up to some degree, there's a big round hole in the breast, and you can use it to suture the front half higher up than it would be otherwise. Good luck. 

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 13 reviews

Ask the surgeon

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Implant removal often is performed with some degree of scar tissue removal. A drain should be placed to reduce the incidence of seroma. 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 40 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.