Should I have my saline implants removed or just replaced?

Question

56 yr old athletic woman who has had saline implants 24yrs now. No problems with them except for the fact in the last 9 years i have developed 3 auto immune diseases. Wondering if implants are the cause. What type of extract procedure should i look for if i were to remove? En blc? Extract with complete capsole removeal? Implants are also under the muscle. I'm really confused on which way to go.

Robert M. Wald, Jr., MD · Answer

No studies have connected directly autoimmune disease and breast implants. However, there is the possibility that this exists- further studies are needed. I would recommend a complete capsulectomy and implant removal to see if this helps your medical condition. En bloc is a complete capsulectomy and if possible can be performed. Please realize that removing your implants may have no affect on your autoimmune disease. However, in my practice, I have seen many woman that have improvement in their symptoms.

Shaher W. Khan, MD · Answer

Hello, thank you for your question. It's completely understandable that you're feeling confused, especially with the health concerns you've mentioned and your long history with saline implants. Let's go through your situation and help clarify your options for implant removal, as well as address concerns regarding autoimmune diseases in the attached video. Given your autoimmune conditions and long history with implants, it may be beneficial to explore more thorough explant options like En Bloc Capsulectomy or Total Capsulectomy, which would address both the implants and any surrounding capsule that might be contributing to inflammation or immune responses. This approach can give you peace of mind, particularly if you're worried about the potential health effects of your implants.
However, it’s crucial to speak with a qualified surgeon who specializes in breast explantation. They can help assess your situation, guide you through the procedure options, and discuss the potential for future changes (like a lift or re-implantation) depending on how you feel after healing.
The right procedure for you will depend on your health, aesthetic goals, and personal comfort, and a well-experienced surgeon can offer the best plan moving forward.

Daniel Barrett, MD · Answer

Dear Exquisite687809,
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

Alan Gonzalez, MD, FACS · Answer

Hello @Exquisite687809, thank you for your question. It is best for your health to remove the implants as soon as possible since you have had them for 24 years and have developed 3 autoimmune diseases. I've been performing breast implant removal from suspicious of Asia Syndrome (BII) from 4 years ago, before that, it was  because of giant cells linfoma. I can attest  that Asia syndrome is associated with implants, is what we call a young desease (is an autoimmune, auto inflammatory desease first diagnosed 10 years ago), but it does not happen in every patient with implants. The statistic shows that from 100 patients one can present Asia Syndrome.  Not all patient develop it , 99% of the patient does not have it. Even if the prosthesis is saline, you must undergo a complete capsulectomy to avoid future inflammation. The prosthetics can be removed, but the key is that a complete capsulectomy is performed by the specialist.  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).

Ryan Rebowe, MD · Answer

While the breast implants are unlikely the cause of the autoimmune issues, an acceptable result can be achieved by removing the implants. If you would like to rule out the implants as the cause or exacerbation of your autoimmune disease, I would ask for an en bloc capsulectomy, which may or may not be feasible depending on how your original surgery was performed. Typically, women who remove their implants will also require a lift with this procedure. I would also inquire about fat grafting, however if you are very athletic you may not have much in terms of donor site tissue to augment the breast following explantation.

Zoran Potparic, MD · Answer

Providing that you do not have any problems with your current implants, the simplest procedure would be replacement with same type and volume, saline implants. In same patients, due to long term implants presence, there may be atrophy, volume and shape change, that may benefit from fat grafting, breast lift or similar. Hope this helps.

Randal Haworth, MD, FACS · Answer

There is ongoing research on the potential link between breast implants and autoimmune diseases. While some studies have suggested a possible association, there is no conclusive evidence to suggest that breast implants cause autoimmune diseases.

If you are considering removing your implants, it's essential to consult with a board-certified plastic surgeon who has experience in implant removal and can help you weigh the benefits and risks of different approaches. The type of extraction procedure recommended will depend on factors such as the type and placement of the implants, the condition of the surrounding tissue, and your desired outcome.

In general, there are two types of implant removal procedures: en bloc and total capsulectomy. En bloc removal involves removing the implant and the surrounding scar tissue (capsule) as a single unit, while total capsulectomy involves removing the implant and the capsule separately. The choice of procedure will depend on the extent of scar tissue and your surgeon's preference.

It's important to have realistic expectations for the outcome of implant removal surgery, including changes in breast shape and size. Your surgeon can help you understand what to expect and whether additional procedures such as a breast lift may be necessary to achieve your desired outcome.

I hope this helps,
best of luck !

Shana Kalaria, MD · Answer

Because you have had your implants for so long, the skin is likely stretched out and you will benefit from a lift at the same time as explantation. You do not need the complete capsule removed unless there is an issue like capsular contracture or irregularities of the capsule which are very rare with saline implants. I would recommend removal of your implants and a breast lift. Please visit with a board-certified plastic surgeon with experience in this procedure. Good luck!

Connie Hiers, MD, FACS · Answer

First, your implants may not be the source of your health problems. Do be checked for food and environmental allergies. Do not get tattoos since the ink does have harmful metals and chemicals present. "En bloc" is a term used for surgery for cancer patients and not for the removal of capsules.  I would first meet with your primary care physician and make sure your issues are not related to things like foods, personal care products, or cleaning products used.  I have seen saline implants that were 40 years old and doing well.

Alireza Najafian, MD · Answer

Based on the most recent studies, there is no evidence that implants contribute to autoimmune diseases and en bloc capsulectomy resolves BII symptoms. Specially in your case with saline implant. However, with old implants, it’s important to have them checked and remove/exchange them as needed. Scientifically, the en block procedure does not offer any advantages over total or partial capsulectomy unless patient has the very rare type of textured implant related lymphoma. As a rule, I always discuss this with patients that my goal is to safely remove as much capsule as possible. However, if the capsule is very thin and healthy looking, or if it has adhesions to the chest wall (in under the muscle cases) and not looking concerning, it can be safely removed in place and just scraped. I have not had a case the capsule could not be removed but it is always important to keep that chance in mind. At the end of the day, your health and safety is your surgeon’s number one priority. Also, after having implant for a long time, they leave a footprint on the chest wall and removal of the implant without replacement or reconstruction would likely result in flat/concave appearance of the chest wall. So that goal also need to be clearly discussed with the surgeon.

Should I have my saline implants removed or just replaced?

Answers (12)

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