Implant explantation without replacement - lift at the same time? Also capsule to be left in or remove?

I am considering explantation without replacement of implants as I am worried about ALCL and any silicone bleed. I guess I would need a lift as my implants are over 500cc. Would you do this at the same time as explantation? I have tuberous breasts. Also would the capsule need to be removed to prevent any future ALCL? My surgeon did say that if it was too stuck to the chest wall he would need to leave well alone. Would fluid just build up all the time in the empty cavity?

Doctor Answers 3

Mplant explantation without replacement - lift at the same time? Also capsule to be left in or remove?

We simply do not have enough information to give you any answers. We would need age  of implants, degree of capsular contracture and photos of your present anatomy. AN exam is always best. But you have already seen a consultant and have an opinioin, so if you don't trust that surgeon I would suggest you get another two or three consults. they will be able to tell you much more than we can. 

Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant explantation without replacement - lift at the same time? Also capsule to be left in or remove?"

Thank you for the excellent question. Short answer: much will depend on your physical examination ( factors such as degree of breast ptosis, current position of breast implants, number of previous operations, assessment of breast skin quality/elasticity…) and your plastic surgeons' clinical judgment.  
Longer answer: in person consultation will be necessary to provide you with precise advice. The main issue of concern is adequacy of blood flow given the extensive breast surgery planned. In my opinion, if the degree of breast lifting ( distance of movement of the nipple/areola complexes) is significant, then you may be better off having the procedure performed in 2 stages. If the degree of breast lifting is relatively small ( shorter distance of movement of the nipple/areola complexes) then it is likely that the procedure can be performed in one stage. If in doubt, in my opinion, the two stage approach is safer.
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.
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 you to additional risks, such as bleeding and minimal size loss. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity).I hope this, and the attached link (dedicated to breast implant removal surgery concerns) helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

Implant explantation without replacement.

Thank you for your excellent question.  Without an in-person examination, or a full series of photographs, it is difficult to offer definite recommendations but based on your implant size alone you will likely benefit from a lift procedure.  This can be done at the same time as your explantation or it can be done in a staged fashion.  Depending on the character of the capsule I will remove it completely when thickened, hardened/calcified, or if it shows some irregularity.  This allows for examination by a pathologist as needed.  At times some capsule is left behind if there is concern for overlying skin viability or if it does not come off of your chest wall.  Hope that this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 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.