Breast Implant Removal (Explant) Procedure

Breast Implant Removal (Explant) – Procedure

Breast Implant Removal or Explant operations by Specialist Plastic Surgeons in Sydney generally come in three variations.

1. Removal of the breast implant only
2. Removal of the breast implant with capsulectomy
3. En-bloc implant and caspulectomy

Removal of the breast implant only is a fairly simple and relatively quick procedure. It usually involves reusing your original scar from your breast augmentation surgery, or creating an inframammary fold scar. The required scar length is the shortest, as there is less need to move tissues around the capsule as it is dissected out. Drains are rarely required, as there is minimal new raw surface area. The pectoralis muscle is rarely repaired. This is the fastest option, it is the cheapest and easiest to find operating time, so waiting time is the least. Because it is a less involved operation, recovery time is the fastest. This can easily be performed as a day only procedure.

Removal of breast implant with capsulectomy is the next most complicated operation. There is a physical trade off between scar length and ability to perform an en-bloc capsulectomy. Sydney Plastic Surgeon Dr Gavin Sandercoe discusses an operative plan with the patient, but the patient also agrees pre-operatively that variations to this are sometimes required.

In normal thin filmy capsules, the lower ¾ of the capsule is often best separated from the surrounding tissues with the implant still in place (en-bloc) but the upper ¼ gets increasingly difficult without extending the scar length. The breast implant capsule is separated from the surrounding tissues until it becomes impossible to continue without tearing the capsule. At this point, either the implant needs to be removed to allow the last portion of capsule to be removed, or the incision (scar) needs to be extended to provide additional access & visualisation of the upper part of the breast implant capsule.

Sydney Plastic Surgeon Dr Gavin Sandercoe then spends time repairing the muscle and removing any additional scar tissue that might distort how the breast gland settles after the explant procedure. Drains are placed into the old breast implant cavity and the area is soaked in local anaesthetic. Discomfort after this procedure is linked to the need for muscle repair – the more involved that the repair is, the greater the expected level of post-operative discomfort. Whilst complete capsulectomy & muscle repair can be performed as a day only procedure, Dr Gavin Sandercoe recommends that patients spend the first night in hospital if they can afford it.

En-bloc capsulectomy is the removal of the breast implant and capsule in a single unit. This is usually requested by patients with systemic symptoms, and is popularised on the internet as a method to contain any disease or contamination that is originating from the breast implant and capsule. There is no evidence that en-bloc removal of the breast implant & capsule is any better or safer for ladies, except in the case of BIA-ALCL. This procedure requires greater physical access to work around the upper end of the breast implant capsule. Most patients have breast implants that are 11-13cm wide, and are usually inserted through an incision that is 5-6cm long. An en-bloc procedure in Sydney requires in incision of 9-11cm to perform the dissection safely and to remove the implant and capsule in one piece.

There are several limitations to capsulectomies and en-bloc procedures.

• Incision length. Complete capsulectomies require an extension of the original breast augmentation scar, and en-bloc capsulectomies may require further extension to allow access to the upper end of the breast implant capsule & remove the breast implant/capsule in one piece.

• Complete capsulectomy cannot be guaranteed. If removal of all of the breast implant capsule would result in death of the overlying skin or breast tissue, result in unacceptable muscle damage, or require the use of bone chisels to remove the capsule off the ribs, then Specialist Plastic Surgeon Dr Gavin Sandercoe reserves the right to leave segments of capsule behind during the explant procedure (except in cases of BIA-ALCL). This almost never occurs to abnormal (Baker Grade 3 and 4) capsules, but can occur to clinically normal (Baker Grade 1) capsules. Experience has shown that normal capsule is dissolved by the body over a few weeks to months.

• Drains are not negotiable after capsulectomy. Capsulectomy creates a large area of newly dissected/raw tissue that will weep fluid for a little while. The body can absorb some of this, but if it accumulates faster than the body can absorb it, then a puddle will form and a filmy capsule (much like a breast implant capsule) will form around the fluid, creating a seroma. Breast seromas are very difficult to cure and are best treated through avoidance. Sydney Plastic Surgeon Dr Gavin Sandercoe uses a thin drain with a small collection canister to make the drain as easy as possible to manage.

• Post operative appearance is not predictable. Sydney Plastic Surgeon Dr Gavin Sandercoe will measure you and perform a volumetric analysis with a Vectra 3D camera at your assessment. If you have all of the information about your implants, we can make an educated guess at the percentage of volume and projection that you will lose. It takes 3-6 months for the breast to completely recover from stretching, much the same way that breast shape is not settled and stable for that period of time after breast feeding.

• Performing a breast lift at the time of explant surgery is possible, but results are more predictable if the breast is given a 3-6 month break, which is the preference of Sydney Plastic Surgeon Dr Gavin Sandercoe. Older styles of mastopexy or breast lift plan nipple position according to measurements taken from the top of the sternum and clavicle (collarbone).  Below is a series of photos of a patient that Dr Gavin Sandercoe agreed to perform a breast lift at the same time as her explant. The nipple was moved into a good position based on chest wall measurements (only up by 2cm) but the 3 months after photos show that her breast shape is likely to have been better if no lift was performed at all!!

• Basic planning on chest wall measurements ignores the importance where the breast takes off from the chest wall (superior pole of the breast base, or upper breast border). Removing an implant changes this position/measurement and performing a breast lift without this information makes it harder for a Plastic Surgeon in Sydney to get your best result. The below diagram shows possible variations in the relationship between breast upper border and nipple position from:-

1. Preoperatively
2. Implant in place with upper breast border shifted superiorly
3. Implant removed and upper breast border returns to normal
4. Implant removed, upper breast border drops and nipple stays in a good position on the breast mound (nipple lift NOT needed, but some lower pole tightening might help breast aesthetics)
5. Implant removed, upper breast border drops and nipple drops on the breast mound (nipple lift will improve the breast aesthetics)

• Fat transfer is the obvious method to reconstruct your breast volume & shape with natural tissues. The major downfall of fat transfer to the breast by any Sydney Specialist  Plastic Surgeon is the inherent unpredictability. Please read the pages on fat transfer written by Sydney Specialist Plastic Surgeon Dr Gavin Sandercoe here. With this in mind, it is recommended that reconstruction is performed 3-6 months after explant surgery. This is most important after a complete capsulectomy, when the ability to contain the fat transfer in the designed space (breast, subcutaneous tissue, and to a lesser extent the pectoralis muscle) is substantially reduced by the removal of the implant capsule.

Breast explantation surgery is not considered cosmetic surgery under Federal & NSW Medical Board Guidelines. The usual 7 day cooling off period is not required for this procedure. This means that we are able to accommodate interstate and international patients that wish to consult on a Tuesday afternoon and have their procedure the following day. Patients wishing to streamline their assessment/operation are sent an electronic information pack, and need to return a form acknowledging that they have read and understood the information provided prior to booking & paying for their procedure.

Find out more about breast explant surgery in Sydney by booking an assessment using the enquiry form below.