Since the introduction of breast implants in the early 1960’s over 2 million women have undergone implantation.
At some point in their life, patients will require either removal or replacement of the breast implants. The most common reasons patients request explanation are ruptured implants, capsular contractures, and the desire for elective removal of the implants.
Why Consider Breast Implant Removal with Dr. Farrell?
We are happy to evaluate and consult our patients who are seeking advice concerning the removal of their breast implants. It is important to determine the age, location, and type of implant used, as well as, any history of pregnancy, weight gain or loss, and breast size before augmentation. Patients should have a base line mammogram within 12 months and a breast examination prior to implant removal.
It is important that we discuss with our patients the expectations for post explanation breast size and the nature of aging on the augmented breasts.
Patients who choose not have to have breast implant replaced may desire additional contouring procedures such as breast lift or mastopexy to improve the breast shape and nipple position.
We are interested in caring for those patients, who are interested in the removal of breast implants without replacement.
Aesthetic Management of the Breast Following Explantation
Management of the breast following explantation, implant removal, and capsulectomy has improved over the last several years. The most common reasons patients request explantation are ruptured implants, severe or recurrent capsular contractures, and the desire for elective removal based upon continued concern about silicone gel-filled implants.
It is important, when possible; to determine the age, location and type of implant that was used, as well as any history of pregnancy, weight gain or loss, and pre-augmentation breast size. In addition a baseline mammogram should be completed at least within 12 months prior to surgery to assess the overlying breast tissue for pathology. Examination of the breasts to evaluate the degree of preoperative ptosis, the amount of breast tissue overlying the implant, the areolar size, and the size and position of the implant and degree of skin elasticity.
The severity of the pre-operative breast ptosis is the most important determinate as to whether a patient is a candidate for breast contouring after removal of the implant. The thickness of the residual breast tissue determines the safety of a simultaneous breast contouring· procedure with explantation. If a mastopexy or breast lift is desired skin elasticity the implant position and nipple /areolar size are important factors.
The goal of explantation is to remove the implant and the capsule if possible without implant rupture. Residual capsules can affect mammograms which make breast evaluation more difficult. Another reason to remove the capsule is the presence of residual silicone particles within the capsule. With explantation drains are often placed at the time of surgery and are usually removed one week later.
Breast Contouring Options After Explantation
There are several options for patients desiring explantation. The patient can undergo breast contouring alone or breast contouring with implant replacement or explantation alone. The type of breast contouring usually performed is called a mastopexy, which involves a rearrangement of the nipple/areolar position and removal of excess skin. Some patients require a delay of breast contouring surgery due to risk factors related to paucity of breast soft tissue, smoking, and the need to transpose or move the nipple more than several inches. Removal of breast implants or explantation has become an important aspect of plastic surgery since in the last several decades over one million women have undergone breast implant insertion for a variety of procedures and an awareness of the issues related to breast implant removal is important to all women who currently have breast implants.
Breast Implant Removal (Explantation)
Implanted breast prostheses are made of silicone shells filled with silicone gel or saline. Implantation can be indicated for medically necessary reasons such as breast reconstruction following a mastectomy or for cosmetic reasons.
Complications can occur with breast implants that would require removal of the implant. Examples of complications include infection, extrusion (implant exposure through the skin), rupture, and contracture. A contracture occurs when the capsule surrounding a breast implant tightens. The breast will feel hard and become painful. Disfigurement can result if the capsule around one implant contracts and the other does not. Contractures have been graded according to the Baker classification as follows:
- Baker Grade I: Augmented breast feels as soft as a normal breast
- Baker Grade II: Breast is soft and the implant can be palpated, but is not visible
- Baker Grade III: Breast is firm, palpable and the implant (or its distortion) is visible
- Baker Grade IV: Breast is hard, painful, cold, tender and distorted
Indications for removal of silicone gel-filled implants
The removal of silicone gel-filled implants placed for reconstructive treatment or cosmetic purposes is considered medically necessary and may be covered by insurance for the following indications:
- Documented implant rupture
- Infection or rejection
- Siliconoma or granuloma
- Baker Grade IV contracture
- Interference with diagnosis of breast cancer
- Surgical treatment of breast cancer
Baker Grade III Contracture
The removal of silicone gel-filled implants placed for reconstructive purposes is considered medically necessary for patients with Baker Grade Ill Contracture where the breast is firm, palpable and the implant is causing visible distortion. Removal of breast implants placed for cosmetic purposes would also be a possibly covered procedure.
Surgery necessary to improve, correct or further alter the appearance of the breast, which has been previously done for a cosmetic indication, is often considered a revision procedure that is not covered by medical insurance. Individual insurance benefits must be verified prior to surgery.
How to Get Started with Breast Implant Removal in Mechanicsburg
To get started with breast implant removal surgery in Mechanicsburg, contact Farrell Plastic Surgery & Laser Center today.