Other Surgical Procedures
Breast Implant Removal Surgery
Many patients have had breast implant surgery for cosmetic reasons and may have questions regarding management of these implants or want to know more about the options for implant removal. Hopefully, most patients were carefully counseled at the time of their original procedure, and were told that there might be a time when the possibility of breast implant removal may need to be considered. Unfortunately, there are patients in their 50s, 60s and 70s who have lost contact with their original surgeon. Some patients who come to Dr. Harris feel “trapped” into having their implants replaced again rather than removed due to concerns related to their breast appearance after loss of the implant volume or concern over the complexity of the breast implant removal procedure.
The most common clinical situations or patient concerns are:
- Complications with breast implant surgery
Many patients develop capsular contracture or hardening of the breast. This frequently results in asymmetry and pain. Many of these patients have had multiple revision surgeries and continue to have problems. The operations become more complex and outcomes more unpredictable-frequently at great expense.
- Mammary ptosis from a large implant placed to “fill-up” the breast skin envelope
These patients may have been better served initially with a breast lift without breast implants. Over the years these large volume implants (particularly those placed above the pectoralis muscle) cause progressive stretching and deformity of the breast with shoulder and neck discomfort.
- Post-implant surgery weight gain in the peri- and post-menopausal years resulting in significantly larger breasts from fatty breast tissue replacement
Though breast size may have initially been satisfactory after implant surgery, these patients are now too large for their body shape. They frequently complain feeling like they have too much bosom and often have difficulty in finding clothes and dresses to fit as they would like.
- Concerns about health issues relating to silicone or saline implants
Despite counseling, many patients’ best alternative may simply be breast implant removal.
- Due to age breast implants no longer fit the body image
This issue may not be something a patient wishes to deal with in the future. Larger breasts inhibit good exercise programs of which become more important during aging in order to maintain posture and balance in the 70s and 80s. Many patients would benefit from downsizing and lowering the their center of gravity as they reach the years when balance is of great concern.
Surgical options may include:
- A removal-only procedure
In most patients this may be accomplished under local anesthesia with or without IV sedation. If breast implants have been in place for a number of years and rupture or calcifications are present, implant removal is a more intensive surgery and might result in the need for a general anesthetic. The majority of patients will not need postoperative drainage tubes unless significant scar tissue is removed. Patients will be happy to know that recovery is significantly shorter than their original surgery with minimal discomfort.
- A concurrent breast lift for patients that have developed breast ptsois
This patient may need a concurrent breast lift to be incorporated with the implant removal. Most patients will need only internal suture lifting. Patients are pleasantly surprised with the look and fullness that result from this procedure.
- Structured fat grafting
For patients who would like to have some replacement of breast volume, structured fat grafting to the breasts may be helpful. Adding a breast (bra) cup size of volume with fat grafting from abdomen or hip “fat donor” areas is a very reasonable expectation. Some feel it is a bonus to lose a bit of fat from a place where they don’t want it! Fat grafting to the breast is now well accepted, and radiologists feel more comfortable discerning between the types of calcifications that may occur after the procedure.
As a physician first and a plastic surgeon second, Dr. Harris is sensitive to the evolving concerns of breast implant patients.