Breast Implant Removal
When Should You Consider Breast Implant Removal?
There are several reasons that patients may choose to remove breast implants.
Breast augmentation is the most popular cosmetic surgery in the world. With a nearly 100% patient satisfaction rating, breast augmentation aims to help women feel more confident in their appearance with breasts that perfectly suit the body.
However, a small percentage of women feel unhappy with breast implants after receiving them. As an individual, it is normal and acceptable to change your mind about wanting breast implants.
Premier Plastic Surgery Center wants every woman to feel confident about her breasts and body. If that means removing breast implants will make you feel true to yourself, then that is something Dr. Ferrari can help with. Contrary to popular belief, breast implants are reversible.
Breast implant removal due to changing your mind about breast implants involves a small incision, usually about 2.5” long (depending on breast implant size and type), that is placed in an inconspicuous area, such as hidden in the breast crease. Dr. Ferrari will then remove the implant and surrounding scar tissue capsule. The incision is sutured closed in layers. Absorbable stitches can be used in most cases. The scar will heal similar to the first operation, eventually fading to a thin, pale line that blends in with the skin over time.
Some women experience little to no sagging after breast implant removal. Younger patients, those with small implants, and women that only had breast augmentation a short time ago often find that the breasts resume a similar shape and perkiness as they had before the initial operation. Women that remove very large breast implants, older patients with poor skin elasticity and patients that have had breast implants in place for many years may notice a degree of sagging. This varies from patient to patient. In the event of breast sagging after implant removal, Dr. Ferrari may suggest a breast lift for the best cosmetic outcome.
Breast implant rupture is, thankfully, rare. Breast implants are medical-grade devices that are designed for a durable outer shell made of high-quality silicone casing. However, implant rupture can sometimes happen.
While breast implants can withstand a lot of impacts, an accident or injury may break the implant shell. Saline implant leaking tends to occur quickly. For implants filled with saline water, the water will leak out rapidly. Saline implant rupture results in a visible difference in size. This can happen over the course of 1-3 days after the shell breaks. The saline water is sterile, so the body will safely absorb and expel it. However, most women choose to remove saline implants that have burst since the breasts will be two different sizes. Most women choose implant removal and replacement in this case.
Silicone implants, on the other hand, are filled with medical-grade silicone gel. The gel is cohesive and is much thicker than saline water. Therefore, silicone implant leaks are often called a ‘silent rupture’ as the silicone leaks very slowly. Most patients are unaware that the silicone implant shell has a leak because the breasts usually change very little in size.
That is one reason why the FDA recommends that women get regular breast screenings every two years to detect a silent breast implant rupture. Silicone implant removal can be performed with or without replacement, based on the patient’s preferences.
Another reason women come to see Dr. Ferrari for breast implant removal or revision is capsular contracture.
This is a condition that occurs when the capsule that forms around the implant hardens. As it hardens, the capsule may constrict the breast implant. This can distort the breast implant shape. Often, late-stage capsular contracture may cause the breast implant to become tight and shaped like a round ball. It may also cause breast implant pain.
There are four stages of capsular contracture. It is usually easier to treat early-stage capsular contracture. If you notice unusual changes to breast implant shape, particularly if it occurs with discomfort, that is a good reason to come see Dr. Ferrari for a follow-up. He will examine the breast implant and the surrounding tissue to determine if capsular contracture is to blame. Affected patients may then choose to get breast implant removal or revision if desired.
Millions of women have had breast implants placed over the past 50 years. The vast majority have had no negative side effects.
There was controversy in the early 1990s over the safety of silicone implants leading to a partial ban on silicone implants by the FDA.
After extensive studies, the FDA released silicone for general use in 2006 after finding that silicone and saline implants had essentially the same complication rates. Many articles have been published over the past 20 years regarding "silicone-induced diseases". Likewise, articles have been published showing that silicone and saline implants are not causing diseases. So, the "jury" is still out. However, there is one entity that no one disputes. Anyone can have chronic infection of a foreign body (breast implant, pacemaker, artificial joint, or any other implanted synthetic object).
Germs can live on a foreign body and secrete a "biofilm" which is like an umbrella covering them. Therefore, antibiotics or your own natural immune system cells cannot fight this infection. The germs live on the foreign body and give off their waste products thereby causing a whole host of symptoms such as fatigue, itching, rashes, tingling, joint pain, toxic shock syndrome, insomnia, depression, hair loss, memory loss, headaches, mood swings, etc. The human body will typically detect there is a problem and wall of this infection with layers of scar tissue.
This makes it even harder for the immune system cells or antibiotics to attack these germs. Therefore, the only way to clear this type of problem is by removing the foreign body and the surrounding scar tissue capsule. Then the body's immune system is able to clear out the remaining germs because they no longer have the foreign body on which to latch on. However, it is important to emphasize that this may or may not cause the improvement of the symptoms. Also, it may take months or years to fully recuperate from the damage done by the chronic infection.
Breast Implant Illness (BII) is not a recognized medical diagnosis. It was derived from women with breast implants (saline or silicone) who self-diagnosed because they had various total body symptoms which they believed to be related to their breast implants.
The symptom could include (but were not limited to) chronic fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain in various body parts, recurring infections, dry eyes or visual disturbances, night sweats, numbness or tingling in the extremities, unexplained rash (or rashes), foul body odor, photosensitivity, new-onset anxiety, brain fog, memory loss, sleep disturbances, depression, various neurologic issues, and even unexplained hormonal issues.
As you can see, the constellation of symptoms is very diverse and the actual cause of these symptoms is oftentimes difficult to figure out. Due to increased attention to this entity on social media, there has been a recent increase in patients reporting Breast Implant Illness (BII) symptoms. There is one BII Facebook group in particular that has more than 50,000 members.
Since BII is not a well-defined medical entity, there is no specific lab test available. Physicians have oftentimes worked up patients with some of the lab tests listed below to rule out other causes of the symptoms.
While there is no one definitive test to determine if your implants are the root of your illnesses, the following tests have been often used to investigate some of the problems caused by breast implants:
One of the theories as to why breast augmentation causes illness is because implants are large foreign objects which can overwhelm and impair a woman’s immune system and this causes the immune system to become dysfunctional and possibly trigger auto-immune symptoms.
The theory continues to say that if the immune system becomes dysfunctional, it could allow opportunistic bacteria and fungi to grow out of control. This could cause serious bacterial and fungal infections in a woman’s body. These germs would then produce large amounts of bio-toxins that overload the organs. In addition, there are concerns that the implants themselves are “toxic” (even though the FDA has declared silicone to be biologically inert).
The problem with this theory is that if it were true, then the vast majority of women with breast implants would suffer similar symptoms. This is obviously not the case. In fact, in 1999, The Institute of Medicine Committee on the Safety of Silicone conducted an extensive review of the available literature and concluded there was “no demonstrated a clear link between silicone implants and any systemic illness”.
Since then, there have been many scientific studies of many different sizes and designs to look at the safety of breast implants themselves. These studies have looked at specific autoimmune disorders and other diseases. In aggregate, as of November 2019, these studies, (with the exception of ALCL related to textured breast implants), show little, if any, links between saline or silicone breast implants and any disease. Studies of patients who have symptoms that they have related to their breast implants have not shown consistent laboratory abnormalities to define a distinct syndrome or illness pattern.
Various studies show different degrees of improvement in patient symptoms after removal of their breast implants, some of which are temporary, and some showing permanent resolution of symptoms.
Some studies indicate that the improvement could be a “placebo effect”. There are no current scientific studies that specifically show which symptoms may or may not improve with implant removal with or without capsulectomy (i.e. complete removal of the scar tissue capsule around the implants).
In other words, there is no guarantee that the removal of breast implants (with or without capsulectomy) will improve a patient’s symptoms or cure any other illness.
There are 3 procedures that can be done. The first procedure is an implant removal without capsulectomy. (A capsulectomy involves removing the entire scar tissue capsule around the implant.)
The problem with this operation is that if there is a chronic infection in the scar tissue capsule, the infection will not resolve. The second procedure is implant removal with capsulectomy. In this type of surgery, the implant is removed first and then the scar tissue capsule is removed.
On the day of surgery, multiple cultures would be sent off to a lab for analysis to see if there are any organisms growing in the breast implant pocket. The scar tissue is also sent to a pathologist for microscopic analysis.
The third possible operation would be an En Bloc procedure. This means that the implant and scar tissue capsule is removed simultaneously as one big “block”. This is often done when it is known pre-operatively that a silicone implant has ruptured because it helps contain the “free” silicone inside the scar tissue capsule.
An En Bloc removal is rarely done with saline implants. Also, this surgery takes longer than the removal of implants with capsulectomies (therefore more expensive) and requires a much larger opening to get all the contents out in a single block of tissue.
In any of the procedures listed above, a drain is placed in each breast to remove the dilute bloody (serosanguinous) fluid that is generated from the surgical trauma. The drains typically stay in for 1-2 weeks. The recovery for the first surgery is very quick, but the second and third surgeries require more time to recover. Most women take a week off from a desk job and don’t exercise for 3 weeks.
How soon after my implants and scar tissue capsules are removed will I start to feel better? There is no guarantee that removing the implants and scar tissue capsules will improve your health.
Since the symptoms women experience tend not to be isolated to the breasts (such as breast pain only), removing the implants may have no benefit in curing total body symptoms.
If the symptoms were caused by the implants being chronically infected, then patients sometimes start feeling better within 1-3 weeks after surgery. If an infection has been there for years, it could take longer to have a full recovery. If the cultures demonstrated an infection, patients are often referred to as an infectious disease specialist. Some patients have also chosen to have “detox” protocols at physician’s offices that deal with “natural healing”.
At Premier Plastic Surgery Center, we understand that choosing to get breast implants removed is a big decision for our patients. Dr. Ferrari can help you decide if breast implant removal will improve your quality of life at a 1:1 consultation. Whether you choose to have breast implants removed or replaced is a decision he can help you navigate. To meet Dr. Ferrari to learn more about breast implant removal, call (704)-844-8344 today.
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