The removal and replacement of breast implants or simply the removal of breast implants is a safe operation that takes about an hour and has very little pain associated with the recovery. This procedure, which is performed under general anesthesia, is usually carried out to upgrade old breast implants, to remove breast implants that are no longer needed or to change the size of the breast implants; usually the replacement of implants is in the same location as the original implants. Women may choose to have their breast implants simply removed and this can be achieved with little to no resulting deformity. Now that many patients are 15-25 years since their original breast enlargement surgery, more and more patients are requesting either removal or removal and exchange of breast implants.
Since the breast implant pocket is not disturbed in most cases, recovery from removal and replacement of breast implants is far more comfortable than recovery from the original breast enlargement surgery.
Usually the original incision that was used for the breast implant surgery is used once again. This incision can be expected to heal in a similar fashion to the original augmentation mammoplasty.
For removal of implants only a light pressure wrap around the chest for a week is worthwhile to allow the tissues to heal together and to help prevent fluid accumulation, now that the implant is no longer occupying the space.
Will there be deformity from the exchange of breast implants?
This is perhaps the most common question asked. It is unlikely that there will be any deformity associated with the removal and replacement of breast implants. Even when the implants are simply removed, here too there is usually no deformity as a result. If patients request to have larger breast implants this can be accomplished easily, as can the insertion of smaller implants. Often the same size is chosen, the surgery being requested to simply remove and update old implants. Time is spent during the consultation to understand the patient’s desires. This helps in the selection of the type of breast implant to be used. Patients can expect to be satisfied with their decision.
What if my breast implants are ruptured?
If the breast implant is leaking, the gel needs to be removed before placing a new implant. The ruptured material is removed using a series of dry sponges on a long instrument that holds the sponge in place and allows the silicone gel to cling to the dry sponge. Multiple washouts of the surgical pocket are also performed in order to remove any residual gel particles.
Specific indications for a new location include changing the location from under the muscle to over the muscle in body builders who do not want the deformity that sometimes occurs with breast implants in the subpectoral location when contracting their pectoral muscles. Changing from over the muscle to under the muscle is used for women who want a more natural looking and feeling result. These considerations are discussed during the consultation.
Sizing of breast implants
Time is spent during the consultation to make sure that the patient is happy with any changes in the size of the implant. Our needs change with time and therefore the surgical outcome should be in harmony with the patient’s desires. It is perfectly acceptable to request removal of breast implants for patients who were never happy with their choice to have breast implants, or for those patients who no longer feel the need for breast implants.
When a patient needs replacement of one breast implant, it is generally best to replace both implants at the same time. This way we start with two new implants and it is less likely that the patient will need to return soon for additional surgery.
There is no specific time gel filled breast implants need to be replaced. Generally they last a long time, about 15 years, but here too leakage can start to take place.
If a gel filled implant leaks, the contents generally stay within the “capsule” that forms around the implant as the result of the body walling off what it perceives to be a “foreign object”.
Sometimes, if the patient has developed a “capsule” or hardening of the implant, additional surgery may be required to either remove the scar tissue that has formed around the implant or to create a new pocket for the new implant.
There are several reasons why a patient may want a new location for the breast implant:
When implants are placed below the muscle, athletic womenmay notice too much distortion when contracting their pectoral muscles (“pecs”). These women would have no distortion once the new breast implants are placed above the muscle.
If women with implants above the muscle do develop a hardening, a placement below the muscle will often give a softer feel to the breast implants.
Small breast implants can be exchanged for larger implants because by now the tissue has stretched and can accommodate larger implants. One has to be careful because the larger the breast implant the greater the risk of atrophy (loss) of the overlying breast tissue. This causes an overall thinning of the breast tissue and can lead to premature hang (breast ptosis).
Why remove breast implants without replacement?
There are many reasons why a woman may choose to remove breast implants and not replace them. The most common reason is weight gain during perimenopause or menopause. The breasts may be involved with the weight gain and may become uncomfortably heavy. The breast implants are no longer needed for appearance in clothing or self image and can be safely removed without resultant deformity. Some women simply want “to be themselves again”. A patient may voice that she never wanted the breast implants to begin with and may have subjected herself to this surgery at the request of her husband or to please her husband.
With time breasts may sag and a breast lift may be needed. If this is of concern, the consultation is a good time to address these issues. Breast lifting operations can be performed at the same time as removal and replacement of breast implants or may be carried out as a separate operation.