How long do breast implants last?
On its website, the FDA warns that implants "are not lifetime devices," and will probably need to be removed or replaced at some point. The longer a woman has silicone-filled breast implants, the more likely she is to experience complications. Those complications include hardening of the breast, scarring, and rupture of the implant, which requires surgery to remove or replace it.
What is explant surgery?
Breast implant removal, or explant surgery, is a procedure to extract the breast implants from a previous breast augmentation surgery. During explant surgery, incisions are made in the breast crease or just above it, allowing the implants to be removed. The scar capsule that forms around the implant can also be removed during the same procedure (capsulectomy).
What is a capsulectomy?
Understanding the capsulectomy procedure requires familiarity with a capsule, which is the scar tissue that forms around an implant. This is a natural reaction of the body and, in most cases, will not change the way your implants look or feel. When removing breast implants, the capsule must always be taken into consideration. If the breast implants are being removed permanently, a capsulectomy can facilitate ideal healing and tissue recovery.
What is en bloc?
In an en bloc procedure, the entire capsule (which is the scar tissue that forms around an implant) is removed with the implant in one intact piece. A complete en bloc capsulectomy is a painstaking and meticulous procedure that removes every bit of the capsule, including the section that may be very adherent to the chest wall and ribs. The implant stays within the capsule during the entire procedure. Our surgeons remove the old capsule via en bloc capsulectomy only when it is safe and appropriate for the patient. It requires larger incisions (which can mean larger scars), and a longer surgery duration time. Importantly, even if a patient opts for an en bloc capsulectomy, the surgeon will not know definitively that this procedure can be performed until they are in surgery and the surgeon can examine the capsule to see if it can be removed with the implant.
Do I need an en bloc capsulectomy?
There are many medical inaccuracies perpetuated by the internet. BII patients tend to believe that a total capsulectomy is necessary to remove all causative agents and they prefer it en bloc, oftentimes without having a full understanding of how large an incision is necessary for en bloc. There are many instances where an en bloc procedure is not possible or not the best decision. If the capsule is too thin and delicate to remove in one piece, your surgeon will remove as much of the capsule as possible with the implant and then carefully remove the remaining scar tissue. Another situation that could prevent en bloc is if the capsule is adhering to vital tissues. For example, if scar tissue is tightly attached to the rib cage, removing the tissue could risk inflicting significant damage to muscles, ribs or lungs. This sometimes means that portions of the capsule will remain in place or is disintegrated with the use of electrocautery. Our surgeons take all steps possible to allow proper healing including sterilising any remaining capsule.
What’s the alternative?
Not all surgeons routinely perform a capsulectomy with explant surgery, but some do. A capsulectomy is also not always performed using the specific en bloc technique. A capsulectomy is the removal of the breast implants and the scar tissue, or capsule, that forms around a breast implant. However, during a capsulectomy, the implant is not necessarily removed while still inside the intact scar capsule (en bloc method). Most surgeons use the term capsulectomy to mean that they will cut the scar tissue capsule, remove the implants first, and then go back and remove all of the scar tissue capsule. In some instances, part of the back wall is left intact to minimise the chances of serious medical complications. Complications of trying to remove the back wall of the capsular contracture include bleeding and pneumothorax.
How will my breasts look after breast implant removal surgery?
Removing breast implants restore patients’ natural aesthetics but may create some changes to soft tissue. Once you’ve had the breast implants removed, your breasts will initially look deflated. It can take two to three weeks for the breasts to regain their volume. Your breasts will not look the same as before you had the original breast implant surgery due to the weight of the breast implants stretching the tissue and causing changes in the rib area. Due to skin stretching to accommodate the implant, sagging or drooping is common after implant removal. If the patient does not want new implants, the breast implant removal surgery can be combined with a breast lift, which involves removing excess skin and repositioning the nipple and areola to create a perkier breast.
