Breast Implant Removal in Beverly Hills

Women that have breast implants may chose to have the implants removed for a variety of reasons. Perhaps the implants no longer fit their lifestyles, implants too large, back pain, implant complications, capsular contracture, or generalized symptoms thought to be related to breast implants.

Breast Implant Illness

A small number of women with breast implants may experience various generalized symptoms and believe that the symptoms are related to their breast implants, these symptoms are referred to as “breast implant illness.” Breast implant illness (BII) is a term used by women with breast implants to describe symptoms such as fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, depression, anxiety, brain fog, sleep disturbances, neurologic issues, hormone issues, and feel that these symptoms are directly related to their breast implants. Silicone in breast implants has not been proven to cause disease, and there is no diagnostic test specifically for breast implant illness. Women with breast implant illness may have normal or abnormal auto-immune test results. Some studies show that breast implant removal improves the symptoms of breast implant illness, but the improvement is not always permanent. It is not clear if capsulectomy is necessary for improvement. So, the symptoms are real, but it is not clear if the symptoms are due to breast implants.

Options for the treatment of breast implant illness:

• Observation without medical work up
• Further workup with a rheumatologist
• Implant exchange, with/without capsulectomy
• Implant removal without capsulectomy
• Implant removal with total capsulectomy
• Implant removal with en bloc capsulectomy

The Capsule

The body normally forms a capsule around a breast implant after implant placement. Forming a capsule is the body’s normal reaction to any foreign object that is placed in the body, as a measure to protect the body from the implant, but also serves to protect the implant from infections in the future. In some women, the capsule can become very thick or even cause the implants to feel hard, this process is known as capsular contracture. Some experts suggest that biofilms can surround the implant, due to skin bacteria, and lead to capsular contracture. Ruptured silicone implants can also lead to capsular contracture, however this is less common with the newer generation implants. Late fluid collections, or seromas, are also related to capsular contracture, and can be due to biofilms, or irritation from the silicone implant shell.

Capsule Removal

Not all plastic surgeons routinely perform capsulectomy with implant removal (explant). Total capsulectomy, or total removal of the capsule, is done in certain instances. During a total capsulectomy, the capsule is opened at some point to remove the implant separate from the capsule, and allows for a smaller incision. En bloc breast implant removal with total capsulectomy removes the breast implant and the surrounding capsule in one piece, without opening the capsule to “look inside.” This ensures that ALL the surrounding tissue is removed without spillage of intracapsular fluid or silicone, but requires a significantly larger incision. En bloc and total capsulectomy can be technically difficult procedures, even with best intentions, sometimes a portion of the capsule must be left behind. Small portions of the capsule may become disintegrated with electrocautery when removing the capsule, to prevent removal of normal tissue. In some cases, portions of the capsule may need to be left behind to prevent damage to muscle, ribs, or lungs.

Total capsulectomy is a highly specialized procedure and has some added risks. The procedure is only offered by board certified plastic surgeons that are experienced in this technique are able to offer it. The procedure requires the utmost attention to detail and requires more time to perform. Total capsulectomy is the treatment of choice (when technically possible) for ruptured silicone breast implants, recurrent breast implant capsular contractures, breast lymphoma (BIA-ALCL), and breast implant illness. En bloc implant removal can be performed (when technically possible) when a woman accepts a larger scar at the inframammary crease for removal of the entire contents in one-piece, and wants to ensure that all traces of the implant and surrounding fluid are removed without contaminating the normal tissue.

Reconstruction

Breast implant removal can result in significant breast deformity. The degree of deformity will depend on a number of factors, including the look of the breasts prior to augmentation, size of implants, length of time implants were in place, amount of diseased tissue to remove. One may consider reconstruction at the time of implant removal, or delayed reconstruction. Techniques of reconstruction may include a mastopexy (breast lift) or fat transfer. Fat transfer will not augment the breasts to the same size that the implants were able to, but may aide in the final appearance. Fat transfer may need to be repeated multiple times to get to a more desirable size.

Dr. Dass is a board certified plastic surgeon, and is an expert at breast implant removal, including en bloc total capsulectomy breast implant removal. A consultation is required to discuss the risks and benefits of each approach, and determine which approach is best suited for each individual.