Breast Implants Removal, Capsulectomy, Breast Implant Exchange

Patients with a history of breast implants may decide to remove breast implants or change the appearance of their breasts or breast implants. Sometimes breasts that have been overly enlarged in the past may eventually become ptotic or sag. Removing breast implants and performing a breast lift (mastopexy) or a breast lift and fat transfer can rejuvenate breast appearance without the enlargement from implants. At the same time, breast implant capsulectomy can be peformed if indicated based on lab testing.

A past history of textured shell breast implants has been associated with breast implant associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is a type of non-Hodgkin’s lymphoma or cancer of the immune system that has been found in the scar tissue and fluid around breast implants and can spread throughout the body. The most recent data suggests that BIA-ALCL may be related to breast implants with a textured surface rather than breast implants with a smooth surface. Although BIA-ALCL is rare, some women who have textured implants may wish for removal of implants or removal and replacement with smooth breast implants. The FDA and agencies in Europe are currently investigating BIA-ALCL and the potential relationship with textured breast implants. Allergan textured breast implants have been recalled by the manufacturer and these were a common implant used by some plastic surgeons. If you have textured breast implants, such as Allergan, and breast symptoms, such as rash, pain, lumps, swelling, asymmetry, capsular contracture or fluid collection, consider seeing us for removal of breast implants and possibly also the scar tissue capsule around your textured breast implant. BIA-ALCL has been found most commonly in patients with late onset fluid collection or seroma around the implant. When removing your breast implants, Dr. Taylor and Dr. Sullivan can collect seroma fluid and portions of the capsule to send to our breast pathologist at Mount Auburn Hospital, a Harvard University teaching hospital, to rule out BIA-ALCL. The fluid and breast implant capsule tissue can be tested for BIA-ALCL with Wright Giemsa stained smears and cell block immunohistochemistry / flow cytometry for cluster of differentiation (CD30) and Anaplastic Lymphoma Kinase (ALK) markers. If BIA-ALCL is detected, a complete capsulectomy is indicated.

Prophylactic breast implant removal for patients without symptoms has not been recommended, though symptoms of BIA-ALCL can be subtle. If you have textured implants such as Allergan 410 and you have symptoms, you may wish to consider an evaluation with Dr. Stephen R. Sullivan and Dr. Helena O. Taylor.

Women with saline breast implants may desire exchange of the implants for the more natural feel of silicone breast implants with less rippling or without the fluid motion sometimes found with saline breast implants.

Other indications for removing breast implants include capsular contracture, neck or back pain, exposure of breast implants, seroma, history of textured implants, asymmetry, or malposition of breast implants. The choice to have breast augmentation, breast implant removal, or breast implant exchange does not have to be a permanent decision. Revisions and breast contouring or rejuvenation is always an option - including breast augmentation, breast lift (mastopexy) or liposuction with fat grafting or both. If you wish to consider breast implant removal or breast rejuvenation after breast augmentation, consider being evaluated by Dr. Helena O. Taylor and Dr. Stephen R. Sullivan, who will help you to customize a surgical approach to safely restore your breasts with a natural appearance. Removing or exchanging breast implants is an outpatient operation with a gentle recovery. Dr. Taylor and Dr. Sullivan follow a careful protocol to limit pain and discomfort so patients can quickly return to normal activities. They are among the few plastic surgeons in the Boston area that offer the long acting medicine, Exparel® which can be used during the operation to eliminate or significantly reduce postoperative discomfort and the need for opioid or narcotic medications.

ruptured breast implant exchange.jpg

Ruptured Breast Implants

If breast implants rupture, they should be removed or exchanged. The image above demonstrates silicone gel breast implants placed 30 years prior. Over time, the silicone shell ruptured and the internal liquid silicone leaked into the breast capsule, known as intracapsular rupture. Modern silicone breast implants use cohesive gel or “gummy bear” implants as compared to those shown above. The above implants were safely removed and replaced with new smooth round high profile highly cohesive silicone gel implants in an outpatient operation with a gentle recovery. Dr. Taylor and Dr. Sullivan can perform an examination or order an imaging study to determine if your breast implants are ruptured and should be removed or exchanged.