Breast Implant Removal: Why?
For various different reasons, some women decide to have their breast implants removed. This could be due to weight gain or loss, or even a change in lifestyle choices that can affect the way that breasts age over time. A poor outcome from primary breast surgery and postoperative issues, such as capsular contracture or implant rupture, may necessitate removal of the implants.
This patient came to us seeking to remove her breast implants after having undergone a breast augmentation procedure elsewhere a few decades ago. These ruptured implants were old generation implants from the 1970s.
This patient came to see us for explantation following breast augmentation surgery a few years earlier (elsewhere). Her main concerns were related to their unusual constellation of symptoms called breast implant illness syndrome (discussed below), discomfort and pain in her breasts. On examination, she showed signs of early double bubble deformity, which is often associated with capsular contractures of breast implants. At surgery, the implants were removed and an en bloc excision (discussed below) was performed with the exception of a small adherent part under the pectoralis major muscle. As you can see in the image, this is the tissue found onto of the breast implants.
What is breast implant illness syndrome?
BIA-ALCL is a rare but highly treatable type of lymphoma. It develops around breast implants and occurs most frequently in patients who have breast implants with textured surfaces. This is a cancer of the immune system, not a type of breast cancer. When caught early, BIA-ALCL is usually curable. Women who received textured implants should contact their plastic surgeon, particularly if you have experienced symptoms such as excessive swelling around the breast implants, pain, major asymmetry, breast enlargement, pain, lump in the breast or armpit, overlying skin rash and hardening of the breast. Any new swellings need to be investigated.
To read more on BIA-ALCL, head to our blog for more articles on the matter.
What is an en bloc resection?
In essence this is treating the implant and its surrounding fibrous capsule as a lesion needing to be excised in full without breach. The body walls recognise the implants as inert medical material with no significant immunogenic response off as a foreign bodies. The capsule has three layers, flat synovial type fibrocyte cells, collagen bundles and blood supply. It is known that the biofilm surrounding the implant material may form a barrier that is impenetrable to antibiotics and other medications as well as body’s immune cells. Thereby forming a focus for ongoing inflammation not only locally but also more systemically it has been argued. The fibrous capsule has been shown to harbour antigens and even non virulent bacteria lending credence to this theory. The idea is that by excising the entire capsule and implant, much in the same way as say cancer would be, the risk of any contamination or ongoing source of inflammation would eradicated.
Whilst technically it is possible to perform an en bloc excision in every instance, the pertinent question to be asked is how much wider spread tissue damage typically to the pectoralis major muscle in the cases of submuscular or dual plane implant placement or when the implant has ruptured with extracapsular leak of silicone.
Why trust us with your procedure?
Breast procedures is an area of Dr Farhadieh’s special interest and expertise. He brings excellence in surgical art, and uses techniques that are innovative and modern to achieve the best results possible. As an internationally recognised plastic surgeon he has both provided expert commentary for international plastic surgery journals, as well as authored a chapter on this topic in an international plastic surgery textbook: Plastic and Reconstructive Surgery: Approaches and Techniques. With this level of expertise guiding everything he does, patients can have complete confidence in Dr Farhadieh’s ability to provide state of the art outcomes.