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Explant or breast implant removal surgery, what you should know?

This lady in her 50s had several surgeries elsewhere over the years and developed recurrent capsular contracture and breast discomfort. Her surgery involved a total capsulectomy and removal of textured breast implants. Her after photos are 6 months following surgery.  Our patient is still considering the possibility of replacement breast implants, however, for now, she is learning to love her new body image without breast implants.  

There are many reasons why you may want to have your breast implants removed, here a few:

• ruptured breast implants
• capsular contracture or hardened scar which may have distorted your breast shape and appearance
• asymmetry or lopsided size or position of implants and/or breast tissue which you can see in my patient below
• changes in appearance after pregnancy or weight changes
• sagging of breast tissue and skin
• breast size may have increased after children which combined with breast implants may mean larger breasts than you wanted
• visible rippling of the implant due to tissue changes and how the breast implants were placed eg. on top of the muscle
• patient reports symptoms of breast implant illness 
• patients concerned about or diagnosed with breast implant-associated anaplastic large cell lymphoma (BIA- ALCL)

People often ask ‘what will my breasts look like after explant?’  

We can’t always predict how things will look as there are many factors  that influence this including:

• how the original surgery was performed (including if the breast fold or infra-mammary fold was lowered)
• how long you have had your breast implants
• size of the breast implant (the larger the implant the more the skin envelope may be stretched)
• how the breasts looked before implants (pre-existing breast shape)
• skin elasticity (e.g. age, pregnancy and breastfeeding factors apply here)
• breast tissue firmness (e.g. age, pregnancy and breastfeeding factors apply here
• scar tissue from the original surgery
• the type of capsulectomy performed i.e. total vs partial capsulectomy (is their hardened capsules that need to be removed).

I am interested in having my breast implants removed, how can I prepare for my consultation with Dr Eddie Cheng?

Typically you have seen a GP especially if your original surgery was performed internationally or you can’t locate your original surgeon.

Our wonderful patient coordinators, Leah, Lauren and Stacey can help you with the following:

• gathering your breast implant information and operation record from your previous surgeon
• organise a referral from your GP
• if you have your before breast implant photos we encourage you to bring these along to your appointment
  take the time to look at your before photos to remind yourself of what it might be like without breast implants as this can help you adjust to your new body image.  Keep in mind,  breasts may not necessarily revert back to their original shape and size especially if you have had your breast implants for many years. 
• imaging- often your GP may send you for an ultrasound scan to assess breast implant integrity.  Sometimes an MRI scan is needed.
• Mammograms can’t check for implant integrity but if you are over 40 we will need to ensure your breast cancer screening is up to date. 

How can I locate my surgery details and breast implant information?

• Contact your original surgeon and ask for your breast implant details, photos and operation notes
• Sometimes your day surgery centre or hospital may also have this information if your surgeon is no longer available.
• You can also contact the Australian Breast Implant Device Registry or ABDR to locate your previous breast implant information.
• Hot Tip!! CHECK YOUR RECORDS!!! If you have breast implants contact your surgeon now and keep good records including before and after photos and implant records. Doctors have legislated time periods that they need to keep records for and once this has ended your records may be destroyed. 

Will I need a breast lift?

What does the surgery involve?

Typically surgery involves:

• a general anaesthetic with your surgeon and specialist anaesthetist
• this can be either be performed in a day surgery or an inpatient hospital facility (if you have private health cover)
• drains usually stay in for several days in each breast, especially if scar tissue is removed at the same time
• surgery usually takes 2-2.5hrs
• incisions are generally made in the breast fold under the breast and the old scar is often used, the original incision line may be used but this depends on safety and access to the breast implant pocket.

What will Dr Cheng do with the scar capsule around my breast implants?

What happens to the breast capsule, depends on several things including results and your own preference.  Some options include:

• leaving the capsule in place and just removing the breast implant
• enbloc capsulectomy - removing the breast implant and the scar tissue in one piece
• total capsulectomy - removing the breast implant and then all the scar tissue separately
• partial capsulectomy - removing some of the capsule along with the breast implant. 

What if I need a breast lift, will it be done at the same time?

Typically if Dr Cheng is explanting or removing your breast implants it is often safe to perform a breast lift at the same time, although it does depend on the amount of scar tissue that needs to be removed and the severity of sagging and nipple position. 

Will private health insurance pay for my explant surgery? 

• if you have private health insurance, silver tier, should provide hospital cover along with a rebate towards your surgery and anaesthetic fees, however, there will be a gap for Dr Cheng's surgical fee.
• check with your health fund to see if you have cover for medicare item no. 45551  or 45548
• fees will vary depending on the complexity and whether you will need a breast lift and capsulectomy or removal of scar tissue
• you can send in photos and we can provide a preliminary indication of fees

• infection
• bleeding
• delayed wound healing
• scarring
• asymmetry
• more interference with blood supply and sensation to the nipple and skin from previous surgery and particularly if capsulectomy is performed
• unknown previous scarring and surgery technique
• longer scar or incision line
• longer time in surgery or under anaesthetic
• you may not like the look of your breasts without breast implants
• If you have had textured implants it may not change your risk of breast implant-associated large cell anaplastic lymphoma or BIA-ALCL. 
• Breast implant illness symptoms may not improve after explant

What can I expect from my recovery?

Recovering from explant surgery has both a short term and a long term considerations:

Early recovery:

• typically same-day discharge with drains for  3-5 days
• review with Dr Eddie Cheng and our Plastic Surgery Nurse day 1
• all post-op patients have my direct mobile contact for any concerns
•  keep wound clean and dry for 2-3 days
• leave the protective bandage in place for 1 day
• patients will be changed to a supportive and comfortable bra day 1
• light walking around the home
• gentle range of arm movements encouraged
• no lifting heavier than a teacup 

Recovery week 2-6

• drains are typically removed by now
• dressings or incision lines remain and are changed weekly
• driving short distances after 2 weeks
• office-based work can return after approximately 2 weeks or longer for physical jobs
• you will be wearing a recovery bra for 6 weeks with no underwire
• no sex for 3-4 weeks
• incision line taping for 6 weeks
• you will be instructed to apply silicone gel from 6 weeks, 2 times daily 

After 6 weeks

• skin changes will take months including the skin adapting and contacting after implant removal
• numbness and nerve twinges may occur beyond 6 weeks 
• scars tissue and incision lines can take 12 to 18 months to settle so be patient with our results
• if you are are unhappy with your breast shape after implant removal, revision surgery such as breast lift can be performed later

‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’