A procedure that is getting more popular with time but is largely falling under the radar, is breast implant removal without replacing them with implants.
There are 2 main reasons for removing implants and not replacing them with another implant. The first reason is that the woman, when she was in her 20’s, wanted a larger breast size. Now that she is in her 40’s or 50’s or even older, she no longer desires the larger breast size. This could have a physical reason. For example, she finds them heavy or she has developed a new interest in long distance running etc. and finds the larger breast size more of a hindrance than a help. The other reason is more personal. What suited her in her 20’s is no longer applicable to how she feels in her 40’s or 50’s or older. She liked the larger breast size in her youth, but now in middle age, prefers a smaller breast appearance.
The other main reason that women will request implant removal relates to health. This is a very controversial topic. As far as I am aware, there is no “proof” that implants have any harmful effect on the woman. There have been numerous well designed studies that have specifically looked at both breast cancer and autoimmune diseases and they have not demonstrated any harmful effect from breast implants. Of course, it is possible that an individual can have a particularly unusual situation that applies just to them but this would be rare. I am aware that there are Facebook groups claiming harmful effects from the implants but until a properly controlled study is done, it is impossible to separate out the placebo effect from a medical finding. This does not mean that a woman should never remove implants if she feels that it is adversely affecting her. I try to compassionately explain that I can remove their implants but they must know beforehand that there is no guarantee that their symptoms will change at all. If they understand and accept this, there is no reason not to remove them. Remember too, if their symptoms do not improve and they do not like their appearance after the implants are removed, new implants can always be placed.
CAPSULECTOMY – YES OR NO?
There is a lot of misunderstanding by patients on this topic. A breast capsule is the term used for the scar tissue that forms around ANY foreign body that is in our body. Everyone will form some scar tissue around a sliver in their foot, a knee replacement, a hip replacement or a breast implant. This is normal. What can happen with breast implants is that a person can form too much and too thick a layer of scar tissue around the breast implant and this can lead to firmness or pain. Many patients, even after many years, will just have a very thin layer of scar tissue. Sometimes it will be very thin like the peel on a peach and other times, it can be very thick, like the rind on a grapefruit and can even calcify. If it is very thin, it makes no sense to try and remove this very thin layer, as it will only lead to bleeding and removing it serves no purpose. The decision on how to treat the capsule is often best made at the time of surgery, when the surgeon can directly feel and examine the thickness of the scar tissue.
WHAT WILL I LOOK LIKE AFTER MY IMPLANTS ARE REMOVED AND NO NEW IMPLANTS ARE PLACED?
This is a difficult question to answer without seeing a particular person. Although it is impossible to know for sure, oftentimes, an experienced plastic surgeon will have a reasonable idea of what the final shape will look like, once the implants are removed. Of course, the breast size will be smaller but the more important question is will they appear very saggy. In general, if they have an excellent shape with the implants in place and do not have too much native breast tissue, frequently, they will have a nice shape. One needs to allow 3-6 months, to allow the breasts to firm up.
If it is suspected that the breasts will be quite droopy after the implant removal, it is certainly possible to plan a breast lift, at the same time. There are a number of different types of lifts, which can be customized to the degree of droopiness which occurs.
IS THERE MUCH POST OP PAIN WITH AN IMPLANT REMOVAL AND WHAT IS THE RECOVERY LIKE?
Most women will have very little discomfort after a simple implant removal. Most should be able to return to work in 2-3 days. Most will not need any narcotics for post-op relief but will do fine with just Tylenol or Motrin. I would expect most women to return to full exercising in a week or so. I recommend that they wrap their chests with 1-2 ace wraps for 7-10 days. I rarely place a drain. If a capsulectomy is required, then I may place a drain. This will be decided at the time of surgery.
The decision to remove implants is a very personal one and it is best to have a frank discussion with your board certified plastic surgeon as to the reasons you are looking to remove your breast implants and what your goals, physically and emotionally are for removing them.