With continuing improvements in breast implant technology and surgical techniques, more women are choosing to keep their implants long term. Since the year 2000, the rate of explant (breast implant removal) surgery has dropped by nearly 30%, according to the American Society of Plastic Surgeons. Today, most explants are performed to exchange old implants for new ones, which is a standard part of having augmented breasts. Though modern silicone implants can last for a decade or longer, most eventually need to be replaced due to normal wear and tear.

By planning for implant exchange ahead of time, you’ll be able to budget for future surgeries and get an idea of what to expect during the explant process. Understanding your aesthetic options will also be helpful if you decide to get your implants removed, but not replaced. For detailed information on the various aesthetic procedures we offer to our explant patients, contact The Plastic Surgery Center of Nashville at (615)-467-6777.

Why do Women Choose to have Their Breast Implants Removed?

Sometimes, breast implant removal becomes necessary due to complications, but this procedure may also be pursued for personal, elective reasons. We usually suggest implant removal to women who find themselves in one of the following situations:

1. An MRI Has Revealed a Problem with Your Implants.

All women with silicone breast implants should periodically undergo MRI testing to make sure their implants haven’t ruptured. The gel inside silicone breast implants is designed to be “form stable,” so you may not notice one of your implants is leaking on your own.

If an MRI shows you have a ruptured implant, you’ll need to have your implants removed as soon as possible. Though silicone isn’t toxic, ruptured implants can cause pain, irritation, and infection if left untreated. After you have your implants removed, you’ll be able to have them replaced with new models, which should last another 10-15 years.

Breast implant removal is also recommended for women who have experienced cosmetic complications, such as capsular contracture, implant migration, or skin “rippling” around their implants.

2. Your Lifestyle or Preferences Have Changed.

If you feel like your breast implants are too large or too heavy, we can replace them with smaller implants or remove them entirely. Some women decide to “downsize” their implants because they want to get more active, or because their current breast size makes it hard to find flattering fitted clothing.

3. You Have Health Concerns That Make Explant Surgery Necessary.

Breast implant removal is medically necessary for women who have received a diagnosis of breast cancer or BIA-ALCL (breast implants don’t increase the risk of breast cancer, but they can interfere with treatment). After you’ve been successfully treated, you’ll probably be able to have your breast implants replaced.

Some women choose to have their breast implants removed because they’re experiencing non-specific symptoms, like fatigue and unexplained fevers, and they think their symptoms are related to having breast implants. This condition is known as breast implant illness, and while it’s poorly understood at present, researchers think it may be caused by an autoimmune reaction.

5 Aesthetic Breast Options to Consider After Breast Implant Removal

1. Implant Exchange.

Breast implant exchange is a very straightforward procedure, especially if you haven’t experienced any complications in the years following your original breast augmentation. Our surgeons will make new incisions along with your existing breast augmentation scars, open up the capsules of scar tissue around your implants, then carefully remove your old implants. Finally, they will insert the new implants of your choice into each breast “pocket” and close your incisions. The recovery period that follows implant exchange is very similar to healing after breast augmentation surgery, so you’ll already know what to expect after this type of procedure.

2. Breast Lift with Implants.

Like large natural breasts, surgically augmented breasts typically sag over time. If you’ve had breast implants for many years, normal aging and the effects of gravity have probably created loose, stretched skin around your implants. Other factors, like weight loss and pregnancy, can also contribute to this problem.

To make sure your new implants sit in the correct position, our surgeons may combine your implant exchange with a breast lift. They’ll remove excess skin from your breasts, insert new implants, and adjust the position of your nipples, as needed. This surgical technique gets rid of stretch marks, corrects breast asymmetry, and creates round, youthful breast contours.

3.A Vertical (Standard) Breast Lift.

Breast lift surgery is a great option for women who don’t want to have their implants replaced. During a vertical breast lift, an incision is made around each areola and down the front of each breast, which allows our surgeons to carefully reshape the patient’s natural breast tissue. By removing loose skin and adjusting the size and shape of your breasts and areolae, our surgeons can recreate the breasts you had before undergoing breast augmentation.

4. An Anchor Breast Lift.

An anchor breast lift is similar to a vertical breast lift, but this technique includes an extra incision along the underside of each breast. Making this additional incision permits your surgeon to remove more excess skin for a dramatic change in breast shape. Anchor breast lifts are usually recommended for women who had large breast implants prior to explant surgery.

5. Implant Removal.

Not all women need to have a breast lift after explant surgery, though many do. If your breast implants were small and you have excellent skin elasticity, you may be able to have your implants removed without also undergoing mastopexy. This type of breast implant removal is a simple procedure: Your breast implants and the scar tissue around them will be removed through small incisions below each breast.

If you have saline implants, we can deflate your implants in our office (by draining the saline solution from them) while you’re awake. This way, you’ll be able to see what your breasts will look like after your implants are removed. Some women prefer to take this approach because it can help them decide whether or not to have a breast lift.

Before you proceed with breast implant removal, you should be aware that your breasts will need time to adjust after this procedure, even if you have a breast lift. Breast implants put pressure on the soft tissue inside the breasts, compressing it into the bottom halves of each breast. This compressed tissue will gradually expand and migrate back into the upper portion of your breasts after you have your implants removed. Until this happens, your breasts may look flat or even concave, but don’t worry: They’ll naturally fill out after six to nine months.

Should You have a Capsulectomy?

Regardless of how you choose to restore the shape of your breasts after implant removal, we can incorporate a capsulectomy into your procedure. During a capsulectomy, part or all of the capsule of internal scar tissue around each breast implant is removed. This tissue is not harmful (encapsulating foreign objects in scar tissue is a normal part of the body’s healing process), but there are cases where removing scar capsules improves aesthetic outcomes. We usually recommend capsulectomy to patients who meet any of the following criteria:

1. You Don’t Want to Have Your Implants Replaced.

If you’d prefer to live without breast implants, you should have a capsulectomy during explant surgery. Otherwise, leftover scar tissue may create unattractive abnormalities in the shape or texture of your breasts. Lumps of old scar tissue can also produce “false positive” results during mammogram tests because they resemble breast tumors.

2. Your New Implants Are Going to Be Placed in a Different Position Than Your Old Implants.

During implant exchange, new breast implants are usually inserted directly into the patient’s existing breast pockets. Sometimes, however, the operating surgeon will decide to place new implants in a different location rather than the patient’s old ones. For example, if your breast implants were originally placed above your pectoral muscles, we might suggest placing your new implants under these muscles (because this technique more effectively disguises the upper edges of each implant). Our surgeons will perform a capsulectomy during this type of implant exchange to prevent the unused capsules from filling with fluid and becoming irritated or infected.

3. The Capsules of Scar Tissue Around Your Implants Are Thick or Calcified.

Over time, internal scar tissue tends to become thicker and harder due to calcification. Calcification is a natural process characterized by the deposition of calcium salts into soft tissue. Gradually, these deposits build-up, creating a hard “shell” around each breast implant. Approximately 30% of all women with breast implants experience at least some scar tissue calcification after having their implants for ten years or longer.

Calcification can cause breast pain and interfere with the results of breast augmentation, so we always remove calcified scar tissue during breast implant removals or exchanges. We also take this step when the scar tissue around the patient’s implants has grown unusually thick or contracted around her implants (capsular contracture).

4. One of Your Implants Has Ruptured.

If an MRI suggests that one of your implants has ruptured, our doctors will perform a modified type of explant surgery known as “en bloc” breast implant removal. During en bloc breast implant removal, your implants will be removed along with the fully intact capsules of scar tissue surrounding them. This technique stops silicone particles from migrating outside the breasts, thereby preventing localized irritation and other concerns related to silicone contamination.

Having a capsulectomy will not increase discomfort after your procedure, and it won’t lead to more noticeable external scarring. This additional surgical step is completely safe, and it may significantly improve your results following breast implant removal. When you visit us for a consultation, our doctors will let you know whether or not a capsulectomy is recommended for you.

Discuss Breast Implant Removal with Our Team of Female Plastic Surgeons in Nashville

Whether you want to have your current implants exchanged or you’ve decided to return to your natural breast size, Dr. Mary Gingrass and Dr. Melinda Haws can help you review your options and get the results you want. As board-certified female plastic surgeons, they understand the many factors that can influence the decision to have explant surgery. For personalized advice, contact The Plastic Surgery Center of Nashville to arrange a consultation with our doctors.