Breast Implant Removal/Explant
Many women choose to undergo breast implant explantation. Various reasons inlude concern for breast implant safety, breast implant ALCL (Anaplastic Large Cell Lymphoma), pain, poor cosmetic appearance, capsular contracture or rupture.
Dr. Cabbabe is a breast specialist with extensive experience in all aspects of cosmetic and reconstructive surgery including all types of complex revision cases. In cases of breast implant removal, en bloc capsulectomy is performed, meaning that the implant is removed with the scar capsule intact, causing no spillage of material including ruptured silicone. In cases where the implant is above the muscle, this procedure becomes significantly easier to technically perform. However, when the implant is located below the muscle, or subpectoral, the thin capsule is often firmly adherent to the ribs and the ability to perform en bloc is significantly more difficult and may not always be possible without significant damage to the chest wall including the ribs or lung.
Proper pathologic studies are alwasy performed based on best available evidence and data. ALCL testing is recommended if fluid is noted around the implant prior to surgery. If no fluid is present, surgery can be done and capsule sent for pathology. After capsule removal, the pocket is irrigated out with a solution containing antibiotics and/or betadine to disinfect and remove and possible microscopic silicone.
Lymph node removal is not routinely performed or recommended at this time unless a breast cancer surgeon has made such recommendation. Drains are always utilized and patients are able to shower with them present.
Surgery is done on an outpatient basis and a breast lift or reduction may be performed simultaneously with possible liposculpting if desired. Average surgery time is approximately 2 hours.
Preparing for Surgery
Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin, ibuprofen or any other type of blood thinner. If you are older than 40, a mammogram within one year prior to the procedure is recommended as part of normal health screening.
Incisions are made based on pre-operative markings and planning. An incision under the breast is preferred due to the size needed for implant and capsule removal. A lift may be incorporated as needed depending on the droopiness of the breast or the location of the nipple – areola.
Antibiotics are given before the procedure and early range of motion is done with the arms. Patients will generally follow-up within 1 day to 1 week and then approximately 3-4 weeks later and then in several months. Drains are removed 1-2 weeks after surgery depending on the extent of the procedure.
Nipple sensation and the ability to lactate are usually preserved in these procedures but there is a risk of loss of nipple sensation.
Recovery is approximately 1-2 weeks depending on the extent of the procedure and the type of work one does. Most women who have this procedure done will be up and about the next day, moving around although they may need pain medication occasionally, but most women state it was not as bad as they anticipated and most of them, if they’ve had it done on a Thursday or Friday, can usually return to work within 1 week.
Dr. Cabbabe strives to make the procedure as easy and comfortable as possible for his patients. Before surgery, patients usually receive anti-inflammatory pain medications that do not cause bleeding. At the time of surgery, local anesthesia numbing medicine is used that is long – lasting into the breast. After surgery, early range of motion is begun and pain medications are given.
The complications that can occur include infections, fuid collections after drain removal and bleeding requiring further surgery to evacuate blood or stop bleeding. Most women have some asymmetry to their breasts and this may be present after surgery unless a recommendation is made to perform a lift or reduction.