Dr Beryl Tan - Removal of Implants With Capsulectomy
Dr Beryl Tan, a specialist Plastic and Reconstructive Surgeon, can assist with the explantation or removal of implants, a procedure now commonly performed with capsulectomy (removal of breast capsule). Some may require replacement if volume and projection of the breasts are key desires.
Read on to learn more about this procedure and its possible suitability for your situation.
WHY DO WOMEN SEEK TO HAVE THEIR IMPLANTS REMOVED?
There can be several reasons why women seek to have their breast implants removed. These can include:
- Capsular contracture
- Rupture or leakage
- Revision – a change in shape due to ageing breast tissue over the implant; or implant malposition
- Patient’s desire
- BII
- ALCL
WHAT IS CAPSULAR CONTRACTURE?
Capsular contracture is the most common complication leading to revision breast implant surgery. The breast capsule is a layer of scar-like tissue that encapsulates the implant, formed by the body in response to the foreign object as your body heals after implant insertion surgery.
Everyone with implants has a capsule encasing the implant, but the capsule’s thickness, composition, and characteristics vary with each individual.
Most capsules do not cause problems. However, roughly 3-19%* of women may develop capsular contracture that causes issues to the breast’s appearance or ‘feel’. Firmer or misshapen breasts that experience pain and tenderness may be the result of this condition.
There may also be an increased risk if there was an infection or haematoma formation after radiotherapy in breast cancer treatment.
*rates vary due to multifactorial reasons; genetics can also play a role, as can the surface and type of implant, plane of pocket, and surgical protocol.
HOW DO I KNOW IF MY BREAST IMPLANTS ARE RUPTURED?
In many cases, implants are “silent” initially, showing no symptoms. However, some people may feel a tearing or popping sensation, usually when engaging in a particular physical activity. In other cases, swelling or oedema, fluid collection, or capsular contracture can appear over time.
WILL THE SILICONE ‘LEAK’ EVERYWHERE?
This often depends on what type of implant you have:
- The first (1960s) to third (1980s) generation implants’ gel are liquid-like
- Fourth-generation implants saw further advancement in the cross-linking of the gel molecules which has produced increasing cohesiveness in the gel
- Fifth and sixth generation implants won’t usually leak when corrupted. The leaked silicone is contained within the capsule (intracapsular). With time, and perhaps with more mechanical pressure (e.g., muscles), the silicone may become extruded into the breast tissue and travel into the lymph nodes. Our body usually recognises this and incites an inflammatory response that results in scar tissue formation encasing the silicone (silicone granuloma).
A highly cohesive gel is sometimes referred to as “gummy bear”. These are usually the form-stable implants, typically made in the teardrop shape with textured surfaces. The cohesiveness of the gel helps maintain its shape and prevents ‘collapse’, especially in the upper pole.
WHY DO WOMEN SEEK A REVISION OF THEIR BREAST AUGMENTATION?
The most common reason for this is capsular contracture; however, there are many other reasons as well, including:
- The desire for a change in size
- Implant malposition (change in position)
- The development of a “double bubble” deformity (the breast tissue and implant form a separate ‘bubble’)
- Correction of ptosis (or saggy breasts) that was not corrected with implants
- Breast implants do not last forever! Most need replacement or revision in about 15 years (10 years in some, 20 years or longer if you have no issues)
WHY DO SOME WOMEN WITH BREAST IMPLANTS WANT THEM OUT AND NOT REPLACED?
Some women decide they simply do not want implants anymore and are comfortable with having smaller breasts. This can often be due to ageing and a feeling of being more confident in their own body. Others may be tired of dealing with complications such as capsular contracture or the possibility of Breast Implant Illness (BII).
WHAT IS CAPSULECTOMY? WHAT IS THE DIFFERENCE BETWEEN PARTIAL, SUBTOTAL, TOTAL OR “EN BLOC” CAPSULECTOMY?
Capsulectomy is a surgical procedure to remove the breast capsule, usually due to rupture (to contain the spillage), to treat capsular contracture, or to treat ALCL or BII (see below).
There are several iterations of this procedure as follows:
- Partial capsulectomy – about half of the capsule
- Total capsulectomy – the whole capsule (may not be in one piece)
- Subtotal – almost a complete removal, but some may be left behind (e.g. stuck to the ribs; when removal may cause more damage and destruction to the adjacent tissue, like the lungs)
- “en bloc” – the capsule is removed in one piece with the implant within it
CAN I JUST GET AN ‘EN BLOC’ CAPSULECTOMY?
Dr Tan cannot guarantee an ‘en bloc’ excision, especially if your implant is under the muscle and the capsule is deeply adherent to the ribs. Your suitability for this procedure also depends on the thickness of the capsule and how adherent it is to your muscle or breast tissue. Everyone is different, and Dr Tan must see it directly to understand what will be possible for you.
IS ‘EN BLOC’ CAPSULECTOMY NECESSARY?
Many patients feel that an en bloc resection is required if they think they have Breast Implant Illness (BII). However, there is no evidence-based data or scientific basis for this.
In fact, a large, very well-designed study in the US is due out soon, and the preliminary data has shown no difference in patients with partial vs total vs en bloc capsulectomy. We will update this section with the results from the final publication when available.
It is important to note that Total capsulectomy is absolutely necessary for treating Anaplastic Large Cell Lymphoma (ALCL).
WHAT IS BREAST IMPLANT ILLNESS (BII)?
BII is poorly understood and, unfortunately, is still not recognised by many medical practitioners. This condition is usually self-identified by women who have had breast implant placement and subsequently developed various symptoms that make them feel very ill.
The duration from implant insertion to the start of symptoms varies. The symptoms are many and can include:
- Chronic fatigue
- Dizziness
- Hair loss
- Skin rash
- Joint and muscle ache
- Poor memory
- Brain fog
- Weight loss and poor appetite
- Unexplained breathing problems
- Depression
- Insomnia
- And others
These symptoms may resolve (although possibly not completely) after implant removal. More information about this condition can be found here.
WHAT IS BREAST IMPLANT-ASSOCIATED- ANAPLASTIC LARGE CELL LYMPHOMA (BIA-ALCL)?
Breast Implant-Associated- Anaplastic Large Cell lymphoma, or ALCL, is a rare lymphoma (a white blood cell cancer) and is not breast cancer. It is associated with having breast implants with a textured surface. The highest risk is with the ultra-textured and macro-textured implants (risk of 1 in 2000 to 1 in 4000).
As a result, these implants have been taken off the shelf.
This condition can develop 3-14 years (or longer) after implant insertion. (On average, eight years). The most common symptom is fluid swelling in the space between the implant and the capsule. Please refer to the following resources for more information:
Book a consultation for an implant removal with Dr Tan today
Your care is always greatly considered and you can rely on Dr Tan’s over fifteen years of experience in various areas of Reconstructive and Cosmetic Surgery. If your implants are creating any issues or discomfort, book a consultation with Dr Beryl Tan today. Patients can access Dr Tan at Brighton, Cabrini and PRSM in Donvale and Drouin.
