Women chose to remove their breast implants for many reasons.  First of all, implants are not considered lifetime.  The American Society of Plastic Surgery recommends removal or exchange every every 10-15 years.

Some women no longer want the heaviness associated with large implants. Therefore they choose to remove them entirely.

Other women are concerned about the health effects of silicone gel implants.  Recently, there has been more information about breast implant illness and breast implant associated lymphoma available.

It is best for women to consult with a board certified plastic surgeons regarding these issues. After discussing all concerns, a decision can be made whether breast implant removal is best for them.  This procedure is also called breast explant surgery.

If the implants are intact, a simple implant removal is possible. The implants should be of moderate size. They should not be surrounded by a thick hard capsule.  This involves making a small incision in the area of the prior incision and scar. The procedure includes dissecting down through the implant capsule and removing the device.  This can be done under local anesthesia with oral sedation and can take as little as 30 minutes.  The thin capsule that is left behind will break down or dissolve and not cause any issues.

If the implants are ruptured silicone gel implants, you should strongly consider a capsulectomy. If the implants are affected by capsular contracture, the same consideration applies.  The capsule is a spherical shell of scar tissue. It forms over an implant after it is in the body for over 4-6 weeks.  Capsular contracture is when this shell of scar tissue becomes thick and hard.  The implants may become quite uncomfortable.  Sometimes silicone gel extrudes from the implant shell and infiltrates the capsule forming a hard calcified shell.  In either situation, removal of the implant, implant material and capsule is recommended.

When the entire capsule shell and implant is removed in one specimen, this is termed an en-bloc capsulectomy.  An important benefit of an en-bloc capsulectomy is that it prevents the free silicone gel inside the capsule. This gel does not contaminate the breast implant cavity.  This free silicone gel can be sometimes difficult to completely remove.

A partial capsulectomy, is most commonly performed.  This involves removal of a portion of the capsule, usually the portion adhered to the breast skin flaps.  The portion against the chest wall can adhere tightly to the chest wall periosteum and perichondrium. This makes it more difficult and traumatic to remove.

If the implants are large, removal may result in significant excess breast skin.  Also if the breast implants have been present for a significant amount of time, a large portion of the breast tissue present before the implants were placed may become attenuated, resulting in a much small breast volume with respect to the skin envelope.  In these situations a mastopexy or breast lift may be necessary to take up all the excess skin.  Otherwise the breasts will have a deflated look with the nipple-areola complex in the lower pole of the breast.  When a breast implant removal, capsulectomy, and mastopexy are performed together, it is important to be very careful with the blood supply to the areola as it may be compromised.

In many cases, women desire a smaller breast size. However, through consultation, they realize that without an implant, their breast size will be too small.  In these cases, the decision can be made to replace the implants with smaller devices.   This can be done with or without a mastopexy.  The greater the size of the prior implants compared to the new implants, the more likely a mastopexy will be necessary.  Most commonly implants are chosen in the 250 cc range to replace much larger implants.

Fat grafting to the breasts is considered a safe procedure. It can add volume to breasts without the complications associated with implants.  Typical volumes that can be grafted are between 250-350 cc.  This translates to roughly 1 cup size in volume that can be obtained with fat grafting.  After implants removal, this option can be considered in patients that desire more volume without implants.