Women chose to remove their breast implants for many reasons.  First of all, implants are not considered lifetime devices and it is recommended to have them exchanged every 10-15 years.  Some women decide that they no longer want the heaviness and look associated with large implants and decide 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.  After consultation with their board certified plastic surgeons regarding these issues, some women have decided to remove their implants.

If the implants are intact, are of moderate size, and are not surrounded by a thick hard capsule, a simple implant removal is possible.  This involves making a small incision in the area of the prior incision and scar, 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 be dissolved and not cause any issues.

If the implants are ruptured silicone gel implants, or the implants are affected by capsular contracture, strong consideration should be given to a capsulectomy.  The capsule is the spherical shell of scar tissue that forms over an implant once 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.  Benefits of an en-bloc capsulectomy are that the free silicone gel inside the capsule is not allowed to 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 that is against the chest wall can be very tightly adhered to the chest wall periosteum and perichondrium and be more difficult and more 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 but through consultation 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 difference in the 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 that 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.