Breast Implant Removal or Replacement

with Dr. Thomassen

Why Remove your breast Implants?

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.

What is involved in removing breast implants?

Simple implant Removal

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.

Implant Removal and Capsulectomy

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.

Implant Removal, Capsulectomy and Mastopexy

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.

Implant Exchange, with or without a Mastopexy

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.

Breast Implant Removal and Fat Grafting

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.

Who is a Good Candidate for a Breast Implant Removal?

Good candidates for breast implant removal are women that desire removal or exchange of their breast implants for a different size, or because of problems with their implants due to rupture or capsular contracture.  Options for a capsulectomy, mastopexy or fat grafting at the same time can be discussed.

Preparing for your breast implant removal

The first step in planning your procedure is a thorough evaluation by Dr. Thomassen.  For your medical history, Dr. Thomassen will inquire about your medical conditions and medications taken.   Any conditions that may pose a risk for anesthesia or surgery will be addressed.


Any medications that may result in excess bleeding will need to be stopped 2 weeks before surgery.  These include anticoagulants like aspirin or non-steroidal anti-inflammatory drugs like Ibuprofen.  Tylenol is safe to take prior to surgery.  You need to provide us with a list of homeopathic medications taken as these could have an adverse effect on wound healing and bleeding.


A history of smoking is very important to report as this could adversely affect your wound healing as well.   In general it is safest to stop smoking for 2 weeks before and 2 weeks after surgery.

Mammogram and Ultrasound

In women over 40 years of age mammographic/ultrasonographic screening for breast cancer is recommended to be done yearly.  If planning a breast augmentation surgery, it is important to have a study done within 1 year of surgery.  If younger than 40, this is not required.  However, if you do have a strong family history of breast cancer, it may be recommended to obtain a study before surgery.

Physical Exam

Dr. Thomassen will examine you to determine how best to undergo the surgery.  Key information gathered in exam is your current breast cup, asymmetry, any axillary or breast masses, and the presence of breast ptosis or excess breast droop.

It may be possible to determine if you will suffer from excess breast ptosis after implant removal and in this case whether you would be a candidate for a mastopexy at the time of removal.  Sometimes, it may be wise to stage the mastopexy for a later date after removal to ensure you would benefit from this additional procedure.

Choosing the Breast Implants

If deciding to replace your current implants with new implants, a decision regarding the size needs to be made.  Many times an exact size is difficult to determine preoperatively and a group of implants will be made available for the procedure.

Preoperative Clearance

Dr. Thomassen will recommend the appropriate preoperative workup required according to your medical history.  This workup usually involves an evaluation by a primary care doctor to ensure you are in an optimal state for surgery.  This includes laboratory evaluation.  If there are any abnormal findings from your workup, Dr. Thomassen will call you and discuss how to proceed.

Days before Surgery

  • Avoid strenuous exercise in the days leading up to your surgery.  You should be well rested leading up to your surgery date.  Also avoid excessive sun exposure.
  • Refrain from alcohol the week before surgery.
  • Pick up your prescriptions with plenty of time before your procedure.  Set up a comfortable recovery area at home and plan your meals including a light clear liquid meal for the first night.
  • Plan for someone to be with you for 24 hours after surgery.
  • You will receive a call from our Operating Room Nurse a few days before your procedure to go over the consent and any preoperative details and instructions to make sure you are ready for surgery.
  • You will recieve a call from our Anesthesia Provider the day before surgery to go over your medications and discuss details about your anesthesia.
  • Use antibacterial soap when showering the day before surgery.
  • Remove any piercings or jewelry you may have before coming in for the procedure.

What to expect the day of surgery

The day of surgery you will arrive at our office at the appointed time.  Wear something loose and comfortable that you can easily remove and put back on after the procedure.  A button down shirt and loose pajama bottoms are ideal.

You will meet the surgical team, including a preop nurse and anesthesia provider.  Dr. Thomassen will answer any final questions you may have regarding the procedure and do some markings.

What Anesthesia is Used for a Breast Implant Removal Procedure?

Breast Implant Removal, including capsulectomy, mastopexy, and even fat grafting can be comfortably performed with IV sedation and local anesthesia.  The IV sedation medications used include Versed, Propofol, and Fentanyl.  Local anesthesia will  ensure you are comfortable throughout the procedure.  When you wake up, you should feel comfortable, without the nausea that accompanies general anesthesia.

How long does the breast implant removal procedure take?

A simple breast implant removal can take only 30 minutes to perform.  If a capsulectomy is also done, this can add 1 hr to the procedure.  If a mastopexy is performed, the procedure can take 3 hours.  When you wake up, you will have a bra and some gauze in place and should be comfortable. You will be able to go home after you meet criteria for discharge. Dr. Thomassen will call you the evening of the surgery to ensure you are doing well.  The pain medications prescribed will make you comfortable.   Dr. Thomassen may provide you with a muscle relaxant that will make you more comfortable if a tight soft tissue envelope results from the augmentation.

What is the Recovery like for a breast implant removal

Your first follow up with Dr. Thomassen will be in 1-2 days after surgery. You will have small steri strips or tapes along your incisions.  Dr. Thomassen will remove these on your second visit. Your breast size will be larger in the first few weeks due to swelling.

You should not undertake strenuous exercise for at least 4 weeks after surgery. Light walking is fine the first week and you can gradually increase exercises as you feel better.

You will be started on implant mobility excercises at 2-3 weeks after surgery. Implant mobility exercises are important for two reasons. First, they appear to be helpful in preventing capsular contracture. Second, as patients are able to stretch their tissues with the exercises, they are able to become comfortable more quickly.

Schedule Your Consultation Today!

If you’re considering plastic surgery, choosing the right plastic surgeon could not be more important. Dr. John Michael Thomassen has the training, experience, and caring to provide you with excellent care. We invite you to have a consultation about the procedure you need.