Category Archives: Reconstruction Removal

When Should You Remove Your Implants?


Breast implants do not last a lifetime. If you get breast implants, you should expect that you will need additional surgery in the future to fix problems or remove your implants. Below are some common reasons why you might need your implants removed. You can click on the links for more information:

Capsular Contracture & Breast Pain

The most common complication of breast implants is capsular contracture. When you get breast implants, your body tries to protect itself from the foreign object by forming scar tissue around the implants. Capsular contracture occurs when the scar tissue hardens and tightens around the implant. Severe capsular contracture can cause extreme breast pain, make it difficult to perform daily activities, and can make the breasts change shape. If you have hard, painful breasts, the only way to improve your symptoms is to surgically remove the breast implants and the scar tissue capsules.

Many women with breast implants also report breast and/or chest pain that is not related to capsular contracture (breast hardening). If the breast pain cannot be treated, you will probably need to have your implants removed.

Rupture

Both saline and silicone implants can rupture and leak. This can be caused by anything from a small hole to a large tear. When saline implants leak, it is usually obvious because they tend to deflate quickly. When silicone implants leak, it may be a slow leak and there may be no symptoms or signs. Silicone can leak and travel to other organs such as the lungs, liver, or brain where surgeons can’t remove it. If your implants are leaking, you will need to have them removed as soon as possible. If you have ruptured silicone gel implants, you should find a plastic surgeon who is experienced at removing  implants en bloc, which is when the scar tissue capsule and implant are removed at the same time, with the implant still inside the intact scar tissue capsule.  En bloc removal prevents silicone and other chemicals from leaking into the woman’s body during surgery.

Autoimmune Symptoms

Many women with breast implants complain of joint pain, chronic fatigue, fibromyalgia, memory issues, hair loss, and flu-like symptoms. If you are experiencing any of these symptoms, they may be autoimmune reactions from the silicone or other chemicals in your implants. This is especially likely if you had autoimmune or connective tissue diseases before getting implants, or if any of your family members have those diseases (such as multiple sclerosis, lupus, arthritis, and scleroderma). Women with autoimmune symptoms or a family history were intentionally excluded from breast implant studies because the implant companies were concerned that the implants could trigger those symptoms. If you are experiencing any of these symptoms, you should consider having your implants surgically removed.

Breast Implant Associated-Anaplastic Large Cell Lymphoma (ALCL)

ALCL is a rare form of cancer of the immune system. Experts now agree breast implants can cause ALCL, and now refer to it as Breast Implant Associated – Aplastic Large Cell Lymphoma (BIA-ALCL). To test for ALCL, your doctor will draw fluid from your breast and test it for cancer cells and/or order imaging tests like a PET scan or MRI. If you are diagnosed with ALCL, your implants and scar tissue capsule must be removed as soon as possible.

Other Problems

Breast implants can interfere with the accuracy of breast cancer screening and might cause mammography to be unbearably painful.  If you are diagnosed with breast cancer, have a family history of breast cancer, or your doctor suspects you have breast cancer, you should talk with your doctor about removing your breast implants.

Infections can occur right after breast implant surgery or months or years after. If you are experiencing recurring or serious infections that might be caused by your implants, you should seek immediate treatment. If antibiotics are not effective, you will need to talk with your doctor about removal.

Breast implants add weight to your upper body, which may cause serious back, neck, or shoulder pain. If other treatments, like muscle strengthening exercises, do not relieve these pains, it may be necessary to remove your implants.

Other complications, like problems with how your breasts look, might also cause you to want your implants removed.

The longer you have implants, the more likely you will have one or more of the complications listed above. If you experience serious issues with your implants and need them removed, replacing them could cause continued problems.  For example, many women with problems like capsular contracture, pain, or autoimmune problems will continue to have problems if their implants are replaced. This could result in an expensive cycle of surgeries.

Removing breast implants is more a complicated surgery than putting them in and requires a skilled plastic surgeon. For more information on finding an experienced plastic surgeon to remove your breast implants, click here.

All articles have been reviewed and approved by Diana Zuckerman, PhD, and other senior staff.

Finding a Plastic Surgeon to Remove Your Implants


Finding a plastic surgeon to perform your explant surgery is tricky because it can be a more complicated procedure than placing implants. If you have already had a negative experience with your breast implants, it is very important to find a surgeon that can remove your implants carefully. Your surgeon needs to be able to minimize any silicone leakage or other problems during the surgery.

You should start by looking for a surgeon who understands that breast implants can cause serious health problems, because those surgeons will be more careful when removing your implants. It is also important that your plastic surgeon be board-certified by the American Board of Plastic Surgery. Any doctor can call themselves a plastic surgeon, but only those who are board-certified have extensive training. The ABPS website lists all board-certified surgeons.

En Bloc Removal

Your explant surgeon should be experienced in en bloc removal, whenever possible. En bloc removal is when the surgeon removes the scar tissue (or capsule) and implant at the same time, with the implant still inside the intact scar tissue capsule. This is especially important if your implants are filled with silicone gel, are ruptured, or are very old. En bloc removal allows the silicone and other chemicals to stay inside the intact scar tissue capsule as it is removed. En bloc removal prevents silicone, other chemicals, and bacteria from leaking into the woman’s body during surgery. It requires a larger incision (which can mean a larger scar), but it is worth it because it prevents leakage that can cause health problems.  

Keep in mind that en bloc removal may not be possible in all cases, and your surgeon may not know if an en bloc procedure is possible until you are in surgery. For example, if your scar tissue capsule is very thin or tightly attached to the chest wall, en bloc removal may not be possible.

Total Capsulectomy

En bloc removal is also sometimes referred to as a total capsulectomy, but they are not exactly the same. A total capsulectomy is not always performed using the specific en bloc technique. A total capsulectomy is the removal of the breast implants and all the scar tissue, or capsule, that forms around a breast implant. However, during a total capsulectomy, the implant is not necessarily removed while still inside the intact scar capsule (en bloc method). Most surgeons use the term total capsulectomy to mean that they will cut the scar tissue capsule, remove the implants first, and then go back and remove all of the scar tissue capsule.

What if en bloc removal is not possible?

Let your plastic surgeon know in advance that if en bloc removal is not possible, you want the surgeon to remove as much of the scar tissue capsule as possible. Surgeons who are experienced in en bloc removal will know how to remove your implants and scar capsule material as carefully as possible.

Unfortunately, there are not many surgeons experienced in en bloc removal and most do not take insurance. If you cannot find a surgeon near you that performs en bloc removal, or you are required to see a surgeon inside your insurance network, you should select a surgeon who can perform a total capsulectomy.

If you are paying for the surgery yourself, keep in mind that the most important factor to consider is the expertise of the surgeon in performing en bloc removal. In some cases, women have traveled to experienced surgeons in the U.S. and still spent less than their local, less experienced plastic surgeon.

Your Decision

Once you have selected a board-certified plastic surgeon experienced in explantation, there are several questions you should ask to ensure your surgeon understands your wishes. You should ask the surgeon how many en bloc or total capsulectomy procedures he or she has performed to gauge skill and experience. You can also ask to speak with one of your surgeon’s patients who has had en bloc explantation to hear about their experiences. Finally, you may ask for before and after pictures of the plastic surgeon’s own patients. Here is a one-page resource that lists all the questions you should ask your surgeon at your next consultation. Click here to print this one-page list of questions to take with you to your next consultation.

It is also important that you and your surgeon are on the same page about your priorities for the surgery. In order to help make sure that your surgeon knows how strongly you feel about the surgery, we have created a short acknowledgement form that you can print and take with you to your consultation. This form will be signed by you and your doctor and acknowledges that your doctor understands your desire for an en bloc explant whenever possible. Click here to print the acknowledgement form to take with you to your next consultation.

Insurance Coverage

If you want health insurance coverage for your surgery, you can find out if there are plastic surgeons who participate in your health insurance plan, are board-certified, and experienced in the en bloc or total capsulectomy removal. You can start by contacting your insurance company’s member service line to speak with an insurance representative. Many insurance company websites provide online databases of participating physicians.

As mentioned previously, many plastic surgeons experienced in en bloc or total capsulectomies do not accept or work with insurance. If your plan is likely to cover your breast implant removal, you will need to determine if your plan allows you to see out-of-network surgeons and seek reimbursement. If your plan requires you to see in-network surgeons, you will need to decide how important it is for you to have your surgery done en bloc and how you will raise the funds to pay for the procedure up-front.

Once you find participating surgeons, you can call their offices to ask about their experience with en bloc removal or total capsulectomy.  If the surgeon meets the above criteria, you should request an in-person consultation before scheduling your surgery.

Questions to Ask Your Explant Surgeon


Once you have selected a board-certified plastic surgeon experienced in breast implant removal, there are several questions you should ask to ensure your surgeon understands your priorities for surgery and is experienced at explanting. Click Here to print this one-page list of questions to take with you to your next consultation.

Questions About Explant
  1. Do you perform “en bloc” removal, which I understand is when the implant is removed while still inside the intact scar tissue capsule?
    • How many times per month or year do you perform en bloc removals?
  2. Do you perform “total capsulectomies,” which I understand is when the implant and capsule are removed separately, but the entire scar tissue capsule is removed?
    • How many times per month or year do you perform total capsulectomies?
  3. Please explain to me in detail exactly how the procedure will be done?
  4. Are there situations where it might be impossible for you to remove the entire capsule? If so, what are they
  5. I don’t want my implants replaced. Please tell me about the possible options to improve the look of my breasts once my implants are removed but not replaced (Breast lifts and fat transfers are two such options to discuss)
    • Can I see before and after pictures of women on whom you have performed implant removal?
  6. Do you have any explant patients who would be willing to speak to me about their experiences?
Questions About My Health
  1. Do I have capsular contracture? If so, what grade (Baker I, II, III, or IV)
  2. For silicone gel implants: Will you refer me for a breast coil MRI to detect rupture? Or ultrasound? I don’t want mammography, because the pressure could cause leakage.
Questions About Insurance Coverage
  1. Do you accept my insurance? Does your office bill insurance directly or do I need to pay up front for the surgery and seek reimbursement? (If Medicare: Are you a Medicare Participating Provider who takes assignment?)
  2. Will you write and/or sign a letter of medical necessity for my insurance claim, saying that based on my symptoms my breast implant removal is medically necessary?
  3. Does your office have the medical billing codes for the specific procedure you will perform that I can give to my insurance company if I am filing on my own behalf?