Removal of Breast Implants: Discover your Options

Explantation breast surgery or removal of breast implants has been on a steep rise in the recent years. According to the American Society of Plastic Surgeons explantation surgery increased by 9% from 2022 to 2023, more than any other aesthetic surgery (link)! Women seek to remove their implants for various reasons. The decision to remove breast implants is not one to be taken lightly, but understanding your options and what to expect can make the process less stressful and more rewarding. Whether you're looking to have your breast implants removed for health reasons, or you're seeking a change of personal and aesthetic motivations, I hope you find this blog helpful in guiding you through your journey.

Why are breast implants removed?

The most common reason for removal of breast implants is implant-related complications. Although there is no expiry date for breast implants, studies have shown that the average shelf-life for breast implants is 15 years and more than 60% of women will need some sort of revision surgery within this time. 

Some women experience pain or discomfort due to implants that are too large or have shifted. Breast reduction by removing the implants can alleviate these symptoms and return a sense of comfort. Another common reason for breast implants removal is their impact on physical activities. We are seeing more women taking up active lifestyles and weightlifting exercises who may find implants uncomfortable and restrictive.

Some women are concerned regarding mammographic detection of breast cancer in the presence of breast implants. This is somewhat true specially in cases where the implant is positioned on top of the muscle. Submuscular implants on the other hand can easily be pushed out of the way during mammographic screening.

Since 2019 the raised awareness regarding Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) with textured implants has pushed more women to request implant removal although this was not recommended by the Therapeutic Goods Administration (TGA, link). It is important to note that the rate of BIA-ALCL with the textured implants currently available in the Australian market is extremely low and we recommend you have a thorough discussion of the pros and cons of these implants with your surgeon before making a decision. We have a dedicated blog on this topic that our patients have found informative (Link).

Another health-related reason for some women seeking to remove their implants is the so-called Breast Implant Illness (BII). Anecdotal reports initially raised the question of a possible association between silicone gel implants and various systemic diseases (in particular, connective tissue diseases), or a "silicon adjuvant syndrome." Although a comprehensive literature review by the US Food and Drug Administration (FDA) and many subsequent studies have failed to show such association, some women continue to link various systemic symptoms to their breast implants. The spectrum of these symptoms collectively known as BII include joint pain, aching, swollen lymph glands, unusual tiredness, greater frequency of colds and flu, hair loss, rash, headaches, poor memory, nausea, muscle weakness, irritable bowel syndrome and fever. It may be that the available studies are underpowered to detect such a relationship, and further studies are warranted. In the meantime, it is important to discuss your concerns with your surgeon who is hopefully not dismissive but rather explanatory and empathetic.

Removal of breast implants with or without capsulectomy?

Thick calcified capsules associated with bilateral ruptured implants. On the left no remaining implant shell was found. A ruptured implant shell was removed on the right side.

Capsule formation around the implant is a natural defence mechanism when the immune cells cannot break down and digest the foreign body. In some situations, however the process of capsule formation becomes excessive leading to a very thickened, stiff capsule often with calcification. This so called “capsular contracture” is a common reason for revision following breast implant surgery. A diseased capsule such as this is best be removed during implant removal. This is called capsulectomy which may be complete or partial. On the other hand, leaving a nice and thin capsule maybe advantageous for breast reshaping and lift or adding extra volume at the time of your revision surgery. Therefore, the decision to perform partial or complete capsulectomy is best left to the surgeon’s intraoperative judgement based on the balance of benefits vs the added risk of capsulectomy such as bleeding and damage to the breast tissue. The exception is when implant removal is done for cancer such as BIA-ALCL. In this scenario ‘en bloc’ capsulectomy should be performed which is removal of the entire capsule and the implant all at once without opening the capsule.

How can I avoid going flat/saggy following removal of breast implants?

Following implant augmentation, the breast skin as well as its fibrous scaffold will stretch to accommodate for the added volume. The breast tissue itself may atrophy specially with larger implants.  With the added weight of the implants exacerbating the effects of gravity and aging tissues, increasing breast ptosis (sagging) develops over time. Therefore, you may rightfully worry that removal of your implants may result in deflated, droopy breasts out of proportion to what would be expected from your natural aging. To overcome this issue implant removal may be combined with various other surgical options to achieve the best outcome based on your wishes and desires and your aesthetic goals.

Implant removal only

This is the simplest option which may also be the most suitable choice in selected cases. A possible scenario is when the volume of the removed implant is small relative to the remaining breast in a relatively young patient with good skin and tissue quality and no ptosis.

Implant removal and replacement ± mastopexy (breast lift)

Top left before, top right and bottom pictures 6 months after removal of bilateral ruptured implants and replacement with similar size implants and anchor-scar mastopexy.

If you are not opposed to having breast implants this is the most straight forward option to restore the lost volume.  The new implants may be placed with or without mastopexy to tighten the skin and adjust the nipple position–collectively called ‘revision augmentation mastopexy’. The choice of implant volume, surface texture and pocket will be discussed similar to primary augmentation. However, you may find volume selection rather tricky in this situation specially if you are planning to go smaller. The alternative is to do this in two stages. In the first stage the implants are removed allowing the tissues to recoil over the next few months.  In the second stage the new implants are placed with or without mastopexy.

Implant removal + mastopexy

If you don’t want implants anymore, a simple mastopexy may be enough to give you the desired upper pole fullness and projection depending on the remaining breast volume.

Implant removal + mastopexy auto-augmentation

Mastopexy auto-augmentation is an advanced technique available in some cases whereby a flap of breast tissue is moved behind the nipple to enhance breast projection. This is particualry helpful in women with significant excess skin that instead of being excised can be repurposed as a native tissue flap to add volume. Mastopexy auto-augmentation allows women to restore volume and rejuvenate their breasts without using implants.

Fat grafting

Autologous fat grafting also called lipomodelling can be added to any of the above techniques for extra volume. Providing you have suitbale donor sites for fat harvest, the suctioned fat can be grafted back to the breasts to enhance volume and contour using your own tissue.

Preparation for implant removal surgery

Removal of breast implants is not a decision to be taken lightly specially if it’s combined with other procedures to enhance your breasts. It involves a great deal of preoperative consultation and planning which is then meticulously executed on the day of surgery. You may have multiple consultations with Dr Tourani before proceeding with this surgery to make sure your expectations are matched with realistic expected outcomes considering your individual anatomy, tissue quality, and risk profile.  During the consult Dr Tourani will go through the options available to you and pros and cons of each option. You will be then taken through Dr Tourani’s photo gallery of his previous patients which is very helpful to showcase the possibilities relevant to you based on your aesthetic goals, your individual tissue quality and anatomy and your comorbidities. As you can imagine there are many moving parts in revision augmentation surgeries, and therefore you are encouraged to take your time to consider various options presented to you and come back for a second consult to discuss minor details and the questions you may have.

Another important aspect of preparation for revision implant surgery is improvements in your modifiable risk factors such as smoking, obesity and diabetes. In fact, I have witnessed many women taking a healthy turn in their lifestyle leading up to their surgery to help them being the best version of themselves and optimise their healing following surgery. 

Cost of implant removal surgery

The cost of explantation surgery can very significantly based on the complexity, the extent of optional extra surgeries following implant removal, the reason for implant placement in the first place, the reason for implant removal, the surgeon’s expertise and your health insurance cover. The MBS item numbers 45548 and 45551 cover implant removal only with or without capsulectomy. Any other additional procedure is generally cosmetic and not covered by your health insurance, unless the original implant was put in the setting of breast cancer or developmental abnormality. Therefore, the cost generally becomes an important part of the conversation when it comes to explantation surgery. At Dr Tourani’s practice we make sure that you are well informed of all the costs early on so that you can incorporate that into your decision-making process. These costs include doctors’ fees including surgeon, assistant surgeon, and anaesthetist, as well as hospital and theatre fees. It may also include the prosthetics used such as breast implants and meshes if required.

We know that a substantial number of Australian women travel overseas for their cosmetic surgeries to save costs. However, explantation and revision augmentation surgery requires a level of technical expertise and excellence in perioperative care that often falls well beyond the scope of practice for overseas cosmetic surgery centres! There are often so many moving parts in these complex operations that you really need the expertise of a well-trained, fully qualified plastic or breast surgeon and their experienced team in an optimal hospital environment to navigate safely through your journey. With Dr Tourani by your side, you can rest assured that your health and wellness is our highest priority. When you choose Dr Tourani his many years of experience in all aspects of breast surgery including cancer and reconstructive surgery will be invaluable in helping you navigate all steps of the way from the initial decision making, to the execution of the planned surgery, judgment calls with unexpected intraoperative findings, and finally excellent care following your surgery. The latter often being the biggest miss for patients seeking ‘medical tourism’ who are often left alone to find an experienced local surgeon to address the complications.

Following your consultation with Dr Tourani, our team remains committed to transparent communication ensuring patients understand every aspect of their financial obligation before proceeding with the surgery. You will be provided with an informed financial consent detailing the upfront costs and estimated rebate from your private health insurance/Medicare. Dr Tourani’s quote will include the cost of all your subsequent follow-up appointments and his fees for any revision surgery that may be required.

Potential risks and complications of implant removal surgery

Explantation surgery like any other surgery can be associated with minor or major complications. Undergoing explantation with Dr Tourani’s experienced team will ensure minimal complications and more importantly early recognition and appropriate management of those complications should they occur. A simple implant removal is associated with the list rate of complications, however as the optional extra surgeries are added the complexity and hence the rate of complications increase.  Below is a list of complications following implant removal surgery:

• Infection

• Bleeding and haematoma

• Seroma

• Wound healing issues and keloid/hypertrophic scars

• Asymmetry

• Mastopexy related complications: nipple loss, changes to nipple sensation, difficulty with breastfeeding

• Augmentation related complications: capsular contracture, implant leakage, malposition, rupture, silicone granulomas, rippling, calcifications causing confusion with breast cancer, potential interference with mammographic screening

• Allergic reactions to anaesthesia

• DVT/PE (blood clots in the legs/lungs)