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Breast Implant Removal

The decision to have breast implants is not to be taken lightly and whilst the majority of ladies have a life-changing outcome for the better, a small number of patients may have a issues with their implants longer term or there may be personal reasons to decide to remove them (explantation).

The commonest reasons for removal (and usually followed by re-implantation) is for a change in size (usually bigger but sometimes smaller), capsular contracture (symptomatic adverse capsule formation) or symptomatic rupture. In these cases, the majority of ladies will have implants re-inserted either alone or in combination with uplift surgery and/ or fat transfer. Some ladies will decide for personal reasons that their implant have served a purpose and they no longer require them to be replaced. So as you can see there are a variety of different scenarios that may occur. Mr Banwell and his team are here to support you through the process whichever approach you decide to take. Any questions that you would like to ask are welcomed.

 

REMOVAL & REPLACEMENT OF IMPLANTS

The commonest reason for breast implant removal is actually for exchange of breast implants – the choice may be to keep the same size, go  bigger or go smaller. The fundamental thing here though is that there is a desire to replace them. In actual fact, we have a page entitled ‘Exchange Implants‘ elsewhere on this site . Please click here if this is your preferred approach – we are sure it will help provide additional useful information.

 

REMOVAL & REPLACEMENT OF RUPTURED IMPLANTS

Rupture is an unusual risk of breast implant surgery. The rupture rate for breast implants varies between 4-10% and seems to become more likely after 8 years. The majority of silicone breast implant ruptures are clinically undetectable and patients may be totally unaware of this but it may be discovered as an incidental finding. However, patients with breast implant rupture may present with signs & symptoms such as pain, breast lumps or changes in breast shape and size or as capsular contracture (which can occur without rupture but also due to rupture). Implant ruptures are usually confined to the peri-prosthetic capsule but it may also extravasate into the adjacent breast tissue and beyond. Patients with ruptured implants have been studied closely and the consensus of the literature states there are no health risks associated with implant rupture. However, it is recommended that symptomatic patients with ruptured implants should be offered the choice of observation, or explantation and capsulectomy with or without replacement.

We are often asked if an ultrasound scan or MRI will help with the diagnosis but this is not necessarily the case as there may be both false positive and false negative results too. Ultimately the only way of knowing whether an implant is ruptured is at operation. Regardless  please ask if you would like a scan organised as this may provide reassurance for you one way or another.

 

CONCERNS REGARDING MACRO-TEXTURING & BIA-ALCL

The introduction of texturing to implant shells was thought to represent a major advance in breast implant design. Capsular contracture rates were reduced from 40-60% down to 10-15%. However, whilst this has been a very positive advance, it has now come to light that the texturing process might be related to the development of a rare condition known as Breast Implant Associated- Anaplastic Large Cell Lymphoma (BIA-ALCL). This has had huge media attention and not surprisingly has created anxiety in many ladies who have had breast implants. Most of the major breast  implant manufacturers have come under scrutiny  as a result of this including Nagor, Allergan, Sientra, Mentor, etc. It is important to recognise that globally, textured implants have been considered standard and thus many, many girls around the world have been affected by these comments.

As ever, much information out there has been sensationalised and thus it is important to put everything into context. At the same time, it is vital that the medical profession is transparent and does everything it can to investigate all potential risks and complications. Currently the risk of ALCL is quoted at around 1:25,000 – it is therefore extremely rare but presents as sudden swelling of the breast (as a late seroma) and can be diagnosed by fluid and capsular tissue analysis. In comparison, the commonly quoted risk of breast cancer in a woman is 1:8, so breast cancer is infinitely more common than ALCL.

The current recommendations and statement by PRASEAG is listed below (April 2019)

Breast cancer experts from across the UK have been working together to look at the risk to people with breast implants of developing a very rare form of cancer. This follows the news that some types of breast implants have been withdrawn in France.

Based on analysis of the latest scientific evidence and on expert clinical opinion, the Medicines and Healthcare products Regulatory Agency (MHRA) advises that there is no need for people with breast implants in the UK to have them removed because there is no new evidence that the risk has changed. The situation will be reviewed regularly by the MHRA.

If people are worried following their breast implant surgery, they should see their GP or the surgeon who did the implant. This is particularly important if they notice swelling around their implant more than six months after having the breast implant (regardless of how many years later).The MHRA issued this advice following close working with the British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Association of Breast Surgery, the British Association of Aesthetic Plastic Surgeons and other experts to assess the risks associated with breast implant associated anaplastic large cell lymphoma (BIA‐ALCL). MHRA is also working closely with organisations doing similar regulatory work in Europe and internationally.

In addition, the independent Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG) has been monitoring UK cases of BIA‐ALCL and working closely with MHRA and the information is regularly updated on the MHRA website.

MHRA is continuing to collect evidence and investigate the disease, both nationally and internationally. Clinicians are being informed of the need to report all cases of BIA‐ALCL or suspected BIA‐ALCL to the MHRA via the Yellow Card scheme.’

 

EXCHANGE TEXTURED IMPLANTS FOR SILKSURFACE

Despite the reassurances mentioned above, some girls would like to exchange their implants for the latest generation SilkSurface, (nanosurface, neosmooth) implants made by Motiva. This may, of course, coincide with 10 year mark but it may be that the latest technology implants are more appealing and that they would like to remove their textured implants just to be on the safe side.  Mr Banwell would be happy to discuss this in more detail if this would be your preferred option. NB. The only other option is to convert back to the archaic original smooth implants of 30 years ago which Mr Banwell believes is a retrograde step.

 

CONCEPT OF BREAST IMPLANT ILLNESS (BII)

Breast implants (like hip/knee prostheses, metalwork for trauma or orthognathic surgery, heart valves and coils) are foreign bodies and as such the immune system recognises them as foreign and responds by generating a wall of scar tissue around them (in the case of breast implants this is called a capsule). This is a completely normal process, the breasts usually feel soft, and in the vast majority of ladies there is no issue. However, in a small percentage of patients (as Mr Banwell always explains to his patients pre-operatively), the capsule can sometimes misbehave and starts to harden & contract. This can cause symptoms such as pain, discomfort and a change in the shape of the breast. Whilst capsule formation per se is considered normal, so-called ‘capsular contracture’ is an adverse response of the body to breast implants.

Over a two decades ago there were some concerns that breast implants may also cause other responses and symptoms within the body. The so-called ‘silicone crisis’ was thought to be due autoimmune-mediated events within the body (also called ASIA syndrome). Whilst independent government scientific reviews around the world have concluded that there is no causal relationship between silicone and auto-immune mediated problems, it appears there maybe a small group of patients who present with a variety of unexplained symptoms and seem to get better when their implants are removed. This condition has been termed Breast Implant Illness (BII). It is still currently debated by the general medical community regarding the significance of these anecdotal reports and further research is required. However, despite this ongoing controversy, Mr Banwell firmly believes it does exist and has seen the significant (and sometimes immediate) benefits of explantation in these patients where it appears as though their immune system has had a hypersensitive response to the breast implants (a predisposed individual can also be affected by the coil or any other implanted foreign body). Mr Banwell is recognised as a specialist in breast implant illness and ‘en bloc’ / ‘total’ capsulectomy surgeries and is very happy to help if a patient thinks they are affected.

 

EN BLOC CAPSULECTOMY

‘Total capsulectomy’ or ‘en bloc capsulectomy’ is the commonest procedure requested by those patients who present with symptoms of breast implant illness (BII). Whilst removing the immune stimulus (ie. the breast implants)  and washout of the pocket seems to benefit patients immediately and is the most important aspect of the operation, the majority of patients also elect to have the capsule removed too. Mr Banwell is very experienced at this procedure and has helped many women in this situation. However, please understand that this does increase the risk of bleeding complications, scar length, seroma formation, thinning of the breast tissues, the length of the operation and indeed the cost. As the medical benefit for removing an asymptomatic thin capsule is not proven ( it has been shown they reabsorb/remodel within a few months) this decision must be weighed up carefully by patients. However, this is usually understood by everyone so if you would like a total (en bloc) capsulectomy this can be performed in association with explantation of your implants. Mr Banwell would be happy for the capsules to be sent away for pathological analysis if patients so wish – please let Mr Banwell’s team know if this is the case (there is an additional cost for this). Please note that Mr Banwell also routinely photographs the implants and capsules for your records.

 

EMPTINESS & SKIN EXCESS FOLLOWING REMOVAL

Removal of implants without re-implantation will leave the breast deflated with a variable appearance depending on the amount of remaining breast tissue. It is recommended to allow tissues to settle for at least 6 months after such procedures and many patients are happy with the resultant appearance. However, some patients elect to have a subsequent breast lift procedure (mastopexy) or fat transfer procedure.

 

 

 

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Treatment Factsheet

For your convenience Mr Banwell has created a factsheet for this treatment to download and retain.

Breast Implant Removal
At a Glance

1 - 1.5 hours

SURGERY TIME

Breast Implant Removal
At a Glance

Day case or 1 night stay

HOSPITAL STAY

Breast Implant Removal
At a Glance

No

ANAESTHETIC ASSESSMENT

Breast Implant Removal
At a Glance

Possibly

PRE ADMISSION TESTS

Breast Implant Removal
At a Glance

Sleeping on back recommended for 1 week

SLEEPING POSITION

Breast Implant Removal
At a Glance

1 day

REASONABLY MOBILE

Breast Implant Removal
At a Glance

Shower after discharge. Bath after 2 weeks.

WASHING

Breast Implant Removal
At a Glance

1 week

DRIVING

Breast Implant Removal
At a Glance

2 weeks

EXERCISE INCLUDING GYM

Breast Implant Removal
At a Glance

2 weeks

SEXUAL ACTIVITY

Breast Implant Removal
At a Glance

4 weeks

FULL RECOVERY

Breast Implant Removal
At a Glance

1 week

TIME OFF WORK

Breast Implant Removal
At a Glance

Required for 8 weeks ideally

BRAS & GARMENTS

Mr Banwell  will discuss with you his thoughts on the best treatment plan for you. Removing breast implants alone is fairly straightforward. However, this may be combined with removal of the capsule as many ladies and girls will decide that removing the capsule may be best the best strategy for them. Interestingly though we have noticed that thin pliable capsules usually reabsorb unlike thick capsules which can cause lumpiness once the implants have been removed.

Removing breast implants is a very personal choice and if not replaced will lead to a smaller, empty breast often with skin excess. However, whilst the final result cannot not always be predicted, our patients are happy with the outcome . Mastopexy can also be performed to tighten up any loose skin and fat transfer can help add additional volume.

The surgery can take anything up to 3 hours depending on the complexity and severity of the problem. Drains are usually inserted on each side, and these will normally stay in for 1 day – the amount of drainage fluid produced is usually more than that produced after your first breast implant operation (but will vary from patient to patient).

The recovery is often similar to your original operation although this will vary from patient to patient. Mr Banwell recommends you commence wearing a sports bra or compression top immediately after your drains are removed and you should continue wearing this day and night for 8 weeks. After the surgery the wound will be dressed with brown micropore tape which is waterproof. You will be able to shower the day after leaving hospital after which you can pat the tape dry with a towel and then use a hair-dryer on a warm setting to ensure the tape is completely dry. You will normally be able to return to work after 1 week depending upon how you feel.

In the first week following surgery you should take things very easy, preventing any mishaps. The following week you will find you can do much more and may be ready to return to work. You should avoid lifting and carrying for 2 weeks following surgery and strenuous exercise/physical activity should be avoided for 4 weeks following the surgery to prevent damage to your breasts and their new implants. Many patients find gentle cardiovascular exercises and having a massage are fine after a few weeks. You can drive when you feel safe to perform an emergency stop otherwise you insurance company may invalidate your insurance.

The operation has a high success rate and patients are grateful once more for a soft, natural breast. However, unfortunately, once an abnormal thickened capsule (capsular contracture) has occurred, recurrence is possible and Mr Banwell will want to follow you up.

Unfortunately complications can occur following any surgery and patients need to be fully aware of this. Mr Banwell does his utmost to minimise the complication rate and likes to practise in a safe manner. The commonest complications are bleeding, haematoma formation and the need to return to theatre, as well as infection, numbness, alteration in nipple sensation, asymmetry in the healing and the final result, DVT & PE.

My expectations were fully met when I went to see Mr Banwell for the first time and he went through very carefully what he would be doing and giving me a realistic prognosis which was what I wanted. He came over as a very thorough and caring person. The skin graft was a complete success and although quite a large area, it is exceptionally neat and gives me no concern. On two further occasions I noticed lumps in other areas, and on getting in touch, appointments were made and Paul removed them immediately, once again very neatly. The after care is also extremely important to me and I have never been disappointed. Luckily I don’t know anybody going through the same thing as me but I would have no reservations in telling them to go and see Paul, as his thoughtfulness and care and attention throughout is excellent, he treats you as an individual. I would also say that I consider him now to be a friend as well as a surgeon. Whenever I am on the phone making future appointments his staff are always friendly, helpful, cheerful and willing to chat, but if you need any reassurance at any time they’re there for you.


Nicky S.

I asked around and was told that Mr Banwell was the best in his field. I don’t know what my expectations were but the result was great, all my friends think my eyes look brighter and more open. I had no bruising which I was told I might have. Mr Banwell and his team excelled in making my life very easy for me, with arrangements and liaising with the hospital which didn’t always have my details correct, they were very helpful and answered all my questions, nothing was too much trouble. Mr Banwell put me at ease and I was not worried about the operation at all.


Wendy B.

Mr Banwell was highly recommended by a friend of a friend. She was very satisfied with results which I witnessed. I trusted what I heard and what I saw. My meetings with Mr Banwell only reassured me further. Mr Banwell offered additional discussion time pre op & several follow ups post op. His admin team were 100% helpful and efficient. His manner was approachable and accessible. I would not hesitate to recommend his professional expertise, competitive cost and charming manner. At no point did I feel judged, intimidated or overwhelmed. This was an incredibly positive experience, many thanks to Mr Banwell and the rest of the team.


Sarah P.

You are the greatest Plastic Surgeon in UK today. Keep me informed. Your excision of my SCC was a masterpiece of Surgery.


Aubrey T.

I was delighted with my care, it was faultless in all aspects. Everyone was highly professional and they all conducted themselves in an exemplary manner throughout. Not only was my treatment successful but the cosmetic result was incredible in that it is hardly visible. Mr Banwell and his team offer a truly exceptional service which I am confident could not be matched elsewhere.


Thomas W.

The end result I have is amazing and completely natural.

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