Implant Removal – Explant Surgery

­­­­WHY CHOOSE DR. GREENWALD FOR YOUR BREST IMPLANT REMOVAL – EXPLANT SURGERY

Joshua A. Greenwald, MD, FACS, is a board-certified New York plastic surgeon. Beast Implant Removal Surgery (Also known as explant surgery) is not a simple procedure, and your result depends on the experience and skill of your surgeon. Each patient is different and requires a unique procedure to achieve optimal results. Dr. Greenwald has significant experience with breast implants (insertion and removal), and performs hundreds of breast surgeries yearly.  As you read below, you will see that patients desiring breast implant removal have many options and a customized plan to your explant surgery is required.  Most patients have minimal or no pain, minimal or no bruising, and a prompt return to normal activities. There are typically no drains or sutures to remove

Dr. Greenwald performs his surgeries at the state-of-the-art Surgical Specialty Center of Westchester. Anesthesia is provided by board-certified anesthesiologists, and all of the nursing staff has significant experience caring for plastic surgery patients.

OVERVIEW OF BREAST IMPLANT REMOVAL SURGERY – EXPLANT SURGERY

While the vast majority of patients with breast implants are very happy, there are many reasons a patient may seek removal of their breast implants (also known as explant surgery).  These include the following:

  • Reduce the size of their breasts
  • Capsular Contracture
  • Implant rupture
  • Concerns about implants causing systemic illness (formerly know as Breast Implant Illness (BII) now referred to as Systemic Symptoms associate with Breast Implants (SSBI)

The process of removing your breast implants may be quite simple (implant removal only) or can be more complicated (implant removal with capsulectomy).  This depends on the status of the breast implant capsule.  If it is thin and translucent, a capsulectomy may mot be needed.  If the capsule is thick and opaque, removal is often indicated.  If the capsule is calcified, removal is also indicated.

There are many types of breast implant capsulectomies described that fall into 2 broad categories: total (en bloc, intact total or total) or partial (if any capsule is left behind). The different capsulectomy techniques will be discussed during your consultation with Dr. Greenwald.  It is important to note that patients with BII/SSBI showed a 74% reduction in self-reported symptoms with no capsulectomy which was not statistically different from patients who underwent partial or total capsulectomies (from McGuire, et al, Aesthetic Surgery Journal).  “En bloc” is a term that should be reserved for the treatment of a malignancy and implies that the underlying malignancy has been removed with a margin of normal tissue; therefore, the term intact total capsulectomy is the proper term for what many plastic surgeons are referring to as en bloc capsulectomies.    When indicated, Dr. Greenwald performs intact total capsulectomies.

Implant removal with or without capsule removal may leave a patient with a breast appearance they are content with.  Often times, a patient may need or desire a breast lift and sometimes even a breast reduction following explant surgery.  Fat grafting for additional volume is also an option.

The patient in the upper left underwent implant removal and partial capsulectomy.  Her skin retracted nicely and no additional intervention was needed.  The patient in the upper right underwent implant removal and partial capsulectomy with plans for a possible delayed lift.  She ended up needing no additional intervention after allowing her skin to “shrink” on its own.  The patient in the lower left underwent an intact total capsulectomy and breast lift.  The lower right demonstrates an intact total capsulectomy specimen (capsule intact, minimal to no fat or breast tissue present).  Before images are in the top row and after images are located in the bottom row.

Often times, it is difficult for the patient (and surgeon) to envision how the patient will look without implants.  This is why Dr. Greenwald often recommends in-office deflation of saline implants and removal of silicone implants prior to formulating a final plan for his patients seeking explant surgery.  This gives the breasts a period to re-expand, tighten, and lift.  Following silicone implant removal alone or saline implant deflation, many patients will be content with their new implant-free breasts and desire no additional procedures.  Another scenario following removal or deflation is that the patient realizes they will not be happy without re-insertion of a smaller implant.  Finally, following removal or deflation, a lift (and sometimes a reduction) is desired by the patient.  With prior implant removal or implant deflation, a subsequent breast lift (mastopexy) or reduction is greatly facilitated once the breast has been unweighted and the breast tissue has had time to expand and the skin has had time to shrink.  Often times, a mastopexy is not needed or desired following implant removal or deflation.

A large portion of Dr. Greenwald’s surgical practice is revisional breast surgery including implant removal, breast implant capsulectomy and breast lift procedures.