Breast Implant Removal Mountain View
Women sometimes want breast implants removed and do not wish to have them replaced. Most often this situation arises when women have previously had breast augmentation with silicone implants. They may be concerned that the implants are ruptured or have anxiety over possible health effects of silicone gel implants. If implants are removed and not replaced, the breast will usually be flat and possibly saggy.
These women are candidates for a breast lift. If breast tissues are thin, it is safest to remove the implants and fibrous capsules, allow the tissue to heal with a better blood supply, and stage the breast lift three to six months later. The risk of nipple/areola necrosis would be increased in such patients if explanation and lifting were done simultaneously.
Lift and Re-augmentation after Previous Augmentation with or without Capsular Contracture
Women whose breasts have become saggy after previous augmentation due to stretching out of the skin envelope may desire a breast lift. Additionally, it is not uncommon for women with capsular contracture, or hardening of the breast after previous augmentation, to desire a breast lift. These women have special problems in that the breast pocket as well as the skin envelope may be disproportionately large in relation to the implant that will be used for re-augmentation. Also the degree of lift needed may be difficult to determine since the contracture abnormally elevated the nipple/areola on the contracted side. The other side, fortunately, can be used as a guide if it is not affected by a contracture.
Cases of unwanted, excess stretching can result over time from use of an overly large breast implant, particularly smooth, round implants, in addition to the usual factors of pregnancy, nursing, and weight gain and loss. The use of an implant that is large relative to a tight skin envelope in a thin woman may also result in excess stretching.
In order to restore shape and decrease the risk of future stretching, an implant of a smaller size than the current implant may be recommended. The implant must be placed in a pocket that precisely fits its dimensions in the side to side direction. When hard capsules are removed, or when large implants are removed, the resulting pocket may be too large and must be reduced. Every case is unique, and sometimes a woman will desire a larger, rather than smaller implant. Furthermore, many women have some degree of volumetric breast asymmetry which may be masked by a previous asymmetrically-sized breast augmentation. Many women have lost the track of the records of their original surgery and it is not possible to know just what size their implants are, or if they are of two different sizes. Having the right implants present at the time of revisional surgery can require taking a very wide range of implants and trial breast implant sizers to surgery. And if the new implants are going to be gel, instead of saline, this can require taking 18 or more implants to surgery, both to ensure the proper wide range, and to have a back-up third implant for each pair used. So even logistically, these are challenging cases to prepare for.
Currently, there are biocompatible materials that can be used to strenghthen the tissues, These include acellular dermal matrix, or Alloderm, and Seri, which is a biosynthetic mesh that gradually is replaced by the patients own connective tissue. These materials reinforce weakened, streteched out skin, and are helpful in correcting or preventing implant malposition, like bottoming out or lateral displacement.
Whichever the situation, these cases are among the most challenging in breast revision surgery. The goal of getting a firm, round, uplifted breast after previous augmentation with or without capsular contracture, requires matching skin and breast envelope to the new implant dimension, and correcting any implant to pocket disproportion. When implants are being transferred from above to below the muscle to decrease the risk of recurrent contracture or to get better soft-tissue coverage, the old pocket must be closed off. If the procedure is being done as a periareolar lift, all the variables of skin, pocket and implant size have to be evaluated and corrective techniques applied at the time of surgery. Because of the complex interplay of implant size, pocket size and skin reduction required to obtain the final result, patients having this kind of surgery should be willing and financially able to accept a second-stage revision at three to six months if one of these variables has not been fully addressed. This might include further internal tightening of the lateral pocket boundary, or further revision of the periareolar lift with more skin tightening. Sometimes insurance is available to pay for these cases. They can be considered reconstructive if capsular contracture has occurred after cosmetic augmentation, or if radiation has caused a contracture in a previously augmented breast in cases of lumpectomy and radiation for breast conserving therapy after breast cancer.
To schedule a breast lift consultation at our center, please contact our plastic surgery practice today.