What are the factors to consider with breast implant removal surgery?
In Australia approximately 20,000 breast implant augmentations are performed each year. Women choose this surgery for a variety of reasons. All breast implants have the potential to require removal. The decision to remove a breast implant requires careful consideration. Please find some general information below that may assist you in arriving at an informed decision regarding breast implant removal surgery (explant).
What are the reasons that breast implants are removed?
The reasons to remove a breast implant are varied and personal. Some of these reasons include:
- Breast implant complications such as implant rupture, breast pain, capsular contracture, or implant migration
- Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
- Breast implant illness (BII)
- Personal preference
Do breast implants need to be removed after 10 years?
Breast implants do not need to be removed if there are no complications. After 10 years, the likelihood of breast implant rupture increases however the implants can safely be kept in place indefinitely if there is no evidence of complication.
What is the risk of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
BIA-ALCL occurs with textured breast implants. It is not associated with smooth breast implants. BIA-ALCL is rare but when it occurs typically presents as a swelling or collection of fluid around the breast implant (seroma). This may result in breast enlargement. A diagnosis of BIA-ALCL is confirmed by testing a sample of fluid from around the implant.
The risk of BIA-ALCL varies depending on the type of textured breast implant. For example, Mentor textured breast implants carry a risk of BIA-ALCL between 1:14,000 and 1:64,000 and Allergan textured breast implants carry a risk of 1:3,000. Most cases of BIA-ALCL occur 1 to 8 years after breast implant insertion. The majority of cases of BIA-ALCL present in the early stages with seroma only or early capsule invasion. Early-stage BIA-ALCL is fully treated with breast implant and capsule removal. Rarely, in more advanced stages of the disease, chemotherapy is required.
What does the management of Breast Implant Illness (BII) involve?
Breast implant illness (BII) may present with symptoms including fatigue, memory loss, rash and joint pain. There is no specific test to confirm or exclude BII. There is also no guarantee that removing breast implants will correct the symptoms associated with BII. The first line of assessment for BII should be to discuss your symptoms with your General Practitioner and ensure that all relevant investigations have been performed. The next step is to seek a referral to discuss the role of breast implant removal surgery (explant).
What is the management of breast implants on the Therapeutic Goods Administration (TGA) recall list?
In 2019 the TGA recalled several macro-textured breast implants from the Australian market. The recalled breast implants are no longer in use. The recalled breast Implants were highly textured implants that were recalled due to the potential risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL). The only remaining breast implants on the market are micro-textured and smooth implants with very low rates of BIA-ALCL and so are considered safe by the TGA. The TGA is not recommending removal of recalled breast implants if there are no signs of BIA-ALCL or other complication.
What are the options to address a breast implant complication?
All treatment options for breast implant complications will be discussed with you in detail at your consultation. Not all breast implant complications require implant removal however if you have a complication such as breast implant rupture, you will be advised to have the breast implant removed. Breast implant removal can be undertaken with or without breast implant replacement. Breast implant removal without replacement, may be undertaken with a breast lift (mastopexy).
What is involved in breast implant removal surgery (explant)?
Explant surgery requires a general anaesthetic and an overnight hospital stay. The important aspects of the surgery include removal of the implant with the surrounding capsule and reformation of the breast. Drains are placed at the time of surgery to prevent fluid build-up. The drains are usually removed a few days after the operation.
Is the implant capsule removed at the time of breast implant removal surgery?
Breast implant removal surgery (explant) involves removal of the implant along with the surrounding capsule (capsulectomy). Removing the capsule is important, especially in the setting of textured implants due to the small risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL). The aim is to remove the whole capsule with the implant. The implant and the capsule are routinely sent for histopathology to examine for any abnormal cells.
Is a breast lift (mastopexy) required with breast implant removal surgery?
After breast implant removal without implant replacement, the breast will drop in size and position. To address this, patients may elect for a breast lift (mastopexy). Mastopexy involves removing excess skin and repositioning the nipple. There are a number of approaches to a mastopexy with different scar patterns. The most common approach gives an ‘anchor’ scar, another option involves a scar around the areolar. At your consultation, Dr Gannan will advise the most appropriate approach for you.