Breast implant removal is a surgical operation to remove breast implants completely. At the same time, surgical removal of the capsule or capsulectomy can be performed, but it is not always necessary depending on the clinical situation of the patient. En Bloc capsule removal is where the implant and the capsule are taken out in one contained piece, so there is no spillage of implant contents. Breast lifts or mastopexy operations are also sometimes necessary with implant removal or explant. Explant surgery is sometimes called explantation. A surgeon who specializes in this operation is called an explant surgeon. This educational writing will review this procedure technically, including the recovery and risks. Part 3 will review the decision to do the simultaneous lift or to not do it.
The operation for breast implant removal or breast explant takes about 45 minutes. The addition of a capsulectomy significantly increases surgery time and recovery. The straight forward implant removal procedure will be reviewed first. This requires a small incision about one inch in length. The pocket is entered and the implant removed. The space where the implant was present is irrigated or cleaned with antibiotics. The closure then performed is meticulous and includes the muscle layers and two additional layers. All stitches are inside, delicate, and absorbable.
The operation without capsule removal requires no drainage tubes. There is actually very little pain after this operation. Many people can use just Tylenol or Motrin and don’t need narcotics. Recovery typically takes about 3-5 days to resume driving, desk jobs, and easy responsibilities. Unlimited activity is allowed after one month. Risks are considered very low. Risks of bleeding or infection are very low too. Other risks would be reviewed in detail during a consultation. The results of the surgery are usually good to excellent. The majority of the patients feel better and improved in their healthy and wellbeing. One thing to understand, however, is that some people are dissatisfied after surgery. This usually is over being a smaller size than desired or deflated in appearance. You aren’t harmed, just possibly disappointed with the smaller appearance. Once again, most woman are happy with the improvement in health and wellbeing.
Complete Capsulectomy and En Bloc Removal
Under some conditions, the patient may wish to have the entire capsule removed in addition to the explant. This might be for concerns over scar tissue formation called capsular contracture or hardening of the implants. Typically with capsular contracture the breasts are significantly hard and often painful. Some patients want explant and en bloc scar tissue removal, because they are worried about breast implant illness, heavy metal toxicity, rare diseases or other concerns related to their implants. These concerns were discussed in Part 1 in detail, and I will refer you back at this time to that writing. If we elect to proceed with capsulectomy, the procedure is more difficult and longer than just implant removal alone. Unfortunately, this also leads to higher expenses for the operation.
I believe complete capsulectomy is the best operation in these situations. It doesn’t make sense to me to just remove some of the capsule and leave some behind. Also to just cut or score the scar tissue, called capsulotomy, is not typically recommended. I believe COMPLETE CAPSULECTOMY is the best operation. I remove ever drop of scar tissue or capsule, so the patient is completely clean inside when the operation is finished. I believe it is an essential part of the operation. When finished you are as “clean as a whistle” inside. I am an explant surgeon, and it is an operation that I specialize in.
En Bloc removal is a highly demanding surgical technique where the implant and scar tissue or capsule are removed in one piece. The technique was originally used for cancer operations. The idea was that the cancer should be removed in one piece to not spill or spread the cancer. This technique is used for complete capsulectomy by me. Along similar lines of reasoning, we are trying to get the implants out along with the capsule and scar tissue in one piece. I love this procedure because it’s complex, technically demanding, meticulous, and rewarding to the patient.
Explant with complete capsulectomy takes about two hours. This is significantly longer than just the implant surgery alone. Drainage tubes are required and stay in place for 3-5 days depending on the output. There is more pain with this procedure than implant removal alone. This is because the surgical procedure is more extensive. The pain, however, is not that bad, and most patients will say that it’s just a 5/10 on a pain scale. Recovery involves a week off from most activities and then a gradual return to jobs and activities of daily living. After one month, you can return to unlimited exercising.
Risks of the procedure include infection and bleeding. Bleeding is higher than just implant removal because of the extensive dissection. Some people will be unhappy with the appearance and/or size of the breasts. This is a risk of the surgery. Other options to improve shape and or size can be done after healing is finished and if it is desired. Other risks are reviewed in detail during a thorough consultation.
Many patients will think they need a lift or mastopexy because the implants are coming out and they are now smaller. This is the topic of Part 3. It should be read by people interested in this operation.
In summary, the operation for implant removal with or without capsule removal is a procedure that makes many women happy. It is called explantation or explant surgery. The procedures have relatively little pain and a quick recovery. Risks are important to understand, but they are low overall in my opinion. It is important to thoroughly understand that a women might feel too small or deflated after the operation. Other procedures can always be done to improve this at a later date if desired. Most women undertaking this procedure are very happy afterwards. In my experience, a large percentage of women will feel improved in overall wellbeing and also their physical and mental health.
