Breast implant removal

Shape depends on implant size, the amount of breast tissue and skin elasticity. Loss of projection, laxity, asymmetry or irregularities may occur. Preoperative assessment helps discuss these possibilities and the need for reshaping.

Results should not be judged in the first weeks: swelling and tissue settling affect appearance. ASPS states that progression to the final result may take up to one year. This is a guide, not a guaranteed timeline for every patient.

References

1. American Society of Plastic Surgeons (ASPS). Breast Implant Removal Results. Institutional guidance. View reference.

The body forms a tissue capsule around an implant. If it becomes excessively firm and contracts, it can change the shape or cause pain: this is capsular contracture. In the Baker classification, grade I describes a normal breast; grade II is firmer without obvious distortion; grades III and IV are more clinically significant, with distortion and, in grade IV, pain.

Risk varies with time and context. In the MemoryGel cohort, the estimated cumulative ten-year risk of Baker III/IV contracture was 12.1% in primary augmentation and 24.4% in revision augmentation. These results concern a specific device and population, not the predicted rate for each patient.

A different retrospective series involving 856 patients and a mean follow-up of 14.9 monthsfound 2.8% contracture. The rates are not directly comparable: observation periods and study characteristics differ. It would be incorrect to conclude that risk disappears after the first years.

The cause is multifactorial. Technique, bleeding, inflammation, implant characteristics and patient factors may contribute. Prevention matters, but contracture does not prove a technical error.

Treatment depends on symptoms and findings. Mild cases may be monitored. Pain or distortion may require capsule surgery, implant removal or replacement, and possibly a change of implant plane. Off-label medications have limited evidence and should not be presented as established cures. Montelukast, for example, carries an FDA warning about serious neuropsychiatric effects. Therapeutic ultrasound and massage do not replace diagnostic assessment or indicated surgery either.

New hardening, particularly with fluid, a mass or late breast enlargement, needs investigation before being attributed solely to contracture.

References

1. Caplin DA et al. MemoryGel Breast Implants: Final Safety and Efficacy Results after 10 Years of Follow-Up. Plast Reconstr Surg. 2021;147(3):556–566. PMID: 33620918. Prospective cohort of a specific device. View reference.

2. Blount AL et al. Capsular contracture rate in a low-risk population after primary augmentation mammaplasty. Aesthet Surg J. 2013;33(4):516–521. DOI: 10.1177/1090820X13484465. Retrospective cohort. View reference.

3. FDA. FDA requires Boxed Warning about serious mental health side effects for asthma and allergy drug montelukast. 2020. Safety alert. View reference.

4. FDA. Risks and Complications of Breast Implants. Safety information. View reference.

Systemic symptoms reported as breast implant illness (BII) are different from BIA-ALCL lymphoma. Some patients report fatigue, muscle or joint pain and difficulty concentrating, among other concerns.

There is no specific test confirming BII or universally accepted diagnostic criteria. Investigation should take symptoms seriously and look for other possible causes, without automatically attributing every change to implants or dismissing concerns because initial tests are normal.

Some patients report improvement after explant surgery, but complete resolution cannot be guaranteed or predicted with certainty. Spontaneous reports support surveillance but cannot establish how many implant users will develop symptoms or prove causation.

If removal is considered, the decision takes account of symptoms, investigations, implant characteristics and risks of further surgery. Capsule treatment requires its own indication; no specific explant technique should be promised to cure all symptoms.

References

1. FDA. Medical Device Reports for Systemic Symptoms in Women with Breast Implants. Medical device surveillance information. View reference.

2. FDA. Things to Consider Before Getting Breast Implants. Guidance for informed decisions. View reference.

The best-known patterns are periareolar, vertical and inverted-T. Selection considers excess skin, shape, areola position and tissue quality.

Periareolar: the incision surrounds the areola and suits selected cases requiring limited correction. A smaller scar does not mean it is the best option for every degree of sagging.

Vertical: combines a scar around the areola with a line down to the breast crease. It may be used for different degrees of reshaping, depending on the technique.

Inverted-T: adds a horizontal line along the crease, allowing treatment of greater skin excess and certain breast shapes.

All scars are permanent. They may fade and become less visible, but may also widen, become raised or need treatment. The aim is a pattern suited to the correction required; restricting an incision beyond what anatomy allows may compromise shape. Preoperative markings show the expected pattern, without guaranteeing invisible scars.

References

1. ASPS. Breast Lift Procedure Steps. Institutional guidance. View reference.

A lift improves position and shape, but breasts continue changing over time. Ageing, skin characteristics, tissue weight and further pregnancies may alter the outcome.

Some settling is expected. It should not automatically be considered a failure, but major changes or persistent dissatisfaction need assessment. There is no universal duration of results or technique that prevents all future sagging.

Maintaining a relatively stable weight and planning surgery around future pregnancies helps preserve results. Bras may provide comfort and support but should not be presented as a proven guarantee against recurrent sagging.

At the consultation, we discuss tissue quality and the possibility of changes or revision. With implants, their characteristics and follow-up needs also form part of planning.

References

1. ASPS. Breast Lift Results. Institutional guidance. View reference.