Breast Implant Removal Without Replacement For Patients With Breast Implant Illness
En bloc capsulectomy and lift, is it safe?
Breast implant removal should be performed with complete en bloc capsulectomy without lift. The capsule should not be left in place for many reasons. In patients that believe that their implants are causing them illness, leaving the capsule behind will not result in any improvement in their symptoms. Because the removal of the capsule and lift performed together can compromise the blood supply to the skin, breast and nipple to a potentially devastating degree, they should never be performed together. After the explantation with capsulectomy is healed, you can develop a plan for further surgery if it is warranted and is safe from a technical standpoint.
Does the capsule need to be removed for explant surgery?
For explant surgery, it is almost always best to remove the capsule in its entirety. This will allow the space to heal. If you leave the capsule in place, it does not heal. Fluid can accumulate in the space. Whatever the situation that brings the patient to implant removal will have an affect on the decision making process. This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns. The body does not re-absorb the capsule.
What about drains, are they necessary?
Any breast revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule. If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower. If the fluid accumulates because there were no drains, it will most certainly cause problems in the future. Anyone that does this surgery without drains has not thought clearly about how the fluid, which will be generated in every case, will be dealt with. Drains are essential.
Will explantation with en bloc capsulectomy make my poorly described illnesses and pain syndromes improve?
The only way to know is have your implants removed. Breast implant removal should be performed with complete en bloc capsulectomy. The capsule should not be left in place or the space will not heal. In patients that believe that their implants are causing them illness, leaving the capsule behind will not result in any improvement in their symptoms. After the explantation with capsulectomy is healed, you will be able to evaluate whether the implant removal has improved your symptoms. Empirically, we see a very high percentage of patients with improvement in their symptoms. Patients with joint pains have been healed. Those who could not wear their wedding rings for the last 15 years are capable of wearing their rings. The stories are endless. The science is less clear.
What is the recovery after breast implant removal?
After breast implant revision or removal surgery, I advise the patients to take one week off from work for breast implant removal recovery. We do not use bras for one full month after surgery. At that point we take out their stitches and drains. The patients may return to work, but may not engage in any strenuous activity. At one month, the patients start to wear a soft cup bra with no underwire and can start low impact cardio. This is when it is safe to sleep on your side or belly. At two months they can wear an underwire bra and engage in more strenuous physical activity.