What's involved with Explantation & Capsulectomy?
Some women have had breast implants in for several years and may have developed an implant rupture, leakage, malposition, or capsular contracture and wish to have their implant and the scar tissue around the implant removed without any replacement of new implants.
Other women may have developed systemic symptoms, pain/discomfort, asymmetries, or other problems related to their implants. Many symptoms can be quite non-specific, and are not correlated with implant type (saline/silicone) or duration of implantation. A significant majority of patients who are experiencing symptoms do seem to report partial or complete resolution of their symptoms after having explantation surgery.
Dr. Sharma will sit down with you to discuss your goals for the surgery and the look you are hoping to achieve. Most patients are interested in a natural appearance to their breasts and we strive to get you the look that you deserve. Sometimes fat transfer can be done to help enhance some breast volume.
Breast implants can cause some changes to the breasts including thinning out of the breast tissue, stretching out of the skin, and enlargement of the areola, which may need to be addressed to achieve the desired results.
Incisions are typically placed below the breast in the crease where your bra underwire sits, known as the infra-mammary fold. Many times due to the excess skin, nipple position, and desire to provide as much natural breast volume as possible, a breast lift with auto-augmentation is necessary to achieve the goals. These incisions go around the areolas and vertically below the areola to the infra-mammary fold. Dr. Sharma will discuss the pros and cons of each of the scar placements and surgical options with you to determine what is best for your individual needs.
Frequently Asked Questions
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Am I a Good Candidate?
Good candidates for this procedure are women who:
- are experiencing several symptoms related to their implants
- no longer wish to have their implants in
- are physically healthy to undergo surgery and have realistic expectations
- may want to correct some breast asymmetry and/or ptosis by addressing the excess skin
- want to provide improvement of their breast shape through preservation of all of the natural breast tissue that does exist with auto-augmentation
- willing to have a reduction in overall breast size with the removal of the implants
Some patients may wish to have more modest volume augmentation done with fat transfer. It is important to remember that fat transfer will not be able to achieve the same volume or projection as a breast implant, but can help mitigate the loss of the volume from removing the implant. Dr. Sharma will be able to go over your options with you.
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Will the implant capsule be removed?
The capsule that forms around the breast implant is your body’s natural reaction to a foreign body and consists of collagen fibres similar to scar tissue. In some cases it can become very tight (capsular contracture), while other times it may feel soft. The goal is to remove the full capsule along with the breast implant so that nothing is left behind. This is almost always done as a full total intact capsulectomy. If it is unsafe to remove en-bloc due to risk of puncturing into the lung space, then the capsule may need to be removed in pieces in order for the full capsule to be removed safely. This will be sent for pathologic analysis, and all implant information including implant type, style, serial numbers, and volumes will be documented. If the implant is underneath the pectoralis muscle, then this will also be repaired.
Dr. Sharma has extensive experience with revision breast surgery and will assess your individual needs to come up with an ideal plan for you.
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What happens on the day of surgery?
Surgery takes place in the operating room with you asleep under a general anesthetic, and can take 2.5-3 hours. Markings are first made before going into the OR to plan the incision locations. Once you are asleep the incisions are made very carefully and the breast implant and capsule are very carefully dissected either above or below the pectoralis muscle. This is all removed and examined with all appropriate documentation of the implants. Typically the excess skin is removed while preserving all of the remaining breast tissue. The lower hanging breast tissue is lifted up and secured to provide ‘auto-augmentation’ of the breasts to improve the overall breast shape. The nipple and areola is kept fully attached and is repositioned upward. Sometimes fat transfer may also be done to the breasts to enhance the overall volume if there is not much natural breast tissue. All of the stitches are dissolving underneath the skin to give you the best possible scars. Drainage tubes are NOT required. Paper tapes and gauze dressings are applied. You are placed into a customized post-operative surgical bra that we give you at the end of your surgery to provide support and minimize bruising/swelling. After surgery, you will be in the recovery room for a couple of hours and monitored closely. All post-operative instructions and prescriptions will be given to you before going home. You will be able to go home the same day of surgery with a responsible adult.
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What happens after surgery?
Recovery is a gradual process. You are encouraged to take it easy but still get up frequently for short walks to reduce the risk of blood clots in the legs from immobility. The first 1-2 days you may need some of the prescribed pain medications, and will be recovering from the anesthetic and medications you were given. Most patients are needing only Tylenol or Advil after that. You will be able to shower directly over the paper tapes after 2 days. Generally it is a good idea to take 1 week off work, depending on what type of work you do. At 2-3 weeks from surgery you will typically feel fully recovered. You will have to avoid heavy lifting and vigorous exercise up until about 6 weeks from surgery. The final breast shape can take up to 3 months before all residual swelling has resolved.
Dr. Sharma will be able to discuss this in more detail with you, and review all of your options to ensure that you are making a fully informed decision.
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