Breast Implant Removal / Replacement

Women seek breast implant removal/replacement surgery for a variety of reasons including to improve appearance or to treat a problem with your current breast implants. In some people, the appearance of your breast and body may have changed over time due to age, pregnancy, breastfeeding or weight loss and you would like your breasts to return to a more aesthetically pleasing appearance. Most women who seek natural-looking results wish to improve or bring back a better balance between their breasts and their overall body figure.

If you are over 18, generally healthy, not overweight and a non-smoker, you are suitable for breast implant removal/replacement surgery. Some women who seek breast implant removal surgery may require a combination procedure to either replace the implant with a new one (implant exchange), replace it with your own fat (autologous fat transfer) or breast tissue (breast auto-augmentation). Occasionally, some women may be happy to go smaller and are therefore suitable to have a breast uplift. If you have a problem with capsular contracture from your previous implant, you may also require a capsulectomy (removal of the capsule surrounding your implant) or capsulotomy (division of the capsule) procedure. During your consultation, you will be advised on whether breast enlargement surgery is suitable for you.

At your consultation, you will meet Dr Kian, a fully-qualified plastic surgeon who is trained in cosmetic breast surgery, breast reconstruction and breast cancer surgery. He will take a full medical history including details of medications, allergies, smoking and family history of breast cancer. Dr Kian also always takes time to understand what your goals and concerns are. It would be helpful if you brought details of your previous procedures and implants (if available).

During your examination, the following will be assessed systematically and standard clinical photographs will be taken for your medical record:

• breast and chest wall measurements
• pre-operative asymmetry
• signs of capsular contracture (Baker classification)
• chest-wall abnormalities
• skin thickness & quality
• potential areas of excess fat (if you are considering fat transfer)

Dr Kian will then discuss the different options for surgery. If you are having an implant replacement, he will discuss different implant types, shapes and surface texturing. He will also discuss the implant placement/pocket and incision site. He will explain the potential risks and complications of surgery so that you make a fully-informed choice. There will be plenty of time to answer any questions that you may have and you can rest assured that Dr Kian will give you his honest, professional advice.

Dr Kian’s philosophy is to achieve natural-looking results. The size of breast implants that you choose will depend on your body frame and chest wall measurements that are taken during consultation. You may wish to increase the size of your implant (within reasonable limits) and the pocket can be extended during surgery. If you require a smaller implant, you may need to have a breast uplift at the same time to reduce the size of the pocket during surgery.

The average lifespan for implants is approximately 10 years according to most manufacturers. Many surgeons will recommend replacing them if they have been in for more than 10 years. If you are not experiencing any problems with them, it is not necessary to remove or replace them, however some patients may seek to do so as a matter of personal choice.

A capsule is your body’s natural response to the insertion of an implant and consists of scar tissue surrounding the implant. In some people, this capsule hardens and squeezes on the implant, and this is called a capsular contracture. Dr Kian has previously done award-winning research into this condition and has shown that this capsular contracture may be a result of an abnormal extracellular matrix (ECM) within the scar tissue.

The symptoms of capsular contracture will depend on severity but it can result in your breast feeling firm, changing shape or being painful in severe cases.

During your consultation, Dr Kian will explain the potential risks and complications of your procedure. Some of these include:

• Scar – for a straightforward removal or replacement, this will commonly be a hidden inframammary fold (IMF) incision, which is in or adjacent to the crease under your breast. Your scar pattern will be different if you have combination procedures such as a breast uplift or auto-augmentation.
• Capsular contracture (for implant replacement) – the body’s natural reaction is to form a scar tissue all round the implant called the ‘capsule’. This is completely normal. In some patients, this capsule contracts causing the breast to feel firm, change shape and sometimes cause pain. If this occurs, you may need revision surgery in the future.
• Implant rupture (for implant replacement) – if the shell of the implant breaks, modern form-stable silicone implants normally do retain its shape. Silicone can leak within the capsule (intra-capsular rupture) or outside the capsule (extra-capsular rupture). If this occurs, you may need revision surgery.
• Infection – some minor wound infections may require antibiotic treatment. However, serious infection may result in implant removal.
• Seroma – this is a collection of fluid in the pocket of the implant. Small seromas may be left alone if they do not produce any symptoms, however larger or symptomatic ones may be aspirated.
• Bleeding/haematoma – Bleeding in the pocket after surgery may require a second operation to remove the blood clot and stop any bleeding.
• BIA-ALCL (Breast-implant associated anaplastic large cell lymphoma) – this is a rare form of lymphoma that is still being researched and is not clearly understood. As it is still being researched, the incidence of this is still evolving, but at the time of writing it is approximately 1 in 35,000 to 1 in 40,000. Breast implants with a higher incidence of BIA-ALCL have been removed from the UK and European market.
• Fat resorption/necrosis (for fat transfer) – there is usually some degree of fat resorption over time, however this varies between individuals. Fat that loses its blood supply can cause firm, tender lumps that may form scar tissue
• Fat migration (for fat transfer) – this is when fat moves and settles down away from the site that it was originally placed.

Dr Kian only uses breast implants with excellent data and safety profiles. Some implants that Dr Kian use also come with a lifetime guarantee for the cost of your implant should you require replacement in the future.

Recovery time is very individual, however for most people this will be between 7 to 14 days. We would normally advise to take a week off work, however you may return to work sooner or later depending on how you recover and the type of work that you do. You may be asked to wear a post-surgical garment/band or sports bra after your surgery for 6 weeks. Full results take at least 6 weeks, however this will vary from person to person.

Dr Kian believes that good aftercare is as important as the surgery itself. You will be given contact details to get in touch should you have any concerns after your surgery. You will have a clinic appointment approximately 1 week after your procedure. At this time, the wound is inspected to ensure that it is healing well and there is no infection. You will have a full review appointment with Dr Kian at approximately 6 weeks after your surgery to check that you are happy with your results and to give you long-term aftercare instructions.

Dr Kian has had experience with a wide range of implants. Some of the implant brands that he uses are Motiva (including Ergonomix implants), Nagor, Mentor, Eurosilicone and Polytech (including B-Lite implants). The choice and suitability of different implant types will be discussed at your consultation.