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Breast implants have been a very popular procedure for many years. Often woman chose to have implants placed to help them feel better about their bodies, or to replace lost volume due to different medical causes. However, women may decide to remove their breast implants for a variety of different reasons. These reasons may include mechanical issues related to the implant, capsular contracture, medical conditions, or a change in size preference.
My implants are 30 year-old silicone implants. Do I need them removed?
Silicone implants placed prior to 1992, were a liquid silicone versus the cohesive gel implants that are currently FDA approved since 2006. These older liquid silicone implants have a higher possibility of leakage through a rupture of the silicone shell. Most of the time, ruptured silicone stays within the breast capsule, however in some cases it may leak into the breast tissue or lymph nodes. A breast MRI is a diagnostic test that can give definitive data on if an implant is ruptured or not.
What is capsular contracture?
Forming a capsule around an implant is normal part of the healing process. However, capsular contracture is when the body develops a strong, overaggressive scar. This can cause the implant to become distorted in appearance. It can also cause physical discomfort. About 75% of all capsular contractures occur within 2 years of an implant being placed. There are different grades of contracture.
- Grade 1: The capsular contracture does not have symptoms. It does not interfere with the size, shape, or firmness of the breasts. The breasts appear normal to touch and appearance.
- Grade 2: Breasts appear normal in shape, but may feel slightly firm to touch.
- Grade 3: The breasts are firm to the touch and appear abnormal. Usually these implants will look overly round and hard-looking. The nipples may be facing downward. There is usually no pain at this grade.
- Grade 4: The breasts are hard and misshapen. The patient’s breasts are often tender and painful to the touch.
Dr. Samimi has a variety of different techniques to help avoid a capsular contracture from forming after surgery.
- Patient screening is important as smoking and other health conditions may increase the risk for hematomas.
- Using the correct breast implant size for the patient since an overly large breast implant with insufficient natural breast tissue coverage can increase the risk. This is why Dr. Samimi does a through breast exam during your consultation and measures your breast dimensions.
- Handling the implant as little as possible as bacterial contamination. Dr. Samimi uses a special funnel to avoid touching the implant and only does surgery in a sterile hospital facility.
- Placing the implant “under the muscle” can significantly lower the risk to about 8-12 % from 12-18% for capsular contracture.
- Dr. Samimi encourages patients to gently massage their breasts while having breast implants. This will help keep them soft and pliable.
I have heard about BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) on the news. What is this?
There has been a fair amount of media coverage of medical conditions related to implants. Dr. Samimi was one of the first surgeons to diagnose a patient with Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). She was treated with a capsulectomy and required no additional treatment. BIA-ALCL has been mostly associated with textured Allergan and McGann breast implants, which Dr. Samimi does not use. This is what we know about BIA-ALCL.
- ALCL is not breast cancer – it is a type of non-Hodgkin’s lymphoma (cancer of the immune system), that affects lymphocytes (immune cells), typically taking between 6-8 years to develop.
- Individuals who have been implanted with textured breast implants at some point during their clinical history have a risk of developing BIA-ALCL.
- In most cases, BIA-ALCL is usually found in the implant effusion (fluid surrounding the implant). BIA-ALCL is typically treated by removal of the capsule and usually does not require additional treatment with chemotherapy or radiation.
It is important to note that as of June 2018, there have been 560 confirmed cases WORLDWIDE.
What is BII (Breast Implant Illness)?
Some patients experience a variety of different symptoms, which they attribute to having breast implants placed. It is possible that these women have an underlying autoimmune illness. Although, there is not a definitive test to diagnose this illness and the FDA has not found a correlation between breast implants and an autoimmune disorder, some patients state their symptoms improve after explantation.
What is an En Bloc procedure?
En bloc removal is when Dr. Samimi removes the capsule and breast implant at the same time, with the implant still inside the intact scar tissue capsule. En Bloc capsuletomy is a challenging procedure due to the tendency for submuscular implants to be stuck to the underlying rib cage. The capsule must be carefully removed to avoid pneumothorax (collapse of the lung). An En bloc procedure often requires a longer incision (larger scar) to accommodate the implant and capsule being removed intact. Dr. Samimi has performed hundreds of these procedures, often several per week.
Total Capsulectomy and implant removal
A total capsulectomy is when the entire breast capsule scar is removed from around the breast implant. It includes removal of both the front and back wall of the breast implant capsule. An En Bloc capsulectomy is when the entire breast capsule with the implant are simultaneously removed intact. A patient may require a partial capsulectomy capsulectomy. This is a surgical procedure where only the anterior portion of the breast capsule is removed. The back wall is left intact is to minimize the chances of complications, such as bleeding and pneumothorax.
Total Capsulectomy with Simultaneous Mastopexy with Implant Removal
Combining a capsulectomy with mastopexy is an option for patients to tighten the skin and soft tissue envelope following breast implant removal. During this procedure an anchor incision is performed to bring the breast up and reposition the nipple. Some patients, with tight, elastic skin, and very small implants, can benefit from a periareolar mastopexy. This is an incision around the nipple, to tighten the excess skin and slightly reposition the nipple.
Total Capsulectomy with Fat Injections to Breasts
In addition to removing your implants, Dr. Samimi can add volume back to your breasts naturally. Fat grafting, also called autologous fat transfer, is a procedure in which fat tissue is removed from other parts of your body, usually the thighs or abdomen, by liposuction. The tissue is then purified and injected into the breast area to recreate the breast. Usually 200cc to 400cc can be transferred per breast.