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Woollahra Sydney . Wollongong NSW
Why Patients Might Consider Breast Implant Replacement
Having your implants replaced has many advantages, which should be considered along with the accompanying risks. It can prevent issues from arising due to old implants, correct current complications, and give patients the opportunity to revise their previous results.
If you are considering implant replacement, speak to Dr Hunt in a private consultation.
Who Needs Capsulectomy?
Capsulectomy is not performed with every implant replacement surgery. Plastic surgeons usually avoid removing the capsule unless it is absolutely necessary. It’s more traumatic and invasive and can increase the risk of surgical complications.
Nevertheless, capsulectomy is sometimes indicated with explantation. You might need capsulectomy if you have:
Capsular contracture
This is the most common complication of breast implants. It’s when the fibrous capsule hardens around your implants, causing deformity and pain. Capsulectomy is necessary for severe capsular contractures (Baker grades III or IV). Severe capsular contractures happen in 8% to 19% of breast augmentations.
Breast Implant-Associated Lymphoma (BIA-ALCL)
This is a type of immune cancer associated with certain types of breast implants. Treatment of BIA-ALCL includes “en bloc capsulectomy”. This means removing the implant and capsule in one piece. Enbloc removal is riskier and could lead to a punctured lung.
Breast implant illness (BII)
This is a group of non-specific symptoms that are thought to be related to breast implants. The role of capsulectomy is still debated in women who have BII but many find improvement with at least partial capsulectomy.
Dr Hunt will determine whether or not you need a capsulectomy when having your breast implants exchanged. He will explain the risks and benefits of capsule removal before you decide.
How is Breast Implant Replacement Surgery Performed?
Depending on why you’re having your implants replaced, Dr Hunt will recommend also getting capsulectomy or en-bloc capsulectomy.
Implant Replacement without Capsulectomy
In most cases, implant replacement is done without removing the capsule. This reduces the rates of complications after implant exchange. The risks are usually those associated with anaesthesia. In this procedure, Dr Hunt performs an inframammary incision (in the crease below the breast). He cuts the capsule open and removes the old implant. He then puts in a new implant, closes the capsule, closes the breast tissue, and finally closes the skin.
The capsule is left as it is, and used as a surgical pocket to hold the new implants. Unless there’s a specific reason to remove part or all the capsule (BIA-ALCL, severe contractures, severe calcification), the capsule is left in place.
Implant Replacement with Partial or Total Capsulectomy
Generally, capsulectomy should only be done when necessary. Capsular contracture is a clear indication to have the capsule fully or partially removed. However, even without capsular contracture, surgeons sometimes remove parts of the capsule that appear to be too hard or have too many calcium deposits. The rationale behind that is that these calcium deposits:
- Can interfere with future mammograms since they can mimic or mask breast cancer
- Can lead to more biopsies and the consequent surgical risks
- Might harden more and cause a lump formation
Partial or full capsulectomy is done directly after removing the implants. Dr Hunt will cut out the capsule in pieces. He will strip it off the ribs and chest muscles, and cut any fibrotic tissue and some of the surrounding normal breast tissue. After the capsule is removed, a new surgical pocket is created, and new implants are introduced.
When Dr Hunt removes parts of a calcified capsule, it’s called “partial capsulectomy”. If the whole capsule needs to be removed, like with severe capsular contracture, then it’s called a “full capsulectomy”.
Implant Replacement with En Bloc Capsulectomy
En bloc capsulectomy means removing the implant and the encasing capsule in one piece. It’s usually reserved only for patients with breast implant-associated cancer (BIA-ALCL).
Breast implant en bloc removal is more invasive and has more risks. Dr Hunt will cut more tissue out, sometimes including the chest and intercostal muscles on your ribs.
There’s a 4% risk of lung puncture and pneumothorax (air leak) with en bloc capsulectomy. It’s a more technically challenging surgery and requires more operative time.
En bloc breast implant removal is performed only in very specific cases, like BIA-ALCL, due to the associated risks.
Implant removal with capsulectomy may carry some extra risks compared to surgery without capsulectomy:
- Increased surgical time by an average of 1 hour
- Increased surgical risks (like pneumothorax)
- Increased costs
- Longer recovery time
- More painful during recovery
- Higher risk of nerve and blood vessel damage (especially when removing the axillary part of a capsule)
Dr Hunt will always weigh the risks against the benefits. Capsulectomy is only performed if you’re likely to benefit from it.
Recovery after Breast Implant Replacement
Recovery after having your breast implants replaced usually takes place over 4-6 weeks. Nevertheless, you can get back to work and daily routines much earlier.
You can expect to experience pain, swelling, and bruising in your breasts. The intensity and duration of symptoms are largely dependent on how invasive the surgery was. Implant removal with capsulectomy usually brings on more pronounced symptoms.
In general, swelling, bruising, and pain, will peak at 3-5 days after your implant replacement. After that, these symptoms should gradually decrease over the next 4-6 weeks.
Dr Hunt recommends that you wear a surgical compression bra for at least 4-6 weeks after your procedure. You should wear this day and night, even while sleeping. Moreover, it’s recommended that you sleep on your back after breast revision.
Risks and Complications
As with any other surgery, breast implant removal and replacement come with some surgical risks. These include:
- Wound infection
- Wound healing abnormalities (keloid scar, hypertrophic scar)
- Seroma formation (fluid collection in the breast)
- Hematoma formation (blood collection in the breast)
- Loss of nipple sensation
- Pneumothorax (lung rupture and air leak when intercostal muscles are dissected and cut in capsulectomy)
- Anaesthesia complications
- Need for further surgery
To reduce risks as much as possible, it is important to choose a plastic surgeon that has extensive experience in breast implant replacement.
