Breast Implant Removal/Replacement

As Plastic Surgeons, it is our responsibility to continually monitor the long-term safety of breast implants to make sure that we can educate our patients on the possible adverse outcomes. While there is still no evidence that implants cause autoimmune diseases, there are some rare disorders that are more common in women with breast implants than in those that do not have them. It is all part of the risk to benefit discussion we have with every patient.

Rarely, implants can cause pain years after surgery. The most common reason is a capsular contracture where your body produces excessive scar tissue around the implant. This is covered by the warranty in the first 10 years after surgery and occurs in less than 1% of cosmetic breast augmentations.

Following a breast augmentation, you may notice that your implants fall slightly as they settle into place. This is completely normal. Eventually, the downward force of the implant and cause some sagging. This takes years to happen and even longer when you work with us choose the implant that fits your breast and chest for a beautiful, natural, long-lasting result.

At this point, we really don’t know. Studies are underway to try and get better data to answer that exact question. In the meantime, we are working collaboratively and diligently with the Breast Implant Safety Alliance (breastimplantsafetyalliance.org). To that end, we helped co-author and pass an Arizona law (first in the nation) that will now ensure that every woman considering breast implants will learn about BII in order to make a truly informed decision.

In the United States, the FDA asked Allergan to voluntarily recall its textured breast implants and expanders (Biocell). The implants have been linked to a rare cancer know as breast implant associated anaplastic large cell lymphoma (BIA-ALCL). Of note, in other parts of the world, ALL textured implants have been recalled as BIA-ALCL has been found with all manufacturers textured implants albeit with different rates.

Breast implant illness can present with a variety of symptoms: joint and muscle pain, weakness, fatigue, rash memory loss, chronic pain, depression, chronic flu-like symptoms, headaches / migraines, rashes or skin problems, frequent infections, difficulty breathing, heart palpitations, anxiety, insomnia and “brain fog.” While the causes of these symptoms are unclear, patients have reported relief of these symptoms with removal of their implants and surrounding scar tissue capsule. We are working to better understand the possible link between breast implants and these symptoms.

As Plastic Surgeons, it is our responsibility to continually monitor the long-term safety of breast implants to make sure that we can educate our patients on the possible adverse outcomes. While there is still no evidence that implants cause autoimmune diseases, there are some rare disorders that are more common in women with breast implants, saline or silicone, than in those that do not have them. It is all part of the risk to benefit discussion we have with every patient.

Unfortunately, yes. We don’t know exactly why, but breast implants can get infected years later. The most common theory is that infections in other parts of the body somehow get to the breast implants through the bloodstream. For example, patients with a UTI (urinary tract infection) or dental infections. We do recommend antibiotics before any dental work to minimize this risk. The good news is that in most cases, the implants can be salvaged with good cosmetic results.

By definition, cellulitis is a bacterial infection that affects the skin. So, no, breast implants do not cause cellulitis, bacteria does. That said, having a breast surgery does increase the risk of infection as the skin is cut during surgery. Once the skin barrier is broken, there is a small risk of infection. We minimize this risk in our practice by giving every implant patient IV antibiotics before and during surgery and we sending them home on antibiotics.

There is a rare cancer associated with textured breast implants that has received a great deal of news coverage of late: BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma). BIA-ALCL is a cancer and in some cases can be fatal. We do not offer these textured breast implants in our practice even though other surgeons in Phoenix and Scottsdale do.

Yes you can. Depending on the reason you are removing them, there are two methods for implant removal. You can just remove the implant. This option requires less surgery and less risk, but leaves behind the capsule. Alternatively, you can remove the capsule and the breast implant at the same time with an en-bloc resection or total capsulectomy. The cosmetic result of removing implants varies depending on your tissues and remaining breast tissue.

With saline implants, the change is usually very noticeable as the breast can deflate over a few days to weeks. Signs that your silicone implants are ruptured can include changes in breast shape, swelling over a period of weeks or even pain. Capsular contracture, where the scar tissue around the implant hardens can happen. Silicone implants can also rupture and not cause any symptoms at all “silent rupture.” In those cases, you would only know if you got an MRI to check.

According to the Institute of Medicine, FDA and the WHO, smooth breast implants are safe. However, there are some women who get breast implants that will go on to have symptoms that have now been labelled Breast Implant Illness (BII). Researchers are working hard to figure out how breast implants are triggering this constellation of symptoms in women. Textured breast implants, and we do not offer these, certainly cause health problems, specifically BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) a cancer.

The most common symptom of BIA ALCL is a swollen breast. An ultrasound guided sample of the fluid around the breast implant can be tested to confirm the disease. If BIA ALCL presents as a lump, a needle biopsy may be needed to make the diagnosis. Finally, at the time of surgery, tissue removed from the breast can be sent and tested for BIA ALCL.

The formation of a capsule or scar tissue around the implant is a normal part of healing and helps to keep the implants in place. In some patients however, the scar tissue becomes usually thick. While at one time this was a common problem, thankfully, capsular contracture in our practice is unusual. The new cohesive gel implants (gummy bear), no-touch technique, and Keller funnel have all contributed to the decrease in risk. Where we do see capsular contracture occasionally is in reconstruction patients, especially after radiation.

For some, relief is immediate. For others, you will need to be patient with your healing process and understand that it can take months or even years to see significant improvements in your health. It can depend on several factors including how long you had the implants, how long you were sick for, if you have the MTHFR gene or other genetic variant and if the implant was ruptured. Most importantly, we will completely remove the capsule either en bloc (whenever possible) or by total capsulectomy (when en bloc is not technically possible).

First, don’t use any tobacco or nicotine products or take aspirin / drugs / supplements that increase the risk of bleeding. Second, try to get some exercise in the weeks leading up to surgery. Even just walking for 30-45 minutes can make a difference in your recovery. And finally, mentally prepare yourself. While we will do everything we can to make you look as good as is possible, removing your implants will not have a positive effect on your appearance.

Our prices are all inclusive: the consult, all pre-operative visits, the surgery, anesthesia and surgery center, as well as all post-operative visits and garments if needed. Breast implant removal en-bloc costs between $10,500 and $11,500. There is a range as each patient is unique as is each surgery performed. Please contact us regarding a private consultation with one of our board-certified plastic surgeons. We pride ourselves on a patient-centric approach to serving you and look forward to meeting you soon.

The early signs of capsular contracture usually develop slowly. You may notice that the breast implant moves around less, is slightly firmer than the other side or that it is sitting slightly higher than the other. As it progresses, the breast may start to feel tight or even painful. If caught early, there may be non-surgical options to halt the progression including medications and ultrasound.

You should be doing a regular breast self-exam both for breast health and for the health of your implants. The FDA currently recommends that you get an MRI three years after surgery and every two years thereafter. (Note: the new FDA draft guideline is after 5 years and every 2-3 years thereafter). Your insurance company may or may not cover imaging for breast implants.

Breast implant illness has yet to receive an ICD 10 code (the universal diagnosis coding system used my insurance companies. Know that we are working diligently with advocacy groups across the country to make this happen. Until then, some insurance will cover breast implant removal when deemed medically necessary. You will have to check with your insurance company for more information.

The symptoms of silicone toxicity aka breast implant illness include some or all of the following: joint and muscle pain, weakness, fatigue, rash, memory loss, chronic pain, depression, chronic flu-like symptoms, headaches / migraines, rashes or skin problems, frequent infections, difficulty breathing, heart palpitations, anxiety, insomnia and brain fog. While the causes of these symptoms are unclear, most patients have reported relief of these symptoms with removal of their implants and surrounding scar tissue capsule. We are working with patients, surgeons and researchers to better understand the possible link between breast implants and these symptoms.

Textured breast implants, we do not offer these in our practice, have been linked to a cancer of the immune system (BIA-ALCL breast implant associated anaplastic large cell lymphoma). In the United States, the FDA asked Allergan to voluntarily recall its textured breast implants and expanders (Biocell). Of note, in other parts of the world, ALL textured implants have been recalled as BIA-ALCL has been found with all manufacturers textured implants albeit with different rates.

The surgery is not dangerous and can be done as an outpatient surgery with a relatively short recovery period. Breast implant removal, like any surgery, has risks. General risks of surgery include general anesthesia, bleeding, blood clots, infection, pain and scarring. Specific to implant removal, there is often some deformity or the breast and even the chest wall. There may be reduced sensation to the nipple and the breast that may be transient (lasting several months) or permanent.

Breast implant bottoming out refers to the implants that have descended too low on the chest. This can happen for a number or reasons including: implants that are too large, pregnancy and breast feeding, loss of skin elasticity (getting less young) or excessive chest muscle use with implants under the muscle. The good news is that it can be corrected with a relatively easy, outpatient revision surgery.

Implants do not actually expire, however, they will not likely last you a lifetime. The current gummy bear implants have a rupture rate that is less than 10% at 10 years. By thirty years, that number is likely much higher. The best way to ensure your implants longevity is to work with one of our surgeons and follow all of the postoperative instructions.

The short answer is that you should have your implants replaced only when they need to be replaced. For one reason or another, it is likely that you will want / need your implants replaced very 10-15 years. Some reasons to have them replaced include: you are unhappy with the size (desire larger or smaller), soft tissue laxity or drooping of the breast (for example after having children or through weight loss), capsular contracture, implant rupture (

The early signs of capsular contracture usually develop slowly. You may notice that the breast implant moves around less, is slightly firmer than the other side or that it is sitting slightly higher than the other. As it progresses, the breast may start to feel tight or even painful. If caught early, there may be non-surgical options to halt the progression including medications and ultrasound.

With saline implants, the change is usually very noticeable as the breast can deflate over a few days to weeks. Signs that your silicone implants are ruptured can include changes in breast shape, swelling over a period of weeks or even pain. Capsular contracture, where the scar tissue around the implant hardens can happen. Silicone implants can also rupture and not cause any symptoms at all “silent rupture.” In those cases, you would only know if you got an MRI to check.

Eventually, the implants will rupture. With saline implants, the change is usually very noticeable as the breast can deflate over a few days to weeks. Signs that your silicone implants are ruptured can include changes in breast shape, swelling, pain and capsular contracture. Silicone implants can also rupture and not cause any symptoms at all “silent rupture.” Ruptured implants should be removed or replaced.

Women choose to have their implants removed for a variety of reasons. Some women that have had their implants for years simply decide they no longer want them. Others feel that their breasts are too heavy or have developed capsular contracture. It may be that imaging suggests that the implants are leaking or ruptured. For some women, their breast implants may actually be making them unwell and removing their implants is an effort to feel better. And if women have textured implants, they may choose to remove them to minimize the risk of BIA-ALCL later in life.

Early signs of capsular contracture (one breast is slightly firmer than the other side or is sitting slightly higher than the other) may resolve with non-surgical interventions like medications and ultrasound. More advanced capsular contracture, when the breast is hard or hard and painful, is not likely to respond to non-surgical options and is best treated with complete removal of the capsule. Implants can be replaced at that same time if you desire.