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Explant FAQs :
Posted by Laurence Weider on October 11, 2023
1. Fluffing after Explant
Fluffing after breast implant removal (explantation) refers to the process whereby the breast tissue re-expands or recoils back towards its size from before the implants were placed. This typically occurs over several weeks to a few months after the implants are removed. However, the amount of fluffing depends on several factors including patient age, weight changes, skin elasticity and of course the amount of breast tissue that the individual has. It’s important to note that each individual’s experience with breast implant removal and the subsequent changes in breast appearance can vary. Some people may see relatively quick results, while other’s results may take longer.
2. Rib pain after breast implant removal
When performing a capsulectomy, the capsule is separated from the adjacent tissue in order to remove the capsule and the implant. When implants are submuscular (subpectoral), a portion of the capsule is adjacent to the surface of the ribs. In these situations, a total capsulectomy can cause increased discomfort after surgery. However, there are ways to minimize the post-operative discomfort. We offer Exparel which is a long acting local anesthetic (numbing medicine) that can be injected into the pectoralis muscles as well as the soft tissues between the ribs minimizing pain. In addition, Exparel can be used in a nerve block to provide even greater pain relief. Many patients don’t experience any rib pain, but if you do it will subside over a period of a few weeks to a few months at most.
3. Flat after breast implant removal
If you’re experiencing changes in the appearance of your breasts after breast implant removal (breast explant surgery), it’s important to note that this can vary from person to person. Common changes include:
1. Deflation: The breasts may appear deflated or less full after the removal of implants. The amount of deflation will also depend greatly on the amount of breast tissue that the patient has as well as the size of the implants that were removed.
2. Sagging: In some cases, the breasts may sag or droop after implant removal, especially if the implants were in place for a long time. Dr. Weider will estimate how much sagging you can expect after your implants are removed and may suggest that a breast lift also be performed at the time of explant surgery in order to minimize the sagging. A breast lift will also reposition the nipples and help to correct any asymmetries between your breasts.
3. Scarring: Scarring can occur around the incision sites from the explant surgery, and this can affect the appearance of the breasts. In addition, the scarring you had from prior surgery, such as the scarring from the insertion of the implants or a prior breast lift, will help to determine where the incisions for implant removal will be placed. For example, if your implants were put in through an incision at the bottom of the breasts (inframammary fold), then Dr. Weider will probably use that location to perform the explant surgery. If a different location was used to place your implants, then other options that may camouflage the scars better may be a better choice.
4. Natural shape: Over time, the breasts may gradually return to their natural shape and size. This process can take several months as the skin retracts and the breast tissue re-expands. At the time of your consultation, Dr. Weider will provide guidance on potential procedures such as a breast lift or fat grafting either at the time of explantation or at a later stage. Your specific concerns and options will be addressed.
4. Leaving capsules in after explant
There are a variety of ways to perform an explant in terms of what is done with the capsule. The simplest way, assuming the implants are not ruptured, is to simply remove the implants, leave the capsule alone and close the incision. While this typically means an easy recovery, there are a couple of disadvantages. If the capsule is left intact, the implant pocket will never heal, so the pocket where the implants were will always be there. This increases the risk of fluid collections inside the implant pocket in the future. The second risk is the possibility that the capsule is inflammatory and could be causing various symptoms. While there are no studies to definitively prove this link, the majority of our patients have reported improvements in their health when the implants and capsules are removed.
The other types of explants involve removal of some or all of the capsule. A partial capsulectomy means removing a portion of the capsule. This is typically done at the time of explant surgery to promote closure and healing of the pocket. Healing of the pocket decreases the risk of fluid collections (seromas) in the future. In addition, some studies have suggested that symptomatic improvement that patients experience with a partial capsulectomy is similar to the improvement achieved with a total capsulectomy. However, only a total capsulectomy can remove all of the capsule that was in contact with the implant. A total capsulectomy can mean a longer recovery period if the capsule was stuck to the rib surface or adjacent muscle. However, this is the only way to ensure that all of the tissue that was touching the surface of the implant is removed. So, a total capsulectomy is the best way to remove all of the capsular scar tissue that potentially contains contaminants such as silicone gel from the implant. In addition, if a silicone gel implant has leaked, then a total capsulectomy will provide the best chance of eliminating any leaked silicone gel. Most of our patients chose to have a total capsulectomy at the time of explantation.
5. BII and explant surgery:
Breast Implant Illness (usually referred to as BII) is a constellation of symptoms that may be related to breast implants. Although there is no medical study that clearly shows a cause and effect relationship between breast implants and the various symptoms that have been attributed to them, studies show that most women who complain of BII symptoms who have the their implants and the surrounding capsules removed notice improvement in one and often in multiple symptoms. The most common symptoms include fatigue, joint pain, hair loss, dry skin, rashes and brain fog. However, there are lists of dozens of symptoms that have been attributed to breast implants. In my own practice, over 80% of the women who undergo a capsulectomy and explantation (implant removal) experience at least some improvement in their symptoms. For many of them, the improvement is life changing.
If you are considering explant surgery or just have questions about the procedure, please contact us at (972) 566-8444 or at firstname.lastname@example.org.
Dr. Weider, a native of Southern California, is a Board-Certified Plastic Surgeon who has maintained a private practice in Dallas, TX since 1999. After attending Stanford University, he obtained his medical degree (M.D.) from Baylor College of Medicine in Houston. He then completed a one year surgical internship in Los Angeles at Harbor-UCLA Medical Center, followed by a four year general surgery residency in Dallas at Methodist Medical Center, and a two year plastic surgery fellowship in Cleveland at Case Western Reserve University.