Breast Implant Removal / Breast Explant in Miami, FL

Breast implant surgery remains as one of the most popular cosmetic and reconstructive surgical procedures around the world today. Since the modern era of breast augmentation in the mid 1960’s, and the ever increasing number of women with breast implants, there is a growing number of women, for various reasons, who wish to have their breast implants removed. Dr Sam Gershenbaum, Miami, Florida with patients from 30 countries around the world, has over 30 years of experience with breast augmentation, correction of breast implant problems as well as removal of breast implants (explantation) with capsulectomies. There are several reasons why women would request to have breast implants removed.

Been there, done that, I’m over it….There are some women that have aged and matured, have had their breast implants for many years, possibly with previous replacement surgery, that are over having breast implants, and simply want them out. It has been more than a couple of times that I have been told, “been there, done that, I’m over it”. Others with breast implants for a number of years may have found that they restrict or limit their active lifestyle such as jogging and intense exercise. Large breast implants were popular with many plastic surgeons and women alike, who now, years later are uncomfortable with the implants, or the implants restrict their activities, or they feel the implants no longer represent their cosmetic goals.

Unhappy with the results…. There are some whom have simply not made the best of choices with their surgeon or the size of the implants and do not have the results they would like. Breasts also do change over many years. This can be due to pregnancy and breast feeding, weight fluctuations and/or tissue changes, gravity, age and time. Some may choose to simply remove their implants rather than undergo revision surgery or additional procedures.

Complications…. There are some women who have had one or more complications for a whole host of reasons which may include poor or inappropriate choices from the initial surgery, capsular contracture, implant displacement, rupture, deformity, infection or a combination there of. Understanding that the very vast majority of times, satisfactory results can be obtained by appropriate choices in revision surgery with an experienced plastic surgeon. Dr Sam Gershenbaum, with his years of experience, is an expert in the correction of breast implant problems and complications. There are some women who may choose to have their implants removed after a complication. There are others who have had multiple surgeries to correct complications without satisfactory results and request removal.
No longer accepts maintenance procedures….As should be carefully explained to every patient, and as the implant paperwork and consents read, breast implants are not designed to be lifetime devices. The original silicone gel implants before 2006 lasted about ten years, sometimes less and no more than 15 years before they ruptured. The saline implants generally lasted a bit longer. I have even seen saline implants last for over 30 years, but that certainly is not the norm. The point is, once a patient has implants they are committing themselves to one or more maintenance procedures. While many choose to keep their implants throughout their lives, other women choose, at some point, to end maintenance surgery/replacement procedures and request implant removal.

Breast Implant Illness (BII) There are some women who have feelings and concerns that their breast implants are the cause of unexplained symptoms that can include fatigue, muscle pains and weakness, joint pains, cognitive dysfunction, brain fog, headaches, depression, memory issues, hair loss, low libido, dry eyes, and anxiety as some of the most commonly reported symptoms of what has recently been called Breast Implant Illness, or BII. It is thought, for some women, that their breast implants have caused some type of autoimmune or inflammatory process leading to a constellation of symptoms. As a diagnosis of exclusion, when other root causes of the symptoms are ruled out, studies have shown, along with countless testimonies, that many or all symptoms improved or resolved when the implants and capsules were removed. Please see the full discussion on breast implant Illness and treatment. Dr Sam Gershenbaum, with his many years of experience and superior technical skill, is a leading expert in implant and explant/capsulectomy surgery and has treated many patients with reported BII. If you are experiencing symptoms that you believe may be Breast Implant Illness, call Dr Gershenbaum for a consultation today.

The Consultation For Explant Surgery

During the consultation, Dr Gershenbaum will review the patient’s reasons for explant surgery, as well as their past medical and surgical history. A physical exam is needed to determine the previous result and all issues so as to determine the best choice of procedure(s) for each individual patient. The patients goals and expectations will be discussed, all options reviewed and then the best possible plan formulated. The explant procedure is carefully explained and the alternatives are discussed. The surgical plan is reviewed, as well as the incision/scar placement.

Additional procedures, such as a breast lift (mastopexy) and/or fat augmentation may be discussed or even recommended. Each person and the results they present with is different and will require a personalized plan. For some, removing breast implants only may result in undesirable results. For instance, if the plan is to remove breast implants, and there is a marked amount of excess breast tissue and skin, flattening and sagging skin would be best served by adding a breast lift (mastopexy) at the same time. For others , additional volume to the breast and cleavage area can be accomplish with concurrent  fat augmentation to enhance explanation results. Some patients choose to have explantation, mastopexy and fat transfer all together to optimize their results. And yet there are other patients, who despite the removal of their breast implants,  have breasts larger than they would like and request removal of breast implants along with a concurrent breast reduction. Dr Sam Gershenbaum has been performing these procedures for decades. His vast experience and attention to detail make him the go to plastic surgeon for all your cosmetic and reconstructive surgery needs, because, you deserve the best. Prospective patients are encouraged to speak with previous patients about their explantation/capsulectomy procedures and result. Dr. Gershenbaum and his staff are always available for question. Following the initial consultation and after time for reflection and decision making, an appointment is scheduled for routine preparation and informed consent. Additional questions and concerns about the pending procedure may also be addressed. Routine blood analysis and medical clearance are required prior to surgery.

Explantation and Types of Capsulectomies

The body recognizes a breast implant (as well as any type of implant) as a foreign body and forms a protective fibrous scar tissue capsule around the implant. This scar tissue capsule is usually thin and soft, not apparent to the outside touch and ideally maintains the implant in position after fully healed.

Depending on the patients exam and reasons for explantation (see above), Dr Gershenbaum will review choices for performing or not performing a capsuletomy. A capsulectomy refers to the removal of the implant capsule. If a capsulectomy is planned, then the capsulectomy options will be reviewed.

1. Simple implant removal without capsulectomy. Generally performed when a patient requests removal of the implants and has no history of implant complications such as thickening, capsular contracture, calsification, or BII. To make note of, there are some surgeons, who always recommend capsulectomy when removing implants. They note reports of capsules granulating or appearing as masses that confuse routine cancer screening.
2. Implant removal with partial or subtotal capsulectomy. The portion of the capsule removed will depend on whether the implant was placed under or over the muscle, and the particular findings. For implants placed under the muscle, this will generally include removing the anterior portion of the capsule and exclude the more adherent posterior portion of the capsule . This is an option for some types of capsular contracture issues as well as BII
3. Implant removal with full capsulectomy. This generally will include removal of the implant first and then a full or total capsulectomy. Dr Gershenbaum is one of the few plastic surgeons with 30 years of experience, an expert in all aspects of capsulectomies who is able to perform a total capsulectomy through the small inferior areolar incision/scar that the implants were placed. Most surgeons will perform full capsulectomy only through a larger inframammary crease incision. Full capsulectomy is the preferred choice for “sick” capsules, such as in capsular contracture with calcification or a ruptured silicone implant. This is also a common choice for patients with BII.
4. Implant removal with total intact capsulectomy commonly, but incorrectly, referred to “en bloc” capsulectomy. This procedure refers to removal of the implant within the intact capsule as one whole unit. This procedure is a preferred choice with known silicone implant rupture with use of an inframammary crease incision. This has also been a common choice for patients with BII.

Any of the above 4 explantation procedure choices, depending on the patients exam and expectations, can be performed with a breast lift (mastopexy) and/or fat grafting to enhance the overall contour, size and shape. Patients are also given a choice to use an absorbable mesh, that creates a stronger framework as the mesh absorbs over one to one and a half years better holding the elevated position of the breast. Dr Sam Gershenbaum has 30 years of experience and is an expert in correcting breast implant problems as well as all aspects of capsulectomies. In deciding on a treatment plan, Dr Gershenbaum will carefully review your history, your problems and symptoms, the current literature and studies, as well as your expectations to come up with the plan that most fits your needs.

Explant Surgery, The Operation

Explant surgery and associated procedures are performed at our state-of-the-art outpatient Brickell Riverfront Surgery Center, Miami Florida. The procedure(s) are typically performed under general anesthesia. The time for surgery will vary from an hour for simple explantation up to about two and a half hours for explantation with total capsulectomies. Additional time will be required for ancillary procedures. The surgical procedure is performed in our state-of-the-art outpatient facility under general anesthesia and will take approximately one and one half hours to perform. In the holding area prior to the surgery the patient’s “before” pictures are taken and then the breasts are marked. After speaking with the anesthetist or anesthesiologist the patient is brought to the operating room. After asleep, lidocaine combined with a medication that shrinks blood vessels and capillaries to reduce bleeding are instilled into the surgical areas prior to incisions. Simple explantation without capsulectomy, uses the prior incisional area/scar. Incision is made through the skin, breast tissues and capsule. The implant is removed and all incisions are closed. With partial or subtotal capsulectomy, after the implant is removed, generally the anterior capsule is carefully dissected from the surrounding tissues and removed, leaving the posterior capsule which is often very adherent to the chest wall rib cage. This prior description details the operation when implants were placed under the muscle. When implants are placed above the muscle, the partial or subtotal capsulectomy will vary depending on exam and surgical findings. A total capsulectomy will entail careful dissection and removal of the entire capsule. Dr Gershenbaum can perform total capsulectomy using either an inframammary crease incision or the original small areolar scar. Total intact capsulectomy with the implant inside the capsule performed in cases of ruptured silicone implants or for Breast Implant Illness, must be performed using the inframammary crease incision. A drain is most always used for capsulectomies to remove excess fluids from the internal surgical site to reduce swelling and promote faster recovery. Ancillary procedures, such as mastopexy and/or fat transfer, or breast reduction would then be completed. Dr Gershenbaum uses absorbable sutures placed under the skin to avoid cross-hatching suture marks and optimize the chances for the finest scars. Steri strips are applied  as well as a post surgical bra.

Explant Surgery, The Recovery Period

Following the surgery patients generally report mild discomfort which is easily controlled with medication. Drains, if placed, are removed after two to five days. Varying degrees of swelling, bruising and firmness subside over several weeks to months. After one week, steri strip are removed and replaced with paper tape to remain in place for the next one to two weeks prior to applying scar gel or silicone strips. Patients can generally return to work after several days to one week. Light exercise may begin after four to six weeks. For those who remove their implants only and have a degree of excess breast tissues and some degree of sagging, laxity or ptosis, the breast tissues and space where the implant once occupied will continue to shrink/contract over the weeks and months ahead.  A support bra is generally worn for two to three months following the surgery and is encouraged as much as possible thereafter to maintain the contour. It must be remembered that complete healing takes time and patience – taking up to one year before realizing the final result of the surgery.

Explant Surgery, Complications

As with most surgical procedures complications are unlikely when performed by a skilled and competent surgeon. Complications include, but are not limited to anesthesia risks, bleeding, infection , poor healing with prominent or obvious scars, deformity,skin/scar retraction,  numbness, altered nipple sensation, loss of nipple sensation, asymmetry in breasts and/or areolas and need for revision surgery. Total capsulectomies include a risk of pneumothorax (collapsed lung)  For those who are removing large implants or are removing implants in the face of sagging or ptotic breasts who refuse mastopexy have an increased risk of retraction and deformity. Also rare, but possible are blood clots or emboli (blood clots that dislodge and travel in the blood stream to distant sites).

At Brickell Riverfront  Surgery Center, Venodyne calf compression devices are used for every surgery. Venodynes are pressure cuffs that fit over each lower leg from the ankle to the knee circulating every one to two minutes to reduce the pooling of blood in the lower extremities and further reduce the possibility of blood clots or emboli. Smoking seriously decreases blood circulation in the skin and increases the risk of complications and poor healing.