Breast Implant Removal & Downsizing

An increasing number of women are undergoing breast implant downsizing or removal. To learn more about your options, schedule an appointment with one of our Finesse plastic surgeons.

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949.272.2085

Implant Downsizing Contact

 

Breast Implant Downsizing

We occasionally meet patients who have one set of implants that lasts them a lifetime. However, most patients change implants at least once, and some change sizes and styles many times. A common trend we are seeing in the last few years is for patients to come in asking to change out to smaller implants. A downsizing procedure can be relatively straight forward in some patients, and in others more complicated. For patients who are looking for a modest decrease in size, the procedure can be very simple. The original implants can simply be traded for smaller implants using the same scar. This works well for small size changes in patients who have great skin quality.

Patients who are looking to have a more substantial decrease in implant size will usually require a breast lift. The original implants will be removed, and a smaller implant placed. Then the breasts will be reshaped over the smaller implants in the same way that a tailor adjusts a dress to better fit your body after losing weight. This does involve adding scars to the breast, but most of our patients will agree that beautifully shaped breasts with extra scars look better than poorly shaped breasts with smaller scars.

Orange County Breast Implant Removal
Orange County Breast Implant Removal 1
Orange County Breast Implant Removal 1
 

Implant removal and capsulectomy

Most of our patients who have breast augmentation surgery will have implants throughout their lives. But we do take care of patients who want or need to have their implants removed. We perform implant removal most commonly for patients who feel like their breasts are too heavy. For patients who have little or no breast tissue it can be quite challenging to create a pretty breast shape with a removal procedure. On the other hand, patients who have a substantial amount of breast tissue can often get very nice results with implant removal and a breast lift. This range of outcomes is something that we spend a lot of time focusing on during our consultations with patients coming in to learn about breast removal surgery. In the photos below you can see how a patient’s anatomy is the main factor that determines how good of an aesthetic result they can get with a removal procedure. In the other set of photos you can see a some examples of implant removal cases. For some patients we remove parts of the scar capsule in strips, while in others we take out the entire scar tissue with the implant still inside (en bloc removal).

Orange County Breast Implant removal and capsulectomy 1

Total capsulectomy. En bloc removal. Implants removed to show calcified interior of capsules.

Orange County Breast Implant removal and capsulectomy 2

Total capsulectomy. En bloc removal. Implants removed to show calcified interior of capsules.En block removal of saline implants. Implants removed from capsule to show condition of implants.

Orange County Breast Implant removal and capsulectomy 3

En block removal of capsule and implant. A total capsulectomy with implant inside the capsule.

Orange County Breast Implant removal and capsulectomy 4

Saline implant removal.

Orange County Breast Implant removal and capsulectomy 5

Saline implant removal.

Orange County Breast Implant removal and capsulectomy 6

Saline implant removal.

Orange County Breast Implant removal and capsulectomy 7

Calcified interior of capsule.

Orange County Breast Implant removal and capsulectomy 8

Removal of saline implants and total capsulectomy. One side deflated.

Orange County Breast Implant removal and capsulectomy 9

Total capsulectomy en bloc removal of capsule with implant inside.

Orange County Breast Implant removal and capsulectomy 10

Partial capsulectomy.

Orange County Breast Implant removal and capsulectomy 11

Removal of ruptured textured implants.

Orange County Breast Implant removal and capsulectomy 12

Removal of ruptured textured implants.

 

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

There have been several media reports regarding breast implants and the risk of developing BIA-ALCL. On July 25th Allergan issued a recall of its textured breast implants and tissue expanders at the request of the FDA. This recall applies to both saline and silicone breast implants as well as tissue expanders. With this recall, all hospitals, surgery centers and doctor’s offices were requested to send the devices in question back to Allergan. This recall does not apply to devices manufactured by Mentor or Sientra. It is important to note that the FDA is not currently recommending the removal of textured devices from patients without symptoms.

What is BIA-ALCL?

BIA-ALCL is not a form of breast cancer. Rather, it is a very rare and treatable T-cell lymphoma that forms in the capsule tissue that forms around all breast implants.

What is my risk for getting it?

BIA-ALCL was first reported in the medical literature in 1997. The FDA made their first statement on a possible association between breast implants and ALCL in 2011. At the time, they estimated that the risk of a patient developing BIA-ALCL was less than one in 500,000. Since that time there has been an intense effort on gathering information about this new lymphoma. As of 2019 there were 573 cases reported worldwide, including 33 deaths. In the patients who did not survive, most experienced significant delay in diagnosis and did not have complete treatment. This is not uncommon during the early phase of a newly discovered disease when doctors don’t know to look for it and don’t have sufficient scientific evidence to know how to properly treat it.

Current estimates for the lifetime risk of getting ALCL range from 1/1000 to 1/30,000. As more information is gathered by the FDA we will have better risk estimates. The FDA reported that approximately 90% of cases were in patients with textured implants. Approximately 10% of patients had a smooth implant at the time of diagnosis, but limitation in available data makes it unclear how many of these patients had a history of having a textured implant previously. The FDA also reported that most cases of BIA-ALCA were associated with Allergan textured devices. There is currently not a single well-documented case involving a patient with a history of smooth implants only developing BIA-ALCL.

What should I be looking for?

This lymphoma usually appears 7-8 years after placement of an implant. Patients with BIA-ALCL experience a new onset swelling of the effected breast. The swelling may increase over days to weeks, leading in some cases to one breast being twice the size of the other. The FDA recommends patients monitor their breast implants and contact their doctors immediately if they notice pain, swelling or any other changes in or around their implants. We encourage our patients to perform monthly self-exams and to follow up with us for an examination every year.

How is it diagnosed?

When a patient comes in with a fluid-filled breast a small needle will be used to withdraw some or all of the fluid to send for cytology. A pathologist will test the fluid for CD30 immunohistochemistry to identify whether features of ALCL are present. If the test is positive the patient will move on to treatment.

Who treats it?

We recommend that patients should contact their plastic surgeon any time they notice a change in the way breasts look or feel after implant surgery. However, a breast cancer surgeon or oncologist can also evaluate new onset swelling. Whichever doctor gets involved first, one of the initial steps will be to refer you to a radiologist to perform a needle aspiration of the fluid. You will also likely be referred for breast imaging.

How is it treated?

The current treatment guidelines call for en bloc removal of the implant and capsule. This means that the entire implant capsule is removed in one piece with the implant inside. The lymphoma cells are found in the scar capsule, so the entire capsule needs to be removed. Patients can decide whether or not they want to have a new implant placed after discussing the pros and cons with their surgeon and oncologist. The oncologist can also give recommendations regarding the possible need of radiation or chemotherapy based on the stage of the disease and how complete the resection was.

Should I have my textured implants removed?

At present the FDA does not recommend patients with textured implants have them removed. The risk of developing BIA-ALCL ranges from 1/1000 to 1/30,000. To put this in perspective, a woman living in the United States has a 1 in 8 lifetime chance of developing breast cancer. Since the risk of getting BIA-ALCL is considered low, and there are potential (although uncommon) complications associated with implant removal surgery, the current suggestion is to leave textured implants in place. However, any patient who wants to discuss implant removal or have it performed is encouraged to call us so we can discuss the pros and cons of all options at length.

 

Your Options

Dr. West has 10 years of experience removing breast implants and capsules, and is one of the few plastic surgeons in California to have diagnosed and treated BIA-ALCL. If you, a family member or a friend have any questions or concerns please don’t hesitate to call us for more information.

For patients who are looking for a modest decrease in size, the procedure can be very simple. The original implants can simply be traded for smaller implants using the same scar. This works well for small size changes in patients who have great skin quality.

Patients who are looking to have a more substantial decrease in implant size will usually require a breast lift. The original implants will be removed, and a smaller implant placed. Then the breasts will be reshaped over the smaller implants in the same way that a tailor adjusts a dress to better fit your body after losing weight. This does involve adding scars to the breast, but most of our patients will agree that beautifully shaped breasts with extra scars look better than poorly shaped breasts with smaller scars.

 

Our surgeons have the qualifications and experience to perform your Breast Augmentation procedure with safety and effectiveness.

Orange

230 S Main Street, Suite 210, Orange, CA 92868

949.272.2085

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