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.
Dr. Justin West
Dr. Justin West has been a leading expert in cosmetic and reconstructive breast surgery since 2010, caring for thousands of patients throughout his career. Breast implant removal is one of the most common procedures he performs, and with nearly 15 years of experience, he is one of the few plastic surgeons in California who has diagnosed and treated Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). If you, a family member, or a friend have any questions or concerns about breast implant removal, please don’t hesitate to contact our office for more information.
Breast Implant Downsizing
For patients seeking a modest decrease in breast size, implant removal can be a straightforward procedure. In many cases, the original implants can be exchanged for smaller ones using the same incision, making it an ideal solution for those who desire a slight reduction in size and have good skin quality.
For those looking to significantly decrease implant size, a breast lift is often necessary. In this procedure, the original implants are removed, and smaller implants are placed. The breasts are then reshaped over the new implants, similar to how a tailor would adjust a dress to fit your body after weight loss. While this approach does involve additional scarring, most of our patients find that beautifully shaped breasts with extra scars are far preferable to poorly shaped breasts with smaller scars.
Implant removal and capsulectomy
While many of our patients will choose to keep their breast implants for life, we understand that some may wish to have them removed. Implant removal is often performed for patients who feel that their breasts have become too heavy or uncomfortable. For those with minimal natural breast tissue, achieving a pleasing breast shape after implant removal can be challenging. However, patients with a substantial amount of breast tissue can often achieve very nice results with implant removal and a breast lift. During consultations, we spend a significant amount of time discussing these outcomes and helping patients understand how their anatomy will influence the aesthetic results of their surgery. In some cases, we remove parts of the scar capsule in strips, while in others, we perform an en bloc removal, where the entire scar tissue is removed with the implant still inside. The photos below demonstrate how a patient’s anatomy plays a critical role in determining the aesthetic outcome of implant removal surgery, as well as examples of different approaches to implant removal.
Total capsulectomy. En bloc removal. Implants removed to show calcified interior of capsules.
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.
En block removal of capsule and implant. A total capsulectomy with implant inside the capsule.
Saline implant removal.
Saline implant removal.
Saline implant removal.
Calcified interior of capsule.
Removal of saline implants and total capsulectomy. One side deflated.
Total capsulectomy en bloc removal of capsule with implant inside.
Partial capsulectomy.
Removal of ruptured textured implants.
Removal of ruptured textured implants.
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
There has been significant media coverage regarding the risk of BIA-ALCL in patients with breast implants. In 2019, Allergan issued a recall of its textured breast implants and tissue expanders at the request of the FDA. This recall affects both saline and silicone breast implants, as well as tissue expanders. All hospitals, surgery centers, and doctor’s offices were asked to return the recalled devices to Allergan. It is important to note that this recall does not apply to devices manufactured by Mentor or Sientra. The FDA currently does not recommend the removal of textured devices from patients who do not exhibit symptoms. However, if you have concerns about your breast implants or are experiencing symptoms, we encourage you to schedule a consultation to discuss your options. Dr. West and our team at Finesse Plastic Surgery are here to provide expert guidance and support throughout your treatment journey.
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.
Meet the Doctor
Dr. Justin West
Dr. Justin West is a board-certified plastic surgeon and the Medical Director of Finesse Plastic Surgery. Specializing in cosmetic and reconstructive breast surgery, Dr. West has extensive training and experience in aesthetic surgery of the face, breasts, and body. He has been consistently recognized as one of RealSelf.com's Top Doctors and was also voted as the #1 favorite plastic surgeon in Orange County by Locale Magazine. Dr. West is committed to bringing both expertise and compassion to every patient he treats.
Schedule a consultation with Dr. Justin West
230 S Main Street, Suite 210, Orange, CA 92868
(714) 978-2445
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