Explant Surgery - Advantages and Disadvantages

Introduction:

Explant surgery or removal of breast implants is done when a patient no longer wants the implant or wants to remove the scar tissue around the implant, which has hardened and formed into a capsular contracture, which may cause the breast to look unaesthetic, firm, and painful. Removal of breast implants is a safe procedure with minimal risk and complications. This article will discuss the indications, procedures, potential risks, and expectations of explant surgery in detail.

What Is Explant Surgery?

Explant surgery, also known as breast implant removal or breast augmentation surgery, is a common plastic surgery procedure involving removing or replacing old breast implants. Breast implant removal surgery is done to remove the silicone implant from the breast. This surgery is done when there is a complication with the implant or when the patient no longer requires the implant.

Why Are Breast Removal Surgeries Performed?

When scar tissue around the implant gets hardened and forms a capsular contracture, it necessitates the removal of the implant. Capsular contracture is the formation of a capsule of scar tissue around the breast implants that helps to maintain the implant in a position preventing slippage. In certain conditions, this scar tissue starts to harden and contract around the implant leading to aesthetic problems and pain. The severity of capsule contracture is measured using the following grading system.

• Grade1: Capsular contracture is normally asymptomatic. The breast looks normal and soft to the touch.

• Grade 2: Capsular contracture shows minor cosmetic changes. The breast looks regular and firm.

• Grade 3: Capsular contracture shows cosmetic changes, firm breast, round, hard, and nipple problems.

• Grade 4: Capsular contracture causes the breast to become hard, causing nipple problems, and the breast can be tender.

What Are the Indications of Explant Surgery?

Breast implants have a limited life span. According to the American Society Of Plastic Surgery, breast implants should be removed or changed every 10 to 15 years. Breast implant removal may also be needed in other conditions like

• A buildup of calcium deposits around the implant.

• Leakage of the implant.

• Autoimmune response to the implant.

• Necrosis (dead tissue) around the implant.

• Pain related to implants.

• Slippage of the implant.

• Changes in the shape and size of the breast affect the looks of the implant.

• Aging, pregnancy, breastfeeding, and weight gain or loss cause changes in the shape and size of the implant.

• When the patient does not want to have an implant anymore.

• When the patient wants to change the size of the implant.

What Happens During the Procedure of Explant Surgery?

The breast implant removal surgery is performed at a hospital along with proper consultation with a plastic surgeon, who will discuss the requirement of implant removal or replacement. The surgeon will perform a thorough examination by taking photographs of the breast and will recommend and guide the patient with treatment options and explain the potential risks or complications of the procedure. They will also perform a detailed history taking.

1. Anesthesia: The surgery is performed under general anesthesia, where the patient is completely sedated and will be unaware of the procedure.

2. Skin Sterilization: The surrounding skin is cleaned with betadine, and a surgical site is prepared.

3. Incision: An incision is made under the breast or around the areola of the nipple to access the implant and scar tissue.

4. Removal of Implant and Tissue Capsule: This depends on the implant and the goal of the surgery. In some cases, the implant is removed, and in some, the tissue capsule is removed, depending on the individual.

5. Incision Closure: Once the procedure is completed, the incision is closed with a suture or fluid adhesive, followed by a bandage and follow-up visits.

What Are the Potential Risks Associated With the Explant Surgery?

Removal of breast implant has certain risks and complications, which include:

• Pain.

• Discoloration.

• Scarring.

• Pus drainage.

• Allergic reaction to the implant.

• Bleeding.

• The appearance of the breast after implant removal might not be esthetic.

What Are the Instructions to Be Followed Before and After the Explant Surgery?

Instructions to be followed before the surgery:

• Some patients may be required to adjust their current medications.

• Avoid drugs such as aspirin which leads to heavy bleeding at the time of surgery.

• Avoid alcohol and smoking before the surgery.

The surgeon will provide specific instructions to follow for better recovery. These instructions may include:

• Care for the incision site.

• Importance of fluid drainage from the breasts after surgery.

• Activity restrictions.

• Education on medications to be taken.

• Regarding the follow-up with the plastic surgeon.

• Regarding the type of bra or undergarment to be worn to compress swelling.

• Regarding the small tubes that are placed inside the skin to ensure proper drainage of excess fluids or blood. These tubes usually come out in a few days.

What Are the Expectations After Explant Surgery?

• Implant removal provides instant pain relief in cases where capsular contracture is present.

• Removing large implants decreases back and neck pain.

• If scar tissue hardens, it may lead to implant rupture. Removing the implant takes away the risk of implant rupture.

• The breast may sag after the removal of the implant.

• Usual activities should be avoided for one to two weeks of surgery.

• Strenuous activities and lifting weights should be avoided.

• Tenderness and soreness may last up to 6 weeks in some cases.

• Patients may not like the esthetic outcome after implant removal.

What Are the Advantages of Breast Implant Removal Procedures?

Some advantages are,

• Mammograms: During the X-ray of breast tissue, the silicone and saline implants placed in the breast may interfere with the X-ray images. In the absence of these implants, the X-ray images will be clear.
• Pain: By removing the implants placed in the breast, pain caused due to capsular contracture can be reduced. Eliminating larger implants can help to reduce neck and shoulder pain.
• Replacement Risk:Removing the implant reduces the risk of rupturing the implant when the scar tissue hardens.

Conclusion:

Explant surgery is the surgical procedure involving the removal of breast implants. The capsular contracture will not heal independently and often requires this surgical procedure. Certain potential risks are associated with this procedure, such as loose skin, bleeding, asymmetry, and scarring. Recovery from this surgery may take around two to eight weeks or more. The plastic surgeon will determine the suitable treatment option for each patient.