There are many reasons why you might or need your implants removed. It could be because of a complication like capsular contracture or rupture, because of a malposition, or simply because “It’s time.” As one of my patients once said to me, “I’m just done with them.” The decision to remove breast implants is personal and not usually very complicated; but the bigger and more complex issue is what to do once they are out.
For one, most patients who are considering removing their implants have had them in place for a long time. After ten or twelve years, you get used to having that extra volume. It can be a hard adjustment to suddenly go back to being small chested. But even if the smaller size is now welcome, there are very few situations in which the simple removal of implants will bring the patient exactly back to where they started.
When implants are placed in the breast pocket, a space has to be created for them. This space is either between the muscle and the breast or between the muscle and the ribs. Either way, the implant will push both outward and inward until it makes the space that it needs. This means that everything over the implant (skin, breast, and often muscle) stretches. The tighter the tissue and the larger the implant, the more the stretch. This can lead to thinning of the skin and atrophy of the breast tissue, and usually a large deformity of the muscle. But what most patients do not realize is that it can also lead to a flattening or even scooping in of the ribs. Ribs are cartilage, which is softer than bone, and they can respond to pressure. This can mean that if the implants are removed, you may be left with a hollowed-out chest wall. The decision about whether or not to replace the implant then becomes more complicated than just living with small breasts again.
When it comes to the skin and breast tissue however, there are some cases where implant removal alone is enough. If the implant was small and the tissues covering it still have a lot of strength and elasticity, then they may retract after explantation and not require any other intervention. This, however, is the exception rather than the rule. In most cases, the stretch and sag of the breast and skin require at least some reconstruction to restore breast shape and move the tissue back up the chest wall.
It has been my experience that patients are generally nervous about removing implants and not replacing them at all. But for the most part, nearly all of those patients are good candidates for post-explant reshaping. Even in cases where there is very little breast tissue, a good shape goes a long way to helping the patient feel whole. I have always believed that shape is more important than size when it comes to breasts, and this continues to prove itself on a weekly basis.
For patients who are “done with them,” knowing that they don’t have to have new ones placed is very liberating. There is a point for some people where they just want to be free, and implants do require long-term maintenance. There is also a point where a patient might decide that they just don’t want to have to have surgery again in the future, and the explant/reshaping option is their best answer. There is also the possibility that a smaller implant, or one with a different profile, might give you the result you are actually looking for. Maybe a different fill would meet your goals, or a pocket change for better functionality. The key is to know your options, and to be given them all.
When considering implant removal, it is crucial to consult with an experienced surgeon who understands that changes that your breast has gone through over the course of time. It is also crucial that that surgeon accepts the fact that not all breasts must be big to be beautiful, and they should give you your options for not replacing them. Some of my happiest patients are the ones who thought that they could never be implant free, got to that point with it, and then were offered this option with no reservations. Given that it is an anatomical as well as a lifestyle decision, you should consider both when evaluating your options.