The decision to remove an implant after breast reconstruction is different from implant removal following cosmetic breast augmentation. After a mastectomy, there may be little or no natural breast tissue remaining beneath the implant. Removing it can therefore result in substantial volume loss or a flat chest.
The appropriate plan depends on why the patient wants the implant removed, whether she wants continued breast reconstruction and what appearance she feels will be right for her.
Why Might a Reconstruction Patient Consider Implant Removal?
Patients may consider breast implant removal because of:
- Capsular contracture, rupture or another implant complication
- Persistent pain or tightness
- Concerns about living with breast implants
- Changes in implant position or breast appearance
- A preference for reconstruction using the patient’s own tissue
- A decision not to have a reconstructed breast at all
Each situation requires a different conversation. Implant removal is not automatically the solution to every symptom or concern.
What If the Concern Is Having Breast Implants?
When a patient wants to remove her implants because she no longer feels comfortable having them, reconstruction using her own tissue may be an option.
Known as autologous or flap reconstruction, this approach uses tissue from another part of the patient’s body to recreate the breast without placing another implant. These are complex operations that require specialized microsurgical expertise.
Dr. Bogue discusses the benefits, limitations and recovery involved with flap reconstruction and provides a referral to an appropriate reconstructive microsurgeon when the patient wishes to explore this option.
What If the Patient No Longer Wants Breast Reconstruction?
Some women decide that they do not want another implant or a flap reconstruction. In that situation, the implant can be removed and the remaining mastectomy skin flaps revised to create a flatter chest contour.
This is sometimes called an aesthetic flat closure. The goal is not simply to remove the implant, but to reduce redundant skin, folds and contour irregularities as much as the patient’s anatomy and previous surgery allow.
Dr. Bogue spends considerable time discussing the expected appearance because removing a reconstructive implant can create a very different result from removing an implant placed for cosmetic augmentation.
What If Pain Is the Reason for Implant Removal?
Breast or chest discomfort can have several possible causes, including:
- Capsular contracture
- Implant position or pressure
- Scar tissue
- Nerve-related pain
- Musculoskeletal pain involving the chest or shoulder
- Changes related to mastectomy, radiation or previous operations
Before recommending surgery, Dr. Bogue evaluates the possible sources of pain and discusses whether implant removal, implant revision or another form of treatment is most likely to help.
Removal cannot guarantee that pain will resolve when its source is uncertain or unrelated to the implant.
What Will the Chest Look Like After Implant Removal?
Appearance is an essential part of this decision. The result depends on:
- How much skin and tissue remain after the mastectomy
- The implant size and position
- Previous radiation treatment
- The location and quality of existing scars
- Whether one or both breasts were reconstructed
- Whether the patient chooses flat closure or another reconstruction
Dr. Bogue explains the likely contour, scars and asymmetry before surgery. When useful, he also discusses clothing considerations and how the chest may look both with and without a bra.
Are External Breast Prostheses an Option?
Yes. A patient who chooses not to undergo further reconstruction may use an external breast prosthesis inside a specialized bra. Prostheses are available in different shapes, weights and sizes and can help create symmetry beneath clothing without another reconstructive operation.
Some women use a prosthesis regularly, while others prefer not to wear one. Both are reasonable choices.
The Decision Belongs to the Patient
There is no single correct approach to implant removal after breast reconstruction. One patient may choose flap reconstruction, another may want a replacement implant, and another may prefer a flat chest.
Dr. Bogue’s role is to explain the medical and surgical options honestly, discuss the likely appearance and help each patient make an informed decision. Ultimately, it is the patient’s body and her choice.
To discuss breast implant removal after reconstruction, call Dr. Bogue’s Boca Raton office at 561-886-1000 or request a consultation online.