Dr. Greenberg does many breast implant removal surgeries, with or without a lift. For years now it has been a focus of her practice. Why do women remove the implants? Typical stories:
The surgery to remove the implant usually involves a capsulectomy, muscle redraping if possible, and commonly also a breast lift. (See below for more information). Part of why Dr. Greenberg has been popular for breast implant removal patients is she excels at the short scar vertical breast lift, which gives great lift and shape with a smaller scar (not the anchor scar used by 70% of the current local surgeons). She has been in practice for two decades, and did additional fellowship training in Breast and Cosmetic surgery after her Plastic Surgery Residency at Stanford. She sees many women after they have had kids or who are perimenopausal. Very commonly at this time, weight gain may happen and the skin loses its elasticity, giving larger droopy breasts.
Many women in their late 40s and early 50s want young, athletic, lifted breasts. Implant removal with a lift (if needed) gives a new lease, with the added benefit of not needing to deal with the implant and possible future surgeries as you age.
Explant: Removing a breast implant
Capsule: The scar tissue that forms around your breast implant after it is placed in the body. All women with implants have a capsule. You cannot feel it if the capsule is thin and pliable. You do feel it if the capsule is thickened, too tight, or calcified. Think of the capsule as a balloon around the implant. If the implant leaks, the contents stay within the capsule as the capsule acts as a containment unit.
Capsular Contracture: When the capsule around the implant becomes thickened, calcified, or too tight. This gives the grapefruit, hard breast on the chest look. We grade capsular contracture on a scale of I – IV. Grade I is soft, flimsy, and not visible or palpable. Grade IV is hard, can be painful, and visibly distorts the breast.
Capsulectomy: Capsule = capsule, Ectomy = removal of. This is where we surgically remove the capsule in surgery.
En Bloc Capsulectomy: This is when you remove the capsule totally, in one piece, with the implant inside.
ALCL: Anaplastic Large Cell Lymphoma. A rare lymphoma cancer associated with textured breast implants. Thought to be capsule related. Seen only in textured implants. 126 cases documented. (over 500,000 implants are placed yearly).
BII: Breast Implant Illness. This is linked to symptoms which may be related to your implant. Fatigue, rashes, joint issues, autoimmune. Again, look at biofilm and ASIA syndrome.
ASIA syndrome: ASIA= Autoimmune Syndrome Induced by Adjuvants, (here the Adjuvant is a breast implant.) This is where a foreign object, the breast implant, sensitizes your body to be hyper aware of everything, so it “overreacts” to things. It has been attributed to things like scleroderma, fibromyalgia, depression.
Breast implants do not last forever.
You will need to replace or remove your implant at some point. The 10 year number sticks in people’s minds because of the 10 year warranty. But you do not need to replace the implant every 10 years- you need to replace or remove it when you have an issue.
What would those issues be to make you remove it?
This is a surgery where you want a plastic surgeon who does a lot of revision breast surgery. Many of these cases are challenging. You want an expert.
Quick answer: removing a breast implant.
Longer answer: When you have an implant, you may remove it someday. An explant is not an implant exchange- it is when you are removing the implant and not placing a new one. When you are doing this, you will do a capsulectomy at the same time to remove the capsule that had formed around the implant.
Explants can be done where you just remove the implant, or they can be done where you do a breast lift at the same time.
Why lift the breast? It is not uncommon for your skin to have loosened with time, aging, and the weight of the implant. When the volume of the implant is removed, expect your breast will droop more than it does now, so you may need to tighten and lift the breast.
There are some doctors who do not remove the capsule. I think it is important to remove the capsule for 3 reasons.
I do a lot of explants. When I remove the implants, I remove the capsule, so everyone is getting a capsulectomy. “En bloc” refers to a specific technique. A true en bloc is where you remove the capsule with the implant inside in one piece. Think of it like a Christmas present- a little balloon (your capsule), which contains the implant inside. This is the nicest way to remove an implant, particularly if we fear a ruptured silicone implant. This tends to be doable with thickened capsules, particularly if doing the capsulectomy at the same time as a breast lift. But there are times where because of logistics, en bloc- trying to get a big hard round thing out through a tiny incision- won’t work in one piece. In these cases the capsule and implant are removed, but other techniques may be used. Sometimes there are small, thin pieces of capsule which cannot be safely removed. To understand en bloc in greater detail, please read my blog on the subject here.
For most women, the answer is no. But for some they may be, what is commonly referred to as BII (Breast Implant Illness).
Silicone gel breast implants were removed from the market in the 1990s, because it was thought they were causing autoimmune diseases like fibromyalgia, lupus, and scleroderma. Huge studies were done to allow silicone gel implants to return to the market. Meta-analysis showed there was no increased autoimmune risk for women with implants, and silicone gel implants returned to use.
Fastforward to today, I have some patients coming in worried their breast implants may be causing health issues: muscle aches, memory problems, joint issues- and the concern is “are my implants causing this?”
Over 500,000 implants are placed every year. For the majority of women the implants are well tolerated, and they have no health issues. There are ways to place the implants (behind the muscle, Keller funnel, use of antibiotics) which try to help minimize the risk of biofilm and colonization to prevent issues.
But can you get issues from the implants? Short answer is yes, but with caveats. I do believe in biofilm which can cause capsular contracture and chronic inflammation, and I think technique when putting in the implants is important. It may be that implants make women feel sick and they feel better with implant removal because you are treating the biofilm. So again, the technique when you put the implant in is so important. There is a true syndrome called ASIA syndrome, where an “adjuvant” (here the adjuvant is the breast implant) triggers the body to become hyperimmune. Read my blog on it HERE.When looking at PubMed scientific articles on the subject, you see case reports, not hundreds of patients. True ASIA syndrome is rare, but when every other stone has been turned and you still feel bad, it is something to consider.
If you feel bad and you have breast implants, and you are worried you have Breast Implant Illness (BII) things to consider:
If you are truly having health issues, you should do a capsulectomy with explant. This means no new implant is placed. If after six months to a year your symptoms did not improve, then the implant was unlikely the cause of your issue, and you could consider placing a new implant.
Bottom line, if you feel bad, and you want your implants out, do it. Knowing your implants cannot be the cause of whatever health issue gives many patients peace of mind. Maybe it is all the bay area California living, but I definitely have patients who want to get rid of their implants because they don’t want anything foreign in their body. I respect that choice.
Ah. This is a tricky one, and there is no single answer. Some people look great, some look terrible. Some need lifts, some do not. You have to remember when you did your breast augmentation surgery in the first place, there was a reason: you were too small, a little droopy, or something… You have now aged since then, perhaps also gone through pregnancy, breastfeeding, menopause, maybe had weight changes. Your breasts would have changed even without implants. This is a reason to pause and think about removing your implants when you have vague medical issues and wonder if the implant is the cause.
If you have saline implants, I will frequently do a in office deflation of the implant immediately prior to surgery, so you can see what natural tissue you have and how droopy you are. I have found this incredibly useful, so you have no surprises after surgery.
If you have had a large implant, particularly if you have a capsular contracture, you may have issues which are hard to correct:
Doing a breast lift at the same time allows me to help reshape the tissue. Doing a simple breast implant removal does not. You may not see the issues as the implant helps hide them. When the implant is removed they become visible.
If your breast is super hard, distorted, or the skin is really thin where the implant is almost breaking through the skin, I would urge you to address the issue sooner rather than later. It is tempting to just ignore it, but the longer the issue persists, the more damage is being done.
When doing a breast implant removal, recovery varies a bit by what is done.
What is the cost of doing a breast implant removal?
Here in the Bay Area in Silicon Valley, the cost of breast implant removal and capsulectomy is around $13,000 – $16,000 dollars. This estimate for Palo Alto includes surgeon fee, operating room, and anesthesia. Sometimes your insurance may cover part of the cost. Insurance coverage occurs only when you have a grade III or IV capsular contracture. Every insurance plan is different, so you need to consult your specific plan.
Why do costs vary?
She changed my life for the better! Dr. Greenberg is an extremely skilled, compassionate surgeon. I had been through 2 breast augmentation and reduction surgeries. One was performed by a well known on TV beverly hills plastic surgeon who is a supposed known expert, who left me disappointed, disfigured and never even saw me after the surgery even though I tried to schedule with him. I have to say since my first appt with Dr. Greenberg, she knew what I had gone through and understood me thoroughly and took the time to understand my needs and she gave me very comprehensive advice. I thought I needed a smaller implant, but she suggested I had enough breast tissue to remove implants and she was correct. I have never even in my twenties had perky nice figured breasts. She uses a technique that leaves minimal scarring and s sure to uplift the breast. Now, I take off my bra and have to stare awhile in the mirror because I can't believe the nice well shaped perky breasts in the mirror are mine. I look at them for the first time admiring them adoringly. Although I have always had a positive outlook and disposition, I cannot explain how Dr. Greenberg's skillful work has given me my life back. I can wear pretty shirts that close and do not pop open, my breasts have a beautiful uplift and I can exercise and even jog again. Life is definitely better. Dr. Greenberg has studied different techniques and explains why she uses the technique she does and explained to me exaxtly what to expect after. This experience was so vastly different than the other two I had. I would recommend my sister, my mother, a friend to Dr. Greenberg because I trust her fully and know that as a woman she cares about women, their health and has the skill to help women beccome the best they can be.*Individual results may vary