Explant Surgery

The capsular contracture occurs when the scar tissue surrounding the implant, known as the capsule, is severely thickened. A grading system rates the degree of contracture from one to four. Clinically significant contractures are described as grades three and four. These capsules are often hard, painful and distort the breast tissue and nipple areola complex. The pain can be debilitating, affecting daily activities and even sleeping habits. Patients often have difficulty exercising, sleeping on their stomachs, wearing clothing that fits well, and are even sensitive to hugging family and friends due to the rock-hard deformity. Along with these issues, the cosmetic appearance can emotionally impact the patient and her partner.

Patients often report feeling a strain on their neck and shoulders from the weight of the implants. This strain can often lead to migraines and headaches. They feel like there is a heavy load on their chest that prevents them from taking a deep breath. The implants can weigh on sensitive nerves along the side of the chest, leading to chronic pain, numbness or tingling in the breast and arms, and even electricity shooting through the nipple area. There is also a size factor where patients are just tired of having large implants that do not fit in clothing appropriately.

Breast implants are not lifelong devices. The shelf life of the implants ranges from 10 to 12 years, and the rate of rupture or leaking increases after this time frame. Patients who present with ruptures or leaking can also develop capsular contracture. In the case of silicone implants, most often, the rupture is contained within the capsule. However, there can be a rupture outside the capsule leading to the spread of silicone within the breast cavity and armpit region. When a saline implant ruptures or leaks, it will look like a deflated balloon, and the body will reabsorb the leaked saline.

The implant shell with saline implant ruptures will often fold in on itself, forming sharp ridges that can cause patients significant pain, most often described as sharp or stabbing.

Patients who have breast implants with minimal breast tissue often report having difficulty with breast imaging procedures, most commonly mammograms. Patients with a strong family or personal history of breast cancer often require frequent imaging (biannually or annually). They are told that the implants are obscuring the breast tissue, leading to more imaging and sometimes invasive procedures.

Many patients suffer from systemic symptoms such as joint pain, muscle aches, confusion, chronic fatigue and autoimmune diseases that have been termed breast implant illnesses (BII).

These patients have typically undergone exhaustive testing with multiple medical specialists. They are often diagnosed with fibromyalgia, lupus or other autoimmune disorders. Many patients opt to undergo explant surgery and find that many, if not all, of their symptoms have resolved over the course of one to two years. Unfortunately, there is no test to diagnose breast implant illness. The thought process is that it is a reaction to a foreign body (the breast implants) that elicits an autoimmune response. This can manifest in a broad variety of symptoms as described above.

BIA-ALCL stands for breast implant-associated anaplastic large cell lymphoma. It is an uncommon cancer that has only been confirmed in patients with breast implants with a rough surface. These implants are known as textured implants. BIA-ALCL is not a cancer of the breast tissue. Instead, it is located in the scar tissue, or capsule, that naturally forms around the implant.

BIA-ALCL is often curable if diagnosed and treated early. However, when an initial diagnosis reveals that the disease has already spread (metastasized) to a patient's armpit lymph nodes or other parts of their bodies, it can be more difficult to cure.

In addition to capsulectomy and removal of the implants, women with advanced disease may require chemotherapy, radiation therapy or even stem cell transplantation. Unfortunately, some women have died from this disease.

Most patients with textured implants opt to have explant surgery to eliminate the risk of developing this rare cancer.