Breast Augmentation
Breast Augmentation

Breast Implant Removal and Redo

My breast implants are MEME Polyurethane Implants 1984, 250cc: . It is recommended that they be removed, because of age of the implants and capsule formation/fibrosis, grade IV. I was determined just to have them removed and have a mastopexy done after several months of healing. My surgeon seems to be in favor of replacing the old implants with new smaller Mentor silicone implants. He thinks that I will not be happy with a mastopexy. What is your experience with redo augmentation using Mentor silicone implants? What do women look like after implants are taken out and how are the usual results for mastopexies post explantation? I feel like my board certified, highly competent surgeon is steering me away from a mastopexy. I have had fibromyalgic syndrome for years. The symptoms started about 6 years after receiving the implants. The contradiction on the issue is confusing and I am really not sure what to do. Dorothee B.-Viertel

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The Plastic Surgery Channel Surgeon Answers: (9)

  1. In order to give you the proper response, I would need to examine you first. Many women who have had augmentations years ago have very little breast tissue left, and their skin is thin. This makes it understandable that your surgeon would prefer to remove the old implants, do a partial capsulectomy, and put in replacement implants. Here you will have  a short scar (can be the same as the old ones – unless they went in through your armpit) and softer breasts. If you have very little breast tissue, a mastopexy alone may leave you with tiny breasts and big scars.

    There has been a tremendous amount of research in the past years and the silicone shows NO causality with fibromyalgia syndrome.

     

    Posted on December 29th, 2009
  2. Hi Dorothee,

    Often when we remove older generation breast implants with thick capsular tissue, it can leave your breasts deflated and aesthetically unappealing. This is probably why your surgeon recommended an exchange to silicone filled implants, to fill in that space. Silicone gel implants are safe and approved by the U.S. FDA for use.  If your older implants are removed with capsular tissue and you are left with very thin tissues, the blood supply to your nipple and areola might be at risk if a mastopexy is performed, leading to wound healing problems. Also, the cosmetic result just isn't as nice oftentimes since a lift leaves more scarring on already deflated breasts. I encourage you to visit your local plastic surgeon again to get your questions answered or another board certified plastic surgeon.  Best of luck!

     

    Sincerely,

    Dr. Jennifer Walden

    Posted on January 2nd, 2010
  3. I used the Meme implants for several years and was quite pleased with them.  Their predictable softness was due to the polyurethane (fuzzy) coating on them.  Unfortunately, over time, there is biologic degradation of the glue that holds the polyurethane to the silicone shell of the implant.  Separation of the coating then occurs and the smooth shell of the implant frequently allows a capsule to form.  These implants were used over 25 years ago and are probably due for replacement.

    The choice of new implants, their location, size and whether a concomitant mastopexy should be performed should all be discussed in detail with your surgeon.  There are no right or wrong decisions in this matter — only opinions based on the doctor's education and experience. Since this is elective surgery, you might be best served by speaking to one or two other board certified plastic surgeons to get additional opinions.

    One point to be made, however.  Although it is still controversial and unproven that silicone implants might cause fibromyalgia, if you wish to be 100% certain, you may want to request replacement with a saline implant.

    Good luck!

    Elliot Jacobs, MD, FACS

    New York City

    Posted on January 3rd, 2010
  4. You are wise to seek several opinions about your options. Of course no one can give you specific advice without personally examining you, but here are some general pointers: First, it is extremely unlikely that your fibromyalgia is related to the implants. This has been extensively studied and so you should feel comfortable going with new implants if that is what you decide. Secondly, if you do a lift then there will be permanent scars, though if done well that is not usually a significant issue. Finally, from my experience you are more likely to be disappointed if you do not replace the implants, unless your breasts have gotten larger since they were put in. Both Mentor and Allergan implants are FDA-approved so the brand isn't as important.

    Posted on January 4th, 2010
  5. The decision to replace an implants following removal can sometimes be a difficult one. Keep in mind that your breasts have changed over the last 25 years and you may have more natural volume than you did when your implants were first placed. If you are unsure, I would advise removing your implants and coming back secondarily once you have determined whether you was to have them replaced or if you want a lift. The best choice isn’t always obvious.

    Posted on January 5th, 2010
  6. In a case like yours I  remove the implants with the surrounding capsule and replace them with new silicone implants (Mentor usually). Most of the time I will replace the implants in the submuscular position. Depending upon your degree of droopiness – If the tissues are thick enough I may perform a mastopexy at the same time but if they are very thin I will delay the mastopexy. The decision as to whether to remove the implants and perform a mastopexy depends upon how much breast tissue you have and how large you want to be. Either procedure – replacement +/- lift vs removal and lift are common procedures in my office. Many women have old implants and are in the same situation that you are. Best of luck.

    Posted on January 5th, 2010
  7. Dear Dorothee

    Thank you for your enquiry – with Grade IV encapsulation, your implants certainly need to be removed together with a complete capsulectomy.  What you do after is really your choice.  It is a very good plan to perform the mastopexy about 3 months post explantation.  The alternative would be to have new implants after 3 months as well.  The decision is really on what you want to achieve.  If you have a good amount of your natural breast tissue without the 250cc implants, then mastopexy is perfectly reasonable.  If you will be left with very little breast volume after explantation, then you may want to replace the volume.  There is no right or wrong approach and it is always your decision.  On your last point regarding your fibromyalgic syndrome – there is no evidence that your implants can cause this.  However, the is a suggestion that if you have had a low grade infection which has caused the encapsulation, this chronic infection can cause symptoms.  I hope that this is helpful, and best of luck with your procedure(s).  Christopher Inglefield BSc FRCS(Plast)

    Posted on January 5th, 2010
  8. Dear Dorothee:

    I am a board certified plastic surgeon in NJ and I specialize in breast augmentation and revision of aging and problem breast implants for almost 20 years. 

    The most important issue is your breast health, which includes mammography to image your breasts.  Your 26 year old implants have an almost 100% probability of being ruptured, and if you ever underwent a closed capsulotomy by your old plastic surgeon, you may have both intra and extracapsular gel. The old Meme implants (polyurethane coated) should be removed along with the entire capsule surrounding the implant. The next question is, do you have sufficient breast tissue on your own, to be happy with your size should you choose explantation  with a mastopexy.  If you will be unhappy with the smaller volume after so many years, and remember, you have aged over the years, then a mastopexy alone may leave you feeling dissatisfied. If you think you will be OK with just your remaining tissue, then the one operation that ensures no further implant related complications is an explant- with a lift.

    The next issue is if you choose to undergo an explantation with replacement to a new gel implant.  Your surgeon must remove all capsule and all loose gel.  He or she should be very experienced and not contaminate the field with loose gel. Your implants were probably placed in a subglandular position, most were in 1985, and your surgeon will have to decide if you have enough tissue to keep the implant in the same place or move the new implant partially behind your pectoralis muscle. Finally you will have to decide between round gel implants, and where available, the newer Form Stable Highly Cohesive gel implants that are available through clinical trials.

    One more option, one that many of my older patients have opted for, is implant removal only.  Many patients have decided that after all the years of implant related problems, removal is the right option.  Most of my patients, already unhappy with their aging bodies, decide to replace the implants after 3-6 months.  This option has resulted in the lowest complication rate among my revision patients who have ruptured gel  implants over  20 years.  The revision is well planned, the size can be determined based on your present body dimentions, and they recover in less than 48 hours.

    I hope you give this decision a lot of thought. Feel free to visit my site, http://www.drglicksman.com and look at revision gallery.

    Caroline Glicksman, MD

    Posted on January 7th, 2010
  9. Hi

    I live in the UK and had meme implants in 1988 when I was 40 years old. The procedure was performed by Mr Clive Orton at Bupa Hospital in Manchester. I have had routine mammograms and apart from a blocked mammary duct I have not experienced any problems with my breasts. My question is should I have the implants removed or leave them insitu.

    Kind regards

    Anne Golding

    Posted on January 12th, 2012

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