Background: Breast implants provide a volume enhancement to the breasts that in many cases will last a lifetime. While no breast implants last forever, most women choose to replace them when that need occurs. But a few women eventually choose to remove their breast implants due to problems such as capsular contracture, pain and implant failure. Usually this occurs in older women (age 60 plus) who have had first and second generation implants that have been in placed for thirty or forty years.
Very old breast implants are usually silicone and often have ruptured years ago. The breasts will feel firm and have some degree of capsular contracture. Due to their hardness they often are painful or at the least uncomfortable. Usually the breast tissue has also slide off of the hard and high implant so that some significant breast ptosis exists.
Removal of old ruptured breast implants and their capsules (not always necessary) is straightforward to do and will solve all of their associated symptoms. But the change in breast size/volume can be dramatic and may leave some women feeling that they have had a mastectomy. Immediate breast reconstruction with injectable fat grafting can hekp abate this loss.
Case Study: This 65 year old female wanted to have her breast implants. She had silicone implants placed 43 years ago which were above the muscle. They had always felt firm to her but after the few years they had become ‘tighter’ and more uncomfortable. A mammogram showed bilateral implant ruptures with surrounding calcifications. She wanted her implants removed but was not interested in a breast lift despite her sagging.
Under general anesthesia, her ruptured breast implants and their capsules were removed through her original inframammary incision. The capsules were removed because they has a lot of calcifications and contained some silicone material. The breast tissue was sewn down to the pectoralis fascia. Using her abdomen as a donor area, 1400 ccs of fat aspirate was removed. The fat was concentrated down to 550ccs and 275cc was injected into the upper pole of both breasts to replace some of the lost volume from the implant removals.
When seen at three months after surgery, the amount of retained fat in her breasts could be appreciated. While the amount of volume was not the same, it was better than that of the complete loss of all upper breast pole volume. In addition all of her breast pain was gone and her breasts were soft and comfortable.
Immediate fat grafting after breast implant removal offers a safe and effective method of subtotal volume replacement. It will not correct any breast sagging. If a lift is needed or desired, fat grafting will need to be deferred for three months afterwards.
Highlights:
1) Removal of breasts implants after decades of use will result in a significant loss of breast volume predominantly in the upper pole of the breasts.
2) Fat grafting at the time of breast implant removal can be done to prevent total collapse of the breast mound after implant removal if one has enough fat to harvest.
3) The focus of injectable fat grafting to the breast is in the central mound and upper pole of the breast which sits above the residual implant capsule.
Dr. Barry Eppley
Indianapolis, Indiana