Breast Revision after Breast Implant Illness: What to Expect

Breast implant illness, a collection of systemic symptoms linked to implants, is a difficult diagnosis to reach. Once you arrive at this conclusion as the root of your symptoms, it is important to learn about your options for removing implants in hopes of achieving symptom resolution and restoring an aesthetically pleasing, natural breast shape.

Explant surgery for BII patients

Patients with BII typically first learn about the breast implant removal techniques available. While you may solely have your implants removed in a relatively straightforward operation, your surgeon may also recommend a capsulectomy, or surgery to remove part or all of the scar tissue “capsule” that forms around breast implants: 

• Partial capsulectomy that involves removing a portion of the scar tissue after removing the implants
• Total capsulectomy that involves removing all of the scar tissue after removing the implants
• En bloc capsulectomy that involves removing the implant intact within the scar tissue capsule as a single unit; this surgery carries more risk, and should be reserved for serious cases of breast implant-related illness, i.e. BIA-ALCL

A final decision on the ideal procedure for you may best be made in the operating room—once the surgeon is able to see your implants and the surrounding tissues and ascertain their condition, they can choose the least risky capsulectomy approach.

Once we have planned the removal procedure, then we will discuss any desired cosmetic reconstruction options, which may include breast lift and/or fat transfer to the breast. 

Breast implant removal with breast lift

Patients who choose to have a breast lift, or mastopexy, to reach their goals for their breast shape can likely have one single surgery combining the removal and lift in a single operation and anesthesia period. Breast lift will not add volume or increase breast size, but raises the breasts and reshapes your natural tissues to form a perkier breast shape.

You may be a good candidate for a breast lift with explanation if your breasts have stretched and excess skin will need to be removed and tightened. A breast lift also allows for raising the nipples to a higher position on the breast mound, if needed, and/or resizing the nipple-areola complex.

Breast implant removal with fat transfer

While an explant and breast lift can be combined in one surgery, many patients today are interested in fat transfer breast enhancement—a natural alternative to implants that can offer subtle improvements in volume. You may be a good candidate for fat grafting if you will be happy with a subtle volume boost, and you do not have significant excess skin or sagging after explant surgery.

While explant and breast lift may be a single-stage procedure, many women need time to adjust to their new breast shape and size after explant before undergoing fat transfer.

However, you may be surprised to learn about an important consideration: if you have had your breast implants for a long time (as most of my BII patients have), we may recommend waiting to have fat transfer to the breasts about 1 year after your initial implant removal surgery. There are two important reasons for this wait time:

• Adjusting to your new body: A period of adjustment is only natural after having implants. Your breasts’ projection, volume, and the feeling you had in your body will be different after removing breast implants. Take this time to get to know your body again and to feel safe and healthy.
• Allowing tissues time to heal: Time for tissue to heal is critical so that fat grafting can achieve an optimum outcome and as much of the fat as possible can “take” in the treated area. 

Additionally, it is possible to have a breast lift as part of your initial removal surgery, and then later decide whether or not fat transfer may help you achieve the natural volume you desire.

Finding a surgeon to help with breast implant illness treatment

If you are experiencing breast implant illness, we understand that it is key to find an understanding and capable surgeon you can trust to give you the results you desire. Look for a cosmetic surgeon who has board certification, many stellar patient reviews, and years of experience helping patients with symptoms of breast implant illness. Expect any surgeon you interview to spend adequate time talking with you in the consultation, and do not be shy about scheduling several consultations until you find a surgeon who is a good fit. 

With BII in particular, beware of any surgeons who advertise and promote en bloc capsulectomy for all BII patients. These doctors are capitalizing on the oft-repeated myth that en bloc capsulectomy is preferable, but the en bloc technique can pose significantly higher risks to your health and is not a research-driven best practice for resolving all patients’ BII symptoms.

About board certified cosmetic surgeon Dr. Alexander Sobel

Dr. Alex Sobel is a triple board-certified surgeon in Seattle with years of experience, a caring and attentive bedside manner, and a special interest in helping patients with breast implant illness find resolution from symptoms and comfort in their bodies. To schedule your consultation with Dr. Sobel, call 425-453-9060 or reach out to us online. También se habla español en nuestra oficina de cirugía cosmética.