Aesthetic Breast Surgery,Breast Implant Revision & Fat Transfer

Breast Implant Removal / Explant surgery

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"Our goal is to set the standard for breast implant removal surgery in Australia."

COSTS:
Plastic surgeon’s fee: from $9,570 - $16,995

Total approximate cost range (uninsured patient, day surgery only, including hospital and anaesthetic costs): $14,800 - $27,500

Total approximate cost range (insured patient, day surgery or overnight, including hospital and anaesthetic costs): from $11,400 - $24,500

Associated item number: 45551

May be performed with: FAT TRANSFER
May be performed with: MASTOPEXY

LENGTH OF PROCEDURE/HOSPITAL STAY:
3-5 hours.

Day surgery for most patients.

Dr Campbell-Lloyd does NOT use drains and there is no need to stay in hospital after surgery.

Important information:

Due to his focus on breast implant removal and revision procedures, Dr Campbell-Lloyd chooses not to offer primary cosmetic breast augmentation.

Other surgeons who perform explant surgery (including those who claim to specialise in breast implant removal) are also routinely performing primary cosmetic breast augmentation. We view this as a conflict of interest.

Breast implant removal is a more complex and challenging procedure than breast augmentation. It demands a different perspective and a range of specific techniques that are often unrelated to breast augmentation surgeries. Central to our philosophy of breast implant removal surgery is the restoration of normal anatomy which has been disrupted or destroyed by the surgeon performing breast augmentation.

Key Features of Explant surgery with Dr Campbell-Lloyd

Total capsulectomy
Dr Campbell-Lloyd will not leave any capsule behind. A total capsulectomy is performed in ALL cases.

Despite the claims that are sometimes made, there is absolutely no evidence to support the assertion that breast implant capsules will be "reabsorbed" by your body naturally. To the contrary, there is extensive evidence, supported by our own observations whilst revising explant outcomes (for ladies who had their explant done elsewhere), that the breast implant capsule will persist in its entirety years after breast implants have been removed where a surgeon chose not to perform a capsulectomy.

It is vital to understand that alleviating the symptoms patients experience and attribute to their implants may not be in any way related to the capsulectomy. There is data to suggest that patients with breast implant illness will experience improvement in their symptoms independent of whether they have had a total or partial capsulectomy.

However, Dr Campbell-Lloyd views a total capsulectomy as a fundamentally important step in all explant procedures. The capsulectomy facilitates other aspects of the surgery including muscle repair, and is necessary to allow for drainless explant surgery.

Please note: 
There are very uncommon circumstances, which may be unpredictable, in which a total capsulectomy simply cannot be completed. As we encounter more ladies with the current generation Motiva implants who are seeking explant, this is an important consideration. The particular properties of Motiva "nanotextured" breast implants  mean that the scar capsules the body forms are often extraordinarily thin. They are quite distinct from the capsules we encounter with any form of textured breast implants, and they are different to those encountered with classic smooth implants. These very thin capsules can be challenging to remove. There are sometimes cases where the capsule is so insubstantial as to almost be absent, especially on the posterior surface of the Pectoralis major muscle and the anterior surface of the underlying Pectoralis minor muscle. In these cases, sub-total capsulectomy may have to be performed to avoid excessive damage to the muscles.

Total intact capsulectomy (often incorrectly referred to as "en-bloc" capsulectomy)
En-bloc is a term widely popularised on social media, but what patients are referring to is more correctly termed a “total intact capsulectomy”, which involves the complete removal of the capsules, intact, with the contained breast implant within. A total intact capsulectomy is always an option, however a longer incision may be required.

  • Dr Campbell-Lloyd has previously written about capsulectomy procedures.
  • Please click here to read about how we discuss capsulectomy with our patients.
  • And click here to read about the issues we see with how capsulectomy is being addressed by the Plastic Surgery industry.

The value of a total intact capsulectomy is particularly relevant to ladies who have known, ruptured breast implants. Performing surgery in this way prevents "spillage" of the silicone contained within the scar capsule.

There is no evidence however to suggest that total intact capsulectomy offers any other benefit over a total capsulectomy performed with other techniques.

Pectoralis major muscle repair
Dr Campbell-Lloyd will always repair the Pectoralis major muscle following capsulectomy. This is absolutely vital for ladies who had "dual-plane" or subpectoral implants, as it will prevent persistent "animation" deformity. Unfortunately, we are now seeing patients who have had explant surgery elsewhere presenting with troublesome animation and distortion/deformity of the breast due to the unrepaired muscle.

This step is not required for ladies with implants on top of the muscle.

"Internal Bra"

Internal bra techniques are vital to creating aesthetically acceptable results after explant surgery. Dr Campbell-Lloyd will carefully rebuild the breast following implant removal, and this involves reconstructing the breast crease, re-establishing the lateral breast boundary, and repositioning tissue internally to undo the damage that results from breast implant placement. Failure to understand the importance of this approach results in the poor results we are now seeing in ladies who have had explant procedures done elsewhere. We see many ladies with scars sitting well below their breast crease, distortion of the lower pole of the breast with flattening and upwards retraction, nipple inversion and prominent creasing through the breast - all of these features are a consequence of failing to accurately rebuild the breast, which starts with reconstruction of the inframammary crease.

Drainless
Unlike other surgeons, Dr Campbell-Lloyd does not use drains for capsulectomy procedures. This allows for patients to go home on the day of surgery, and is associated with less pain.

Associated procedures
Fat transfer & mastopexy are commonly performed in the same procedure as explant surgery.

It is important to appreciate that whilst mastopexy may be an absolute necessity in some cases, it certainly adds challenges to the surgery.

Reasons To Consider Breast Implant Removal

Personal preference - Many women simply realise that they no longer like the appearance of their breast after breast augmentation surgery. Whilst some women express regret from the time of their original surgery, for other women it may be changes in the breast over time or after having children that leads to this decision. This is a very personal process and it is an individual experience for every woman.

Capsular contracture - tightening, hardening and distortion of the breast are all a consequence of capsular contracture. The risk of capsular contracture after breast implant surgery is variable but does increase with time. The older the breast implants, the more likely it is that capsular contracture will be an issue.

Painful implants - often associated with capsular contracture, and with previous “under the muscle” or dual-plane implant placement. There are many reasons that breast implants cause pain, and you can read more about that here.

Change in breast shape – most commonly a result of capsular contracture, or incorrect positioning of the implant at the time of the original breast augmentation. In less common scenarios, some ladies may notice sudden swelling or enlargement of one breast due to a fluid collection, or even bleeding around the implant.

“Botched” breast augmentation procedures – unqualified or inexperienced doctors performing breast augmentation may be responsible for implants which are incorrectly placed, incorrectly positioned & the wrong size. There may be progressive problems leading to pain and cosmetic deformity.

Breast implant rupture – more common for long standing breast implants, and when contracture is present. Breast implant rupture is not dangerous to your health per se, and is best considered a consequence of another underlying problem rather than a cause of a problem in itself.

“Animation deformity” – the movement of the implant (typically upwards, and/or outwards) due the effect of the Pectoralis major muscle on the implant creates an unaesthetic breast shape, widening of the cleavage, and a disconcerting sensation with activation of the Pec muscle. This is a common problem and is the reason why many ladies avoid specific movements or exercises after breast augmentation.

Concern regarding possible “breast implant illness (BII)” symptoms – the symptoms attributed to BII are extensive and the experience of every patient is different.

What To Expect after Breast Implant Removal

Dr Campbell-Lloyd believes strongly that removal of breast implants should be performed in conjunction with a total capsulectomy.

Because most breast augmentation procedures in Australia involve cutting the Pectoralis major muscle and placing the breast implant “under the muscle”, Dr Campbell-Lloyd has developed a technique that involves removal of the breast implants, total capsulectomy and careful repair of the muscle. This technique has many functional and cosmetic benefits, and it also allows the surgery to be performed as a day-case procedure, without drains.

Appearance

We consider it vital that patients understand that the aesthetic outcome after explant surgery may not be ideal. We can offer no guarantees regarding the results of explant surgery. There are many variables at play in performing explant surgery, and despite the enormous amount of time, effort and experience we bring to these procedures, some patients will require revision surgery.

The appearance of the breast after explant surgery can be hard to predict. This is an essential aspect of explant surgery that all patients must accept. Unpredictable aspects of appearance include the nature of scars, breast shape and contour. The risk of requiring revision surgery to correct any (or all) of these aspects of the breast after breast implant removal must be accepted prior to undergoing explant surgery.

There will always be a loss of volume after the implants have been removed. Even with breast lift procedures and fat transfer, the breast will always appear smaller, and more natural after explant surgery. We have an extensive archive of before-and-after images which will allow you to visualise your outcome by considering patients with similar builds and similar breasts to your own.

The difficulty in determining your post-operative appearance after explant surgery relates to the wide variety of changes that may have taken place in the breast over time since the original breast augmentation surgery. To understand how Dr Campbell-Lloyd approaches this complex topic, and to read more about the factors that will impact your post-operative appearance after explant surgery, please read this detailed article. Dr Campbell-Lloyd has also written an article discussing the possible reasons for dissatisfaction after explant surgery, and the ways such issues might be addressed.

Mastopexy

The final appearance of the breast may be harder to predict when mastopexy is performed concurrently with breast implant removal. For ladies with a reasonable natural tissue volume, the outcome of mastopexy at the time of explant is relatively controllable and is somewhat akin to ladies having a breast reduction (if you consider the removal of the implant volume to be analagous to the removal of excess breast tissue volume). However for ladies with very modest natural tissue volumes and proportionately large implants (where a mastopexy may be required simply to address stretched and attenuated breast tissue and skin), creating a aesthetic breast shape is very challenging.

Two particular issues relating to mastopexy are worth considering:

1) Scars are the fundamental trade-off, and scars are inherently unpredictable. Whilst most breast scars are very satisfactory, the risk of stretched or hypertrophic scars remains, and scar treatment or revision is sometimes required.

2) Areolar size after mastopexy depends on the size of the areola before surgery. This is a particular issue for ladies with small areolae, as a mastopexy introduces the risk of areolar enlargement after surgery. We prefer not to use permanent sutures (such as Gortex) as a tool to try to prevent this issue, as Dr Campbell-Lloyd considers the risk of complications relating to those sutures is too high, including suture spitting, suture infection, and a failure to prevent the stretching as intended. Ultimately, for ladies who do experience areolar stretching this may require subsequent minor revision surgery. For ladies whose areolae have stretched (most commonly with changes in breast size during pregnancy) before surgery, then the areolar size is always reduced as part of the mastopexy, and this is a predictable outcome.

Body Image and "explant regret"

Body image can be variably impacted by breast implant removal. Dr Campbell-Lloyd has written about this previously, and body image is a very important component of the pre-operative discussion. We encourage our patients to consider this aspect of their recovery very carefully before surgery.

Some patients will go on to regret their decision to remove their breast implants. Whilst explant regret is rare, it is the major reason we consider it vital that women do not feel rushed into having explant surgery performed.

We are unfortunately seeing a rise in "explant-related harm" due to an increasing number of surgeons offering explant procedures for what appear to be commercially expedient reasons. Dr Campbell-Lloyd is increasingly being asked to fix incorrectly or poorly performed explant surgery for women who have had breast implant removal performed elsewhere. When done incorrectly, explant surgery can lead to some women suffering from persistent Pectoral muscle animnation, breast distortion, visible creasing and indentation of the breast; other ladies will suffer from incorrect scar placement, or incorrect positioning of the breast tissue. Whilst these issues are correctable, they may be very challenging to address.

Post-operative details

All sutures are dissolving sutures, under the skin. A layer of glue is then applied to any incisions. There are no “sticky” dressings applied which can cause irritation and prevent showering.

After breast implant removal and total capsulectomy, patients are discharged home with a surgical compression bra which must be worn at all times for the first 4-6 weeks.

Patients are discharged with antibiotic tablets, and pain-relief medications.

Patients are discharged home with detailed instructions. The instructions include emergency contact details for Dr Campbell-Lloyd.

Routine follow-up appointments are made for:

  • 1-2 days post-op
  • around 1 week post-op
  • subsequently on demand/ as required during the first 6 weeks
  • then at 6 weeks post-op (first post-op photos)
  • and around 4 months post-op (second set of post-op photos, when breast shape has typically resolved, although scars are still settling).

Patients are then seen every 4-6 months as scars fade. Most patients are stable and are discharged at 12-18 months post-op, however we are happy to see any of our patients in an ongoing fashion.

We do not charge for post-op consultations.

There will be some pain. Most patients will experience pain at the incision site in the crease under the breast for the first 7-10 days. Some patients will experience occasional discomforts relating to movement after that time as the healing process continues.

The nature of this surgery is such that patients should expect to require pain relief medication for at least the first 2-3 weeks. Some patients will require simple pain relief (such as Nurofen) on occasion for up to 6 weeks as they increase activity. The need for pain relief will be dependent on the original surgery performed, the size of the implant to be removed, the presence of capsular contracture, and level of activity after surgery.

It is vital to maintain a decreased level of activity for 6 weeks after surgery to ensure that the muscle repair is not inflamed or aggravated.

It will take at least 3-4 months for full recovery. Final results can only be appreciated after that time, once scars have softened and relaxed. Scars may only fade after 6-12 months on the breast.

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