Silicone implant removal is a procedure that may be performed for various reasons. To better understand this, we should first distinguish the cases in which breast implant removal or replacement is carried out into three categories.
There are cases where a breast surgery procedure is performed for medical reasons, such as aesthetic or functional complications; cases where the reason is subjective; and cases where it is done as a preventive measure. Usually, it is a procedure that is jointly decided by the plastic surgeon and the patient, once one of the above has been confirmed and all alternatives have been exhausted. In general, silicone implant removal is a process we try to avoid whenever feasible!
What medical reasons lead to removal of silicone implants?
Regarding the first category, meaning implant removal for medical reasons, the most common indication for silicone implant removal is the so-called capsular contracture. To better understand this, the capsule is the membrane that the body forms around silicone implants, as it would around any surgically implanted foreign body—this is a normal physiological response. This capsule stabilizes the breast implants, and its proper formation is crucial for a successful outcome.
However, in some cases, for reasons that are not always clear, this capsule may harden, thicken and muscle and other cells may migrate onto it. These changes can cause shrinkage and deformation of the capsule, leading to a change in breast shape and the appearance of various symptoms. Some of these include pain, heaviness, and breast firmness. In such cases, silicone implant removal is deemed necessary.
Silicone implant removal due to implant rupture
Another medical indication requiring silicone implant removal is implant rupture, meaning a tear in the outer shell of the implants. In general, modern silicone implants used in breast surgeries undergo extensive testing during manufacturing to ensure long lifespan and durability. However, after many years, the outer shell may degrade and eventually rupture.
The silicone in breast implants is not in liquid form and does not leak into the tissues, but removal or replacement is still required. The diagnosis is not always straightforward and is based on clinical evaluation as well as imaging findings from breast MRI and ultrasound.
Implant removal due to poor aesthetic result
The indication for silicone implant removal or replacement also applies in cases where the aesthetic outcome is poor. This may be due to incorrect implant sizing, the patient’s desire for a different volume, implant displacement, or specific issues such as bottoming out, rippling, symmastia, asymmetry, etc.
Each case is evaluated individually to determine the most appropriate solution, which may include replacement, removal with re-implantation at a later stage, breast lift, fat transfer, or other specialized procedures.
Removal of silicone implants due to anaplastic lymphoma
A very rare condition that can lead to silicone implant removal is BIA-ALCL Anaplastic Lymphoma (Breast Implant-Associated Anaplastic Large Cell Lymphoma). It is a form of malignancy that has been associated with silicone implants, mainly those with a textured surface. It is not breast cancer and is fully curable when the silicone implants are removed together with the capsule.
The symptoms may include swelling and heaviness, typically appearing 10–20 years after surgery. Diagnosis is confirmed using PET-Scan, ultrasound, and fluid aspiration for testing. Once the diagnosis is confirmed, silicone implant removal with total capsulectomy is performed, and no form of chemotherapy or radiotherapy is required. The global incidence rates of ALCL are extremely low and there is no reason for panic. An annual clinical examination with palpation, mammography, and ultrasound is necessary, as it can detect both breast malignancies and changes in the implants or capsule.
Finally, there is a special category that is not clearly defined as medical or subjective — known as breast implant illness. Because this condition has received significant attention, especially on social media, we will analyze it separately.
Breast implant illness: What is it and when does it lead to the need for silicone implant removal?
In recent years, we have observed a new trend leading to the decision for silicone implant removal, which has been amplified by the media. This relates to “breast implant illness,” known as BII (Breast Implant Illness). This condition has not been scientifically confirmed, as it mainly presents with subjective symptoms that are difficult to verify, such as:
- fatigue
- difficulty concentrating
- sleep disorders
- joint pain
- myalgia
- stress
- trouble breathing
- dry eyes or dry mouth
- hair loss
- gastrointestinal disorders
- headaches
- depression
The above symptoms may appear individually or in combination, and there is no consistent pattern of occurrence or any scientifically documented correlation with breast implants. It is possible that the symptomatology may be, to some extent, psychosomatic, as it resembles symptoms experienced by patients with high levels of stress from any other cause.
From a medical standpoint, we acknowledge that any aesthetic intervention can cause stress in certain patients, and when the above symptoms are severe, they may constitute an indication for medical intervention.
How is the diagnosis that leads to the decision to remove silicone implants made?
Unfortunately, these symptoms may become amplified when someone begins researching information online or on social media, leading to the so-called “medical student syndrome”: while studying pathology, we often believed we had every condition we read about. We cannot entirely rule out the possibility that silicone implants may cause some form of bodily reaction, but on the other hand, careful judgment and accurate information are essential to avoid unnecessary stress and unnecessary procedures.
The diagnosis of breast implant illness is usually made by exclusion, meaning that other conditions that may cause similar symptoms must first be ruled out. Once all possibilities have been thoroughly investigated, and if at least 6 months have passed since the breast augmentation surgery without improvement of symptoms, implant removal may be considered. In such cases, total capsulectomy and implant removal are performed, and symptoms typically resolve within a few months.
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Preventive removal of silicone implants and replacement of breast prostheses
The final category concerns the preventive replacement of breast implants, which is also a matter of discussion and is decided on an individual basis. In the past, doctors recommended replacing implants approximately every 10 years. This recommendation applied to older-generation implants, and there was also insufficient data at the time to determine how and when breast implants deteriorate over the years. Today, based on experience, clinical studies, and statistical data collected over 50 years, we generally refer to a 15–20 year lifespan for implants, although even this is not considered absolute.
From my personal experience, I have encountered cases where patients kept the same implants for more than 30 years without the slightest issue. Likewise, I have seen cases where implant rupture occurred before the 10-year mark. My personal advice is to consider replacement around the 20-year point, or earlier if there are symptoms or noticeable changes in the breast.
Techniques for replacing or removing silicone breast implants
A key difference in the technique involves how the capsule formed around the implant is managed. In some cases, this capsule is left intact, while in others it is partially or completely removed.
Regarding replacement, this may be performed during the same procedure as the removal of the old implants, or a few months later. The strategy chosen depends on each individual case and is fully personalized.
Therefore, we distinguish the following procedures:
- Silicone implant removal with total capsulectomy
- Silicone implant removal with partial capsulectomy
- Silicone implant removal with capsule preservation
- Silicone implant removal with capsulorrhaphy
- Silicone implant removal & two-stage replacement
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Complete removal of silicone implants
Total capsule removal along with the implants is the procedure of choice when there are medical or aesthetic issues related to the capsule. In cases of severe capsular contracture, BIA-ALCL, breast implant illness (BII), or complex aesthetic complications, complete capsulectomy ensures that the breast returns to a previous state, similar to how it was before silicone implants were placed.
This is a relatively demanding procedure with a higher complication rate, mainly bleeding, compared to standard breast augmentation. For this reason, when a total capsulectomy is planned, simultaneous placement of new implants carries greater risk, and it is usually preferable to perform it in two stages.
Silicone implant removal with partial capsulectomy or capsule preservation
Partial capsulectomy involves the selective removal of part of the capsule, usually the lower pole, and is performed when there is no significant problem with the capsule. This technique is particularly useful when changing the implant pocket — for example, replacing implants placed above the muscle and positioning the new ones below the muscle, or vice versa. It is a less invasive and simpler procedure compared to total capsulectomy, with significantly lower complication rates.
Capsule preservation is typically the procedure of choice when the existing capsule is healthy and we simply want to insert new implants of the same or different size. It is a relatively simple and quick procedure, minimally invasive and atraumatic, with fast recovery. It may be combined with capsulorrhaphy, meaning the reshaping of the capsule using internal sutures or with the pop-corn technique. This allows us to reduce or better contour the implant pocket for optimal results.
In more complex cases, a two-stage correction is preferable. In the first surgery, we remove the implants — usually along with their capsule — and after approximately 6 months, new implants are placed. This approach ensures a more predictable healing process with fewer complications. It is typically applied in severe conditions such as major capsular contracture, implant rupture, or complicated aesthetic issues.
Additional procedures after removal of silicone implants
Finally, there is a wide range of complementary procedures that can be performed when removing or replacing implants. A good strategy, for example, when we want to completely remove the implants, is to restore part of the lost volume with fat transfer, which can be performed during the same surgery or at a later stage.
Fat can also be used as a complementary technique in any other procedure to correct aesthetic concerns such as wide implant spacing from the sternum, rippling, double bubble, etc. Additionally, in cases of total implant removal, a breast lift may be required. This is advisable when sagging is present and is further worsened by the removal of the implant, requiring correction. Finally, in some complex cases, special surgical meshes may be used to better stabilize the lower pole of the breast.
Recovery after replacement or removal of silicone implants
Recovery after silicone implant removal can vary significantly depending on the type of procedure performed. The simplest recovery is seen in straightforward implant replacement without capsulectomy. Patients usually experience little to no pain or discomfort, drains are not required, and they can return to daily activities within just a few days. The result is immediately visible and continues to improve over 3–6 months.
Recovery is slightly more demanding when a partial capsulectomy is performed. Discomfort and pain are similar to those after breast augmentation, and equivalent care is needed during the first 6 weeks. However, in certain special cases, more caution is required — particularly if additional stabilization with mesh or internal sutures has been performed.
In the case of a total capsulectomy, recovery is still relatively straightforward and pain is minimal, however, drains usually need to be placed for a few days in order to limit fluid accumulation as much as possible. As mentioned earlier, performing a total capsulectomy and placing new implants during the same procedure carries a higher risk, especially within the first 48 hours, because there is an increased chance of bleeding. While the bleeding is not life-threatening, blood collection around the implant may lead to early capsular contracture and aesthetic concerns.
If you are interested in learning more about silicone implant removal in Thessaloniki, contact us!
Dr. Prodromos Papaioannou
He completed his plastic surgery specialization in Germany, at the Pirmasens Hospital, the Asklepios Wandsbek Hospitals in Hamburg, the University Hospital in Magdeburg and the Braunschweig Clinic. He worked as a specialist-deputy director at the Braunschweig Clinic (specializing in breast reconstruction after cancer and cosmetic surgery). He also participated in scientific research and completed his doctoral thesis (Dr. Med.) at the Magdeburg Clinic.