For women with breast implants there may come a time when you are interested in removing your implants. Sometimes this can be for a medical reason, or more of a personal and individual choice. Your breasts will undergo changes throughout your life, especially during pregnancy & lactation or weight fluctuations. As we age, our bodies change and what was once a good fit or proportionate breast shape and size can change. It is common for women to be interested in a change or removal of breast implants to accommodate their body as they age.
BIA-ALCL stands for Breast Implant-Associated Anaplastic Large Cell Lymphoma. It is a separate entity than other forms of Lymphoma but is still a form of cancer. There is still much ongoing research about BIA-ALCL, including several papers recently published by Dr. Davison and his colleagues. (click here)
To the best of our understanding, BIA-ALCL stems from a type of chronic inflammatory process in the breast implant capsule that forms around textured implants. It is understood to be more problematic among the Macro-textured surfaces of certain implants, but may be possible with all types of textured implants. To date, there have been no confirmed cases of BIA-ALCL associated with the sole use of smooth implants[2]. The position of the American society of plastic surgeons is that there are no confirmed BIA-ALCL cases that involve a smooth implant only[3]. No cases of BIA-ALCL have been reported in Canada with any smooth surface implants. The current consensus from Health Canada is that smooth implants are safe and continue to be used. If you have textured implants, you should consult your surgeon for a detailed discussion about the risks and benefits of keeping them vs. having them removed.
Dr. Davison is actively involved in research at the MUHC regarding breast implants and implant safety. He has not used textured implants for breast reconstruction or breast augmentation since starting practice in 2014 for various reasons, including the concern of ALCL.
Some women experience pain in the breast or chest related to the implants. Especially if the capsule has become tight over time (capsular contracture), this can often be associated with pain. Sometimes pain can be explained by the capsular contracture, or muscle cramping, but sometimes the direct etiology (source/cause) of the pain cannot be determined. For some women, the discomfort is more vague and can be felt in the shoulders, upper back, neck, or elsewhere. In many cases this can be improved with implant removal but since pain pathways are complicated and multifaceted, resolution of pain following explantation can’t be guaranteed. There have been many studies demonstrating the benefit of a breast reduction (of natural tissue) for women with large, heavy breasts. Reducing the size and weight of the breast as well as repositioning it to a lifted position on the chest will typically improve one’s posture and reduce shoulder and neck pain. This hasn’t been as well studied for explantation patients but the premise is the same.
Certain types of focused breast pain, especially if it is only on one side and is new or associated with a breast lump could be a sign of a more serious problem such as a breast cancer. This should be evaluated as soon as possible by your family physician or a breast surgeon. Dr. Davison is specialized in breast cancer reconstruction and works closely with an excellent group of colleagues at the MUHC Breast Cancer centre.
There is no ideal breast size or volume. The ideal body proportions have often been defined by an hourglass-type curvature of the hips-waist-breast ratio. But in reality this varies for each woman’s overall body proportions and to a large degree their style or personal preference. Over the ages, the desire for large and small sized breasts has been influenced by the styles and fashion of the era. Many women are interested in explantation because they are no longer interested or comfortable with the larger breast size produced by the implants.
It is very common to increase in body weight as we age and with this typically the natural breast tissue will also increase in volume. In this case, you may no longer need the added volume of the breast implant. Also, the implant itself may now be a smaller proportion of the overall breast volume and removal may not result in as much of a decrease in size as you might think. Dr. Davison may suggest a mastopexy with auto-augmentation, which takes advantage of the lower breast tissue to reposition it essentially into the space occupied by the implant. This creates a lifted breast with tightened skin, while maintaining as much of the upper fullness and volume as possible. The breast shape will settle somewhat in the early period following surgery and the final shape is usually a more natural and sloped upper breast, than the more rounded shape of an implant.
Many people are prioritizing a more natural diet and lifestyle and aim to live more organically and avoid unnecessary exposure to synthetic products. For some women this is one of the motivating factors to remove their breast implants. An alternative of implants for a natural breast augmentation is using your own fat, called fat grafting. Fat grafting has its limitations especially in terms of the volume that can be transferred at one time but also has many benefits. Dr. Davison can use liposuction to remove fat from an unwanted location and transfer it to the breasts. The key limitation of fat grafting is that the maximum amount that can be reliably augmented at one time is between 100-300 mL (but this can vary widely by patient, depending on their original breast size and shape). Also, only 60-70% of the fat survives long-term (beyond 3 months), regardless of technique used. This is therefore adjusted for during the surgical planning. However the fat that survives will then last a lifetime and change with you (gaining or losing weight).
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Dr. Davison is a Canadian board certified Plastic Surgeon and an Assistant Professor of Plastic Surgery at McGill.
