BY. LISA B. CASSILETH MD, FACS
Beverly Hills breast specialist Dr. Lisa Cassileth has been performing explant surgeries for over fifteen years. Many patients seek out her expertise when faced with symptoms of breast implant illness and capsular contracture. Read more to learn about the best techniques for breast implant removal and what to look for in a explant surgeon.
While removal of breast implants is not challenging, ensuring that the patients breasts look great after breast implant removal, however, requires following critical steps and lots of experience. The entire capsule must be removed and should be evaluated by pathology and PCR with microbiology sent. Then the muscle should be repaired. After those steps are completed a surgeon should ask, “What does it look like? This is the crucial part – where aesthetic finesse and expertise come in to play to ensure that you do not look like a flat tire.
Repairing the Muscle
This is a critical step, but few perform pectoralis major repair for submuscular implants. We aren’t sure why, since it goes a long way to putting the breast back together again. Not only does the repair get the pectoralis muscle moving normally again and strengthen it, it also pulls the base of the breast back together, making a neater, tighter breast.
The Shape of The Breasts
The breast tissue essentially gets a concave center, and thick edges with the implant in place like a doughnut. The tissue can (and should) be elevated and recentralized. The tissue is usually repositioned at the level of the pectoral fascia, which allows the tissue to slide together and avoids nerves and blood vessels that pass through the breast.
The Size of The Breasts
After the breast implant is removed, the lost volume can make the breast sag or look too small. Fat can be grafted from other areas of the body (such as thighs, hips, and flanks) into the breast, making the breast bigger and restoring size and volume loss. Fat grating is truly a labor of love, as we repackage our fat into 3cc syringes and inject them in 0.1cc aliquots which then in spread through the breast using tiny cannulas (blunt tipped needles). It is more time consuming, but well worth it as our permanent fat take rate is 83%. Liposuction is also an art form, and divots, dents, or other signs of liposuction should be meticulously avoided by using small cannulas and a careful crosshatching technique. We can usually double the size of the natural breast for most patients, often making up the size of the implant with natural, healthy tissue.
A breast lift can be performed at the same time as the removal for patients. The lift technique is critical because of the hollow center left by the implant removal. The loose skin and fat below the breast are used to replace the lost implant size in a technique, called “auto augmentation”. This restores the breast shape and removes extra skin at the same time. .