Not All Breast Explants Are Equal: Contemporary Strategies
in Breast Explantation Surgery
by Tanna, Neil; Calobrace, M. Bradley; Clemens, Mark W.;
Hammond, Dennis C.; Nahabedian, Maurice Y.; Rohrich, Rod J.; Zhang, Ben H.;
Bregman, Dana; Perry, Adam D.
Plastic and
Reconstructive Surgery: April 2021 - Volume 147 - Issue 4 - p 808-818
Summary:
Breast implant removal and replacement has been a common
secondary breast procedure in the long-term maintenance of breast augmentation,
but more recently growing concerns about silicone-related systemic illness,
breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and
changing perceptions of aesthetic beauty have seen breast implant removal
without replacement become increasingly requested by patients. Explantation can
be challenging, especially when performed with a total capsulectomy. Currently,
there is no evidence regarding whether a partial or total capsulectomy has any
effect on BIA-ALCL risk mitigation in patients that have textured implants
without disease. Total capsulectomy with incomplete resection of a mass can
contribute to hyperprogression of BIA-ALCL and death. There have also been
cases of BIA-ALCL diagnosed years after removal of the textured device and
“total capsulectomy.” Therefore, the common practice of simple prophylactic
capsulectomy in a textured implant to mitigate future disease has not been
established and at the current time should be discouraged. In addition,
aesthetic outcomes can be quite variable, and patients should have appropriate
preoperative counseling regarding the indications and contraindications for
explantation, associated risks, financial implications, and postoperative
appearance. The authors review salient aspects related to the planning and
management of breast implant removal.
