BEFORE & AFTER PHOTOS
*DISCLAIMER: This site contains graphic & surgical images that may be disturbing to some viewers.
This site is intended for individuals over the age of 18.
**Please note that none of the images posted throughout this site have been enhanced or photoshopped.
Silicone implant Removal and options following implant removal:
I HAVE SILICONE IMPLANTS FROM BEFORE 1992, WHAT SHOULD I DO?
These older implants were filled with a silicone material which had the same consistency as pancake syrup. Once the outer covering or skin of the implant is broken or ruptured, the silicone material could leak out of the implant bag into the breast.
When the implant is first inserted, your body reacts to any implant (knee, hip, breast etc.) by putting a layer of scar tissue around the implant we call a capsule.
If the implant breaks or ruptures, and this capsular layer of scar surrounding the implant remains intact, the silicone material stays within this scar pocket or capsule. This is called an intra capsular leak (a leak within the capsule).
If the capsule of scar tissue has also ruptured (this can happen spontaneously, or with the forces of an air bag after a car mishap, a mammography examination or a bad fall on the chest, etc.), then the silicone material can then leak beyond the capsule pocket into the breast itself, and even into the axilla (arm pit area). This is called an extra capsular leak (a leak outside the capsule).
These older implants were never designed to be left in your body for life. If you have had a silicone implant prior to 1992, it is very likely your implants are broken and you have an intra or extra capsular leak. A consultation with Dr. Giuffre is recommended.
The pre 1992 type of silicone implants were taken off the market in 1992. There was a moratorium (no silicone implants were inserted) on using any silicone breast implants from 1992-2002 in North America.
After 2002, a new silicone implant was designed and is currently being used today called cohesive gel implants (gummy bear implants). These are a far superior silicone implant than the older variety. They have an anticipated life expectancy of 10 years.
If you have had the older variety of silicone implants (pre1992), there is a strong likelihood that your implants are broken, OR will break or are leaking.
Implants placed before 1992 should be removed.
Dr. Giuffre recommends a consultation and an assessment.
If you have had the newer (post 2002) implants and the implants are approaching 10 years old, then it is recommended that the implants should be exchanged. Dr. Giuffre recommends a consultation and an assessment.
The implant removal is most often done through the incision that was made to put in the original implants. This incision may be enlarged slightly, but there is little additional scarring to remove the implants. This surgery requires a General Anaesthetic.
If there is an intra capsular leak, the implant and the surrounding breast capsule is removed. The tissue is sent to pathology for examination. There is often a drain placed in the surgical site for up to a week.
If there is an extra capsule leak and silicone has infiltrated into the breast itself, then as much of this involved tissue is also removed and sent to pathology. This may create a contour deformity of the breast if a large amount of tissue is removed. There will be a drain placed in the surgical site.
What happens to the pocket that held the implant within the breast?
The capsule around the implant, along with the implant, is removed at the time of surgery. The pocket then collapses and reseals itself. After 1 year, the pocket that held the implant is gone.
What will my breasts look like afterwards?
After the implants are removed, the patient may wish to not have further implant surgery done. After healing, the breasts will take on their natural shape and size.
Will my breasts look like they did prior to having implant surgery?
The effects of gravity, aging, weight gain or loss, pregnancy and breast feeding will all have an impact on how the breast will look after the implants are removed.
After 6 weeks, the breast shape and size has stabilized.
If the patient does not wish to have further restorative surgery done, then regular breast examination and breast surveillance is recommended. There is no time line to have further restorative surgery done. If the patient changes her mind years after implant removal, further restorative surgery is possible.
The surgical procedure to remove ruptured, leaking or old implants (pre 1992) WITHOUT RESTORATIVE SURGERY is done under General Anaesthesia and is covered by AHS.
If I am having implant removal due to a breast cancer diagnoses, is this covered by AHS?
Any procedure related to breast cancer, whether it is for treatment of a breast cancer, or for breast reconstruction, is covered by AHS.
If I decide that I need Breast reshaping following the implant removal, how long must I wait to see Dr. Giuffre again? Can I have a breast lift if my breasts are droopy (ptosis) after the implant removal?
At the time of Implant removal, a breast reshaping procedure (Breast lift) can be done at the same time as the implant removal.
If the patient wishes to have restorative surgery done at the same time as the implant removal, this option would be discussed with Dr. Giuffre at the time of consultation and assessment, before the planned implant removal surgery. This restorative surgery (enlarge, or lift, or enlarge and lift is not covered by AHS).
*Please see FAQ Breast Lift and FAQ Breast Augmentation.
Alternatively, the patient may wish to defer the breast shaping procedure until the breast shape and size had restabilized. At 6 weeks following the implant removal the breast shape has stabilized.
If the patient is not sure whether they wish to have restorative surgery until after the implants are removed, then the decision is deferred until the 6 week check up with Dr. Giuffre.
At the 6 week mark after the breast impant removal surgery, the patient will see Dr. Giuffre for a checkup.
The breast shape and posture has stabilized. At this point, the patient may wish to have restorative surgery which is arranged as an additional surgery. This restorative surgery, enlarge or lift, or, enlarge and lift is not covered by AHS. The reshaping procedure could then be done at anytime.
*Please see FAQ Breast Lift and FAQ Breast Augmentation.
Will I have scars?
If the implants are being removed with no additional restorative surgery, the scar to remove the implant is the same scar as the patient to insert the implant at the original surgery.
If the patient chooses to have restorative surgery (Breast lift) at the same time as implant removal, or after the breast size and shape has stabilized, (after 6 weeks), there will be additional scars
I HAD MY SILICONE IMPLANTS PUT IN AFTER 2002. WHAT SHOULD I DO?
NEW Silicone implants: a new generation of silicone breast implants was introduced in 2002 and is often referred to as a “gummy bear” implant. In medical terms we call this implant a “Cohesive Gel Implant”. If you were to cut this implant in half, the two halves would stay together similar to splitting a gummy bear in half. This implant has less rippling and feels softer than a saline implant (if you were to hug someone).
This GUMMY BEAR IMPLANT has a finite life expectancy (like a tire on your car). Changing the implant every 10 years is recommended. There is a cost to replacing the implant every 10 years.
Surgical Options:
The new version of silicone implants should be exchanged every 10 years.
If there is a history that suggests the implant may be broken, an MRI would be done to confirm the status of the implant. Any suspicion would be investigated immediately and not wait the 10 years.
If there is any suspicion the implant is broken, the surgery to remove the suspected broken implant would be done under General Anaesthesia and the implant along with the capsule would be removed and replaced.
At 10 years, if the patient does not want the implant anymore, the implant would be removed. This could be done under local anaesthesia. It would require a General Anaesthetic if an implant rupture was suspected.
At 10 years, if the patient wants to maintain the same original implant size, the exchange of implants of the same size can often be done under local anaesthesia.
At 10 years, if the patient requests a larger size than the original implant, then a General Anaesthetic would be required to enlarge the space for the larger implant.
If I want to leave the implant out, can I have a breast lift if my breasts are droopy (ptosis) after the implant removal?
At 10 years, if the breast has aged and has become droopy (ptosis), in addition to changing the implant, the patient may wish to have the breast lifted at the same time as the implant exchange. This would require a General Anaesthetic.
At 10 years, if the breast has aged and has become droopy (ptosis), and the patient does not want the implant anymore, the implant would be removed and the breast lifted at the same time as the implant removal. This would require a General Anaesthetic.
What happens if I leave the gel implant in past ten years?
When the implants are first put in, they are very sturdy and can withstand considerable force and pressure. As time passes, the skin of the implant may weaken.
If a large amount of force over the chest was suddenly transmitted on the aging implant (>10years), like an airbag going off in a car accident, or a bad fall on your chest, or a mammogram, some of the cohesive silicone gel material within the implant could extrude through a weak spot in the skin of the implant (similar to hitting an open tube of toothpaste and the toothpaste squirts out).
If the scar capsule pocket surrounding the implant remains intact, then the result would be an intra capsular leak.
If the scar capsule pocket surrounding the implant was also broken with the hard force on the chest, then the result would be an extra capsular leak.
How can I tell if this has happened?
Often there are no immediate clinical symptoms or signs that anything is wrong. As time passes, there may be a change in the shape or feel of the breast. If the leak is extracapsular, your body will react to any extruded silicone by forming scar tissue around the silicone which will produce a lump, (we call this a silicone granuloma).
This can make breast surveillance for breast cancer difficult because the silicone lump can mimic a breast tissue lump.
Is there any test that can be done to help ?
An MRI is the best investigative tool we have to determine if the implant is intact. The only other way is to surgically explore the breast and remove the implant, (and extruded silicone if a rupture has occurred).
Will the silicone travel elsewhere in the body?
The silicone does not travel. It stays in the breast area. If the implant has ruptured and is left untreated, more of the silicone will extrude out of the implant with any ongoing force.
If the rupture is intra capsular, it may convert into an extra capsular leak with time and ongoing force.
If the leak is extra capsular, the silicone will extrude into the breast tissue and may extrude into the axilla (arm pit) or in rare cases through the skin. It does not go into your blood stream or travel to distant locations in your body.
Can silicone affect my health?
Extensive studies worldwide have been done on silicone and its potential impact on human health.
Please refer to the Mayo clinic and John Hopkins studies for more information.
The findings and conclusions to all of these investigations were that silicone is immunologically inert (does not produce an immune response) and does not affect human health.
What a broken and leaking implant can do is allow the silicone to infiltrate into the breast and surrounding tissues creating lumps (silicone granulomas). This makes breast examination and breast surveillance for breast cancer difficult.
The silicone itself does not cause breast cancer, but makes detection more difficult because of the formation of these lumps (granuloma).
Is there a difference between having a silicone implant removal vs. having a saline implant removal?
There is no difference on the appearance of the breast.
If there is an extra capsular leak of silicone, where silicone has infiltrated into the breast, then removal of this silicone that has infiltrated into the breast may affect breast contour and shape.
The shell of the saline implant is silicone, but there is no silicone inside the saline implant. It is filled with salt water (saline), therefore, the risk of a change in breast contour and shape does not occur in saline implant removal.
What do I do if my breasts are asymmetrical following implant removal?
If your breasts are asymmetrical after implant removal they were asymmetrical before the original silicone implant surgery, and a larger silicone implant was placed in the smaller breast to correct the asymmetry. After implant removal, the original asymmetry will be evident.
Breast Lift/ Reduction restorative surgery can be used to correct this asymmetry.
I don’t want to remove my implants but my breasts are too large. What can I do?
If the patient wishes a somewhat smaller breast size, a smaller implant would be required. The silicone implant exchange could be done under local anaesthetic.
This smaller implant size will reduce the breast size.
If the patient wishes a dramatic decrease in breast size but still wants more volume than her original breast size, then a much smaller implant would be required. This may require reducing the size of the breast pocket size. This would require a General Anaesthetic.
BREAST SALINE IMPLANTS : Removal and options following:
I HAVE SALINE IMPLANTS THAT WERE PUT IN YEARS AGO. WHAT SHOULD I DO?
A Saline implant:
This saline implant comes out of the sterile packaging filled with air. At the time of surgery, the air is removed and replaced with saline after it is inserted into the surgical pocket created surgically behind the breast.
The implant is then filled with saline through sterile tubing connected to a saline filled intravenous bottle. The saline goes directly into the saline implant and never touches the outside world. Therefore the saline inside the saline implant remains sterile.
There is no risk of bacteria or mold (as some internet blogs have claimed) growing within the saline implant that is within the breast pocket created at surgery.
This implant tends to ripple more than silicone implants so it is overfilled to smooth the ripple. It therefore feels firmer.
The saline implant has the rare potential to leak. If that happened, the sterile saline would be absorbed by the local tissues like a glass of water with no harm to your health.
Over 24 hours, the majority of the saline would leak out of the implant and the implant would deflate leaving the breast its original pre implant size and therefore considerably smaller than the breast with the intact saline implant.
If this were to happen, the broken saline implant would require replacing.
If this ever happens, contact the surgeon immediately for an assessment.
There is no schedule of replacement for saline implants. They can last for many decades. Regular breast surveillance is recommended.
The reasons for removing or changing the saline implants would be primarily because the patient wishes a change in the size of the breast, or no longer wishes to have a breast implant.
If the patient wishes the implants to be removed, this can be done under local anaesthesia. Once the implant is removed, the capsule that surrounded the implant will slowly disappear spontaneously. The capsule around the implant is your body’s response to a foreign body. Once the implant is removed, the scar (capsule) slowly resolves and disappears over time.
After healing, the breasts will take on their natural shape and size. The effects of gravity, aging, weight gain or loss, pregnancy and breast feeding will all have an impact on how the breast will look after the implants are removed.
Can I have a breast lift if my breasts are droopy (ptosis) after the implant removal?
After the removal of the saline implant, if the patient wishes to have the breast shape improved or a further reduction in the breast size, a breast lift and or breast reduction could be done.
*Please see FAQ Breast Lift, FAQ Breast Reduction, and FAQ Breast Augmentation.
This would require a General Anaesthetic. This restorative surgery is not covered by AHS.
If I decide that I need Breast reshaping following the implant removal, how long must I wait to see Dr. Giuffre again?
At the time of Implant removal, a breast reshaping procedure (Breast lift) can be done at the same time as the implant removal.
Alternatively, the patient may wish to defer the breast shaping procedure until the breast shape and size had restabilized. At 6 weeks following the implant removal the breast shape has stabilized.
The reshaping procedure (breast lift) could then be done anytime.
What do I do if my breasts are asymmetrical following implant removal?
If your breasts are asymmetrical after implant removal, they were asymmetrical before the original saline implant surgery, and a larger saline implant was placed in the smaller breast to correct the asymmetry. After implant removal, the original asymmetry will be evident.
Breast Lift/ Reduction restorative surgery can be used to correct this asymmetry
I don’t want to remove my implants but my breasts are too large. What can I do?
If the patient wishes a somewhat smaller breast size, some of the saline fluid within the implant can be removed from the original saline implant using a fill valve.
This will decrease the implant size and therefore reduce the breast size. This is done under local anaesthetic
If the patient wishes a dramatic decrease in breast size, but still wants more volume than her original breast size, then a new smaller saline implant would be required. This may require reducing the size of the breast pocket size. This would require a General Anaesthetic.
Will I have scars?
If the implants are being removed with no additional restorative surgery, the scar to remove the implant is the same scar as what was used to insert the implant at the original surgery.
If the patient chooses to have restorative surgery (Breast lift, or Augmentation) at the same time as implant removal, or after the breast size and shape has stabilized (after 6 weeks), there will be additional scars.
Patients often want to have their Saline implants checked. Is that OK?
Patients that have had saline breast implants in for a long time, and would like the breast and implants assessed, may call for an appointment with Dr. Giuffre by contacting his office.