Breast Implant Removal in Beverly Hills

If you never really liked your implants or don't want the extra volume, Dr. Killeen thinks removal is the right choice. Just keep in mind that removal will make you smaller.

Many women simply don't want a foreign body, or want to be done with implant upkeep: imaging, future exchanges and the possibility of implant problems down the road.

Once a full workup with your primary care doctor has ruled out other causes, removing your implants is a reasonable choice (see breast implant illness).

A silicone rupture should be dealt with within a couple of months, by replacing or removing the implant, and the capsule comes out too (see ruptured silicone implants).

For a Baker III or IV contracture, Dr. Killeen removes the entire capsule when the implants come out. If you would rather keep implants, see capsular contracture treatment.

Textured implants are linked to a rare lymphoma called BIA-ALCL, and many women with them want them out (see textured implants).

There is no set expiration date, and ten years is not long for current implants. For implants placed many years ago, replacing or removing them before they rupture is reasonable to consider even if they look fine (when to consider replacing implants).

Many silicone ruptures cause no symptoms, and the breast usually keeps its shape, so a rupture is often found only on imaging. Silicone implants should be checked with ultrasound or MRI starting about five years after surgery and every other year after that, since a mammogram checks the breast tissue, not the implant. Silicone implants a couple of years old or older should be imaged before any breast surgery (imaging before breast surgery), and Dr. Killeen can perform the ultrasound in her office.

A ruptured silicone implant is not an emergency, but it should be replaced or removed within a couple of months. Over time, silicone can escape the capsule, which is harder to treat, and it can cause a contracture, firm and often painful lumps called silicone granulomas, or silicone in the lymph nodes (what happens if a rupture is left in place).

With a ruptured silicone implant, Dr. Killeen recommends removing the capsule even if it looks normal, because silicone collects in the capsule tissue. With older implants, the implant and capsule are often removed together in one piece to keep the gel contained. If silicone has escaped and formed firm lumps (granulomas), she tries to remove them too, although not every bit of escaped silicone can be removed. Normal gel bleed from an intact implant is not a reason to remove the capsule.

Silicone that reaches the lymph nodes usually causes no trouble. Sometimes the nodes become painful, and the silicone can even block lymph drainage from the arm.

A ruptured saline implant deflates, and the salt water is absorbed by the body without spreading into tissue or lymph nodes. Insurance usually does not cover a saline rupture in cosmetic patients.

There is no evidence-proven right answer. The FDA does not recommend routine removal of implants in women without symptoms, and removing the implant and capsule has not been shown to lower or eliminate the risk of BIA-ALCL. Removing or replacing textured implants is still a reasonable choice in Dr. Killeen's view if you want them out, although insurance usually does not cover removal for that reason alone.

For textured implants that have not ruptured, whether the capsule also comes out is a conversation to have with your surgeon, since removing it has not been shown to lower the risk.

See your doctor if a breast suddenly gets larger from fluid without an injury, or for a new lump or swelling or pain that does not go away. When fluid has collected, the recommendation is to drain it and send it for lab testing.

If BIA-ALCL or BIA-SCC is diagnosed, the operation is an en bloc capsulectomy. In that case, insurance generally covers removing the implant and capsule, even for cosmetic implants, unless your plan excludes all complications of cosmetic implants.

The first thing Dr. Killeen checks is where the nipple sits: about level with the middle of the upper arm, and roughly 18 to 20 cm from the notch at the base of the neck. The smaller the implant, the better the chance the tissue tightens on its own. Skin quality matters too, since years of heavy tanning or smoking often leave looser skin. If the nipple sits low along with the implant, or you were a little droopy before your augmentation, a lift is probably needed. An implant sitting high can make the nipple look lower than it is, and after removal some of these women need only fat grafting to the upper breast (see breast lift).

In Dr. Killeen's view, it is never wrong to remove the implants and see how the tissue settles, and many of her patients who wait never come back for a second surgery. With enough breast tissue and no capsulectomy, results are typically similar whether a lift is done at the same time or later. When the capsules come out or the tissue is thin, staging is often better, because a lift at the time of removal puts more strain on the blood supply.

Fat grafting can smooth the contour and add a little volume, including contour irregularities that remain after a lift. Removing the capsule or doing a lift at the same operation limits how much fat can be grafted, so with thin tissue or little fat to spare, waiting can get more out of a round of grafting (fat grafting with a lift or explant).

When an implant has dropped below the crease but the breast itself sits where it should, removal alone often works well, because the stretched skin below the breast usually tightens. Dr. Killeen may also use the extra lower tissue to add shape, an auto-augmentation, rather than cut it away (the crease and auto-augmentation).

With a small implant and a fair amount of your own breast tissue, removal, with a muscle repair if needed, may be all you need. Doing nothing more is a reasonable choice, and a lift or fat grafting can always be done later.

• Imaging: Any recent ultrasound or MRI of your implants (silicone implants a couple of years old or older are imaged before surgery)
• Records: Implant cards and operative notes, if you have them
• Your workup: If symptoms are the reason, the results of your primary care checkup
• Your goal: The size and shape you want, and whether you would consider a lift or fat grafting

• Which type of removal do you recommend for me, and will the capsule come out? Why?
• Do my implants need an ultrasound or MRI before surgery?
• If my implants are under the muscle, will the muscle be repaired?
• How likely is my skin to tighten without a lift, and what are my options if it doesn't?
• If fat grafting is planned, how much fat do I have, and how much can realistically be grafted?
• Do your before-and-after photos show a range of operations, from removal alone to a lift?
• Are you board-certified in plastic surgery, with privileges at a local hospital? (There is no separate explant certification.)
• If tests, supplements or detox programs are recommended, what evidence supports them?
• Does my diagnosis qualify for insurance, and will your office ask for approval before surgery?

The cost depends on what the operation includes, such as capsule removal, muscle repair, a lift or fat grafting, along with anesthesia and facility fees. A capsulectomy you do not need adds cost and risk, and a lift or fat grafting can be done later if you prefer. Dr. Killeen provides a personalized quote at your consultation.

Implants placed for reconstruction are much more likely to be covered. For cosmetic implants, first check whether your plan excludes all complications of cosmetic implants, because some do. Otherwise, a ruptured silicone implant confirmed on imaging, a severe contracture or a documented capsule cancer may qualify. Coverage usually pays for removing the implant and capsule, and sometimes the muscle repair, but generally not a lift, fat grafting or a new implant. Symptoms alone, a ruptured saline implant or simply having textured implants are usually not covered.

A phone answer that a procedure is covered is usually a general one, not a decision that you meet the plan's criteria, and without a qualifying diagnosis the cosmetic billing code is the correct one. It is easier to get approval before surgery than after, and letters from your other doctors can help. Dr. Killeen's billing team submits pre-authorizations, and covered still means your deductible and coinsurance apply.