Breast Implant Removal

This plastic surgery video is on a breast implant removal. This woman had breast implants placed several years ago, done by another surgeon, and she is dissatisfied with the size and would like to have them removed. So I'm going to use an inframammary incision, or an incision placed along the crease of her breasts, to remove the implants.

What you're seen as a little bit of numbing medicine being placed into the tissues that will keep the patient more comfortable, as well as control the bleeding. This patient is asleep, so she is completely comfortable during the surgery. The numbing medicine helps control the postoperative discomfort.

This surgery is a relatively quick surgery, when the tissues are relatively receptive, and I don't need to remove the scar tissue pocket. This particular patient's scar tissue pocket is very thin, and so it does not have to be removed. Over time, the pocket will tend to be reabsorbed, so that's really good for her. Her recovery will be relatively quick.

The pencil instrument you see me use actually controls the bleeding, and you'll see here I put a little bit more numbing medicine in, to keep her comfortable during the recovery period.

Again, the electrocautery, or pencil device, is very effective and can also be used to cut the tissues, in addition to cauterizing them or controlling the bleeding. So at this point, I have cut through the scar tissue envelope, and you just got a little glimpse of the implant. Now the retractor is in there, and I'm going to go ahead and get the implant out.

It's a very small hole, so I can't even get my finger in there to take the implant out. So I had to use that instrument. Here comes the implant. This is actually a silicone gel implant, and you can see it's intact. So after I've taken the implant out, I will control the bleeding, make sure everything's okay, and then I'm going to go ahead and work on the other side and take the implant out on that side.

Just to be sure, I like to make sure that they're going to be comfortable, I use a lot of a local anesthetic to make their postoperative experience better. So just like on the other side, I use a small incision, three centimeters, and this incision's right in the crease so it's not really gonna leave a visible scar, longterm.

I will cut through the tissues. Then I will control the bleeding with the electrocautery device. I'll divide her tissues down to the scar tissue pocket, or what we call the breast implant capsule, and then I will use the electrocautery to cut through the capsule, and then I'll remove the implant.

If the scar tissue pocket was very restricted or very thickened, I might have to take some of the capsule out or all the capsule out. It really just depends. I couldn't do that to this small of an incision, but fortunately for her, I did not think she would need it, and I was correct. She did not. So she will not have this incision made any larger, and I'm just going to go ahead and take out the implant. So very similar to the last side, I'm just going to kind of gently grab the implant in and pull it out.

Now her postoperative course is going to be very, very good for her. She's basically going to wake up. The incisions will be numb for about 12 hours, and then she'll be a little bit uncomfortable from the incision, but other than that she won't have any pain.

She'll be able to go back to the gym and start exercising again, wear sports bras. She can swim in a couple of days, and she should have a very nice postoperative course.

Now at this point, what I'm going to do is close the layers. The first layer I'm going to close is the capsule, and I'm going to bring one edge of the capsule to the other, and you can kind of get a sense of that thin layer, which is what I just kind of picked up. Then I'm going to pick it up again, and I'm going to put a suture in it twice, and I'm going to go ahead and close that pocket off. Then I'll close the next layer of tissue together, followed by the deep side of the skin and in the superficial edges of the skin.

All of these stitches will dissolve over time, so she won't have to have any stitches removed from the inside or leave any permanent stitches inside. There will be one external stitch, which will not leave any stitch marks, because of the technique I use when I close the wounds.

Sometimes when I do implant removals, the breast tissue will require a lift. Otherwise it's going to sag too much. Now this particular patient, because of vary the amount of existing tissue and her nipple position, it really doesn't need anything else done. So fortunately for her, she's just has this small incision, with a very quick recovery, and some of the problems that she had with the implants are essentially taking care of.

As a plastic surgeon, I like the wounds to be closed in many layers, without any tension. This is done to give her the finest scar possible. Ideally, the scar will just blend right into one of the breast crease lines, and you won't even be able to see it.

So again, I'm going to sew the wound in several layers. Then I will put one final layer in the skin edge, and this will be a running stitch, unlike the last stitches, which were all, what we call interrupted. This will just run along the edge, and it will be a pullout stitch. She will have no visible dots on the sides of her incision.

These stitches will come out in four days, and so she'll have a very nice recovery, and she'll be free of the implant concerns, and you can kind of get a sense of her before and after pictures.