An Algorithm for the Management of Explantation Surgery

Abstract

In long-term management of breast aesthetics after breast augmentation, patients will require revisional breast surgeries to maintain their desired aesthetics. This may be due to issues related to the breast implant, such as a rupture or capsular contracture, or it could be related to the changes in the breast, such as enlargement from weight gain or advancing ptosis. More recently growing concerns about implant-related systemic illness (BII or breast implant illness), BIA-ALCL and changing perceptions of aesthetic beauty have seen breast implant removal without replacement become increasingly requested by patients. Creating pleasing breast aesthetics after an explantation can be challenging, especially when performed with a total capsulectomy. The necessity of a capsulectomy for a variety of breast issues is not completely agreed upon, no matter the indication. For certain, the addition of a total capsulectomy increases the morbidity and cost of the operation and often impairs the final aesthetic result. The common indications for explantation with or without explantation will be reviewed in this chapter. An algorithm for the management of explantation patients provides a framework for treatment of the capsule and the breast to optimize outcomes. The final aesthetic results can be quite variable based on the need for capsulectomy and the quality of the breast itself after explantation. Patients should have appropriate pre-operative counseling regarding the indications and contraindications for explantation and capsulectomy, the associated risks, financial implications, and the post-operative appearance. The purpose of this manuscript is to review salient aspects related to the planning and management of breast implant removal patients and their correction through mastopexies, auto-augmentations and fat grafting.