Implant Removal Candidate
Patients who are candidates for removing or explantation of implants without a breast lift should be evaluated preoperatively. These patients should be placed in the standing position, arms should be down straight to the thigh. Evaluation of tissue integrity can often be determined prior to explantation, looking at the position of the nipple areolar complex in relation to the inframammary fold is vital. If the nipple is 1 to 2 cm below the fold, there is a significant chance that a breast lift would be required. Patients who have nipple position above the fold would probably do well not having a breast lift at this time, allowing for compression over the next six months and evaluating final positioning of the nipple areolar complex. Patients who do well with explantation without a lift usually have had smaller saline or silicone implants and have not had increased skin laxity over time. Patients with thicker tissue, increased glandular tissue and tighter skin and normally patients who have not breast fed or dropped through pregnancy process will also do better with explantation without requiring a full breast lift. It should be noted that patients who are on the border of having a lift may desire not to do the lift and see how the tightening occurs using a Dr. Linder Bra with significant compression over the next six to 12 months and then reevaluating. Not crossing the bridge of doing a full breast lift with an anchor scar may prevent the patient from having unnecessary scarring.
Implant Removal Surgery
The operation of an explantation without a lift is performed with an inframammary incision made, implant is explanted and removed either by puncturing the implant or removing it intact, the pocket may be irrigated with antibiotic irrigant solution, capsule can be removed if necessary and if there is no significant scar tissue the capsule an be maintained and not taken out. At this time a 7 mm JP drain is placed through this inframammary incision with the incision closed around it, is placed to bulb suction. Dressings include Xeroform, Bias wrap.
Implant Removal Recovery
On postop day 1 the dressings are removed and a Dr. Linder Compressive Bra is placed. The drain is normally removed after 7 to 10 days after there is less than 24 cc of serous sanguinous fluid. The patients are maintained on antibiotics, either Keflex 700 mg four times a day if they have no allergy to penicillin or Ciprofloxacin 500 mg twice a day for 10 days if they are penicillin allergen. Patients are maintained in the compressive bra for the next six months in order to allow tightening.