Practice Trends Update: More Women Pursue Breast Implant Removal

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January 29, 2019
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Breast implants are a costly, elective surgery, and many women experience a boost in confidence after undergoing this plastic surgery – but for others, the outcome isn’t so happy. In fact, some women are so dissatisfied with, or even physically sickened by their implants that they’re asking to have them removed. Sometimes referred to as an “explant,” breast implant removal rates increased by 10% between 2010 and 2014, and the numbers continue to climb. But what’s behind this reversal?

When asked to perform an explant or reduction after breast augmentation, doctors need to fully assess a woman’s physical condition and ascertain the underlying cause of the request. While some women simply want to remove their implants because of discomfort or because they underwent the initial enhancement for the wrong reasons, some seek the procedure due to serious autoimmune reactions that require treatment and further follow-up.

Downsizing Breast Implants

One of the most common reasons that women seek to have their breast implants removed or reduced is because the implants are too large and are uncomfortable. In these cases, the most common age of removal is between 35 and 50, at which point many women’s implants are also wearing out, resulting in hardening or even implant rupture. Women in this age range also describe difficulty shopping for supportive bras, oversized breasts caused by weight gain around the implants, and the desire for a more natural appearance. Large, enhanced breasts may have been appealing in their 20s, but older women are more concerned with comfort and more confident in their bodies.

In addition to comfort, some older women request breast implant removals or reductions because they underwent the initial surgery to please a former partner. Under pressure from a partner, young women size up, only to separate and realize that the enhancement wasn’t their idea – and they’re not happy with it. These cases suggest insufficient screening before surgery and plastic surgeons should be cautious in interactions with young women that include a partner; speaking to the woman independently and instituting a small waiting period for consideration can help women avoid an unwanted surgery, and the need for a future breast implant reversal surgery.

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Implants And Health Concerns

Of course, not all breast implant removals are motivated by simple regret or discomfort. In a growing number of cases, women are seeking implant removals because they are concerned that the implants may lead to an autoimmune disease or even cancer, and research backs up their claims. Recent studies show that women with silicone implants are more likely to have an autoimmune disorder, including such conditions are rheumatoid arthritis, Sjogren’s syndrome, scleroderma.

Silicone implants have been a source of conflict in the medical community for years now, with the FDA briefly banning the implant material in 1992, while they conducted research on the risk of cancer, connective tissue disorders, and autoimmune disease. Since then, new versions of the implants have been approved, but concerns remain.

It’s not surprising that women are concerned about how breast implants may influence their risk of autoimmune disease. Women are already at a higher risk of these conditions, and modern lifestyle habits have increased population-wide risk of immune disorders. Everything from increased stress to unhealthy food and a sedentary lifestyle are correlated with immune problems, and introducing a foreign body in the form of a medical device may make things worse; the immune system may attack the implant and the surrounding healthy tissue, triggering a cascade of health problems.

Identifying Implant-Linked Health Problems

In addition to being at a greater risk for autoimmune disease, women are also more likely to be misdiagnosed or have complaints dismissed as being psychosomatic, despite serious physical problems. The same problem also applies to illnesses linked to breast implants, and there’s a growing community of women reporting what they term “breast implant illness,” which includes a variety of autoimmune symptoms. According to plastic surgeon Dr. Pankaj Tiwari, these patients are also more likely to experience non-specific symptoms, such as muscle aches, memory problems, and joint pain, in addition to full-fledged autoimmune disorders triggered by their breast implants. Most concerning of all, though, is that doctors rarely take these women seriously, and women have formed support groups to discuss and advocate for breast implant illness awareness.

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As health care providers, it’s imperative that we follow-up on these complaints with thorough testing, despite the lack of a singular breast implant-associated illness, and while such follow-up may be time-consuming, it can also be life-saving. It may even detect cancer.

In 2011, the FDA found a small, but serious increase in the risk of a rare cancer, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of T-cell lymphoma that may develop after breast implant insertion. The condition is easily curable if detected early, but doctors must take women’s complaints about post-implantation health issues seriously to make the diagnosis.

Finally, it’s important to note that breast implants were never meant to last a lifetime and that their long-term use has always been associated with risks. In fact, though the FDA denies a connection between breast implants and health issues, they also concede that women are more likely to experience complications as implants age. The age of the implants is a serious concern, particularly in the case of silicone implants, which are more dangerous when they break down than their saline counterparts. With that in mind, patients and doctors should consider whether implant removal, either via implant removal en bloc or implant capsulectomy. This should be done before rupture causes serious health problems, and removal may also relieve many symptoms.

Medical wisdom and understanding changes regularly, and healthcare professionals need to take that into account when addressing requests for breast implant removal surgery. While all women should feel empowered to control their appearance, they shouldn’t have to advocate for comprehensive medical care when presenting with a complaint.