Many of our patients ask about removing their breast implants but it is very important to have a discussion about what we will do after your implants are removed. Let’s go thru some of the options.
1. Do nothing. This is the simplest option. Some patients are perfectly happy with this option. You will be flat or indented and may have some loose skin or sagging. If there is a large amount of skin, you may want to have some of the skin removed. Some patients choose this option but decide to replace their implants later if they are unhappy with their appearance.
2. Breast lift (mastopexy). The breast tissue that is left can be rearranged to improve the shape of the breast and remove excess skin. This is a good option if you don’t mind smaller breasts and have adequate tissue to rearrange. There will be additional scars with a lift.
3. Replace implants. While most patients that want their implants out do not want them back in, you still have the option of replacing them with a newer device. For example, a textured implant can be replace with a smooth implant.
4. Autologous reconstruction. Tissue can be taken from another part of your body (e.g. abdomen, back or buttock) to replace the volume lost after implant removal. This is usually done in breast reconstruction and there can be problems with the area the tissue is taken from.
5. Autologous fat. Fat can be taken from other parts of the body and placed into the breast. This can be a good option in patients who need a small volume replacement, have contour deformities or don’t want implants replaced.
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We see many patients in the office who are interested in having their beast implants removed or replaced, especially with the recent media attention on breast implants. They often have been told by their primary care doctors, other plastic surgeons, breast surgeons or their insurance carrier that insurance will pay for all or a portion of the cost of removal and/or replacement.
The first question we ask is if the implants were placed for a cosmetic or reconstructive (e.g. after breast cancer) indication. If placed for cosmetic indications, the answer is “maybe”. If the implants were placed for reconstruction, insurance will usually cover the procedure but the patient would be responsible for their deductible, coinsurance, etc.
If implants are placed for cosmetic reasons, the insurance carrier will usually only consider paying for removal and/or capsulectomy and only for ruptured implants or for painful capsular contracture. This would not include implant replacement or addressing the loose skin or sagging breast tissue that is frequently associated with removing an implant and not replacing it.
The problem with having your insurance carrier cover implant removal is that they will frequently deny payment after the surgery is performed and the patient might be responsible for the surgeon’s fee, anesthesia fee, and O.R. fee which far exceeds the fee that would have been charged if the procedure would have been done as a cosmetic procedure.
Also, as a way to avoid this confusion, we usually don’t charge for removal of implants if a capsulectomy or mastopexy (breast lift) is being done at the same time, as a cosmetic procedure. Our office is happy to answer any questions you might have.
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There has been a lot of recent media coverage about breast implants and BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). Many of our patients have come in or called asking about their implants and risk of BIA-ALCL. They ask if their implants need to be removed. The short answer is “probably not”. BIA-ALCL is a very rare lymphoma that is primarily associated with textured implants and also depends on the type of texturing used. Certain brands of textured breast implants have a higher incidence of BIA-ALCL than others but even in this category, the incidence is rare. In patients who are not having any problems that have textured implants, we would not recommend removal or replacement unless there was some other reason to change or remove the implants. It is important to follow up with your plastic surgeon if you have implants especially if you notice any changes in your implants. Implants do not last forever and need to be replaced periodically. That is why periodic follow up (we like to see our patients every year) is so important. It also gives us an opportunity to educate our patients on any new information regarding their implants.
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