Just as our faces lose volume, the same holds for breasts. As we age, they naturally flatten and fall, not to mention the impact pregnancy has on the size and shape, which begs the question. Have we finally reached an era of acceptance where the perfect cup size is what nature provides? Editor Trudi Brewer shares a growing trend, explant surgery and the plastic surgeon renowned for it.
Plastic surgeon Dr Tristan de Chalain.
“There are valid concerns over ‘breast implant illness’ that shows in a cluster of symptoms, such as tiredness, lethargy, vague pains and a general feeling of malaise, associated with silicone breast implants.”
Heres what you need to know about explant surgery?
Breast shape and size has long been hotly debated, and with each decade, it's been at the centre of fashion. Today in 2021, it's clear that bigger is no longer better. "In the '80s and '90s, breast implants were a big trend. Exploited by the movie and magazine industries, the trend exploded. A flat chest was out, and big, in some cases voluminous breasts were in," says top plastic surgeon Dr Tristan de Chalain. Thanks to social media, there has been a wave of openness on body image and self-love, including explant surgery. Several high-profile stars have shared how they're 'over the implants' and want 'natural boobs'. Their need to remove them varies. From ruptures to breast implant illness, sharing debilitating aches and pains, brain fog and anxiety. Some decide it's time, including culinary entrepreneur Ayesha Curry to Yolanda Hadid, former model and mother to Bella and Gigi Hadid. Perhaps some of the most outspoken include fashion designer, and beauty brand founder Victoria Beckham, who was quoted in Vogue saying, "Don't mess with your boobs, just celebrate what you've got." Model, Chrissy Tegan included. She had implants at the age of 20, now at 34, she wrote candidly on Instagram, "They've been great to me for many years, but I'm just over it." Even 76-year-old actress Jane Fonda who had breast implants at 51, justified her surgery by saying, "it made me feel more like a woman." She, too, joined the list of celebrities to remove her implants. According to data compiled by US plastic surgeons and published in The Aesthetic Society, the number of breast implant surgeries fell by 14 per cent in 2019, while explant surgery rose by 34.4 per cent. That's certainty food for thought.
Nikki’s breast implant story
Having breast implants after her first baby, Nikki wanted to improve the look and shape of her breasts. "Once I lost my pregnancy weight, I noticed I had also lost a lot of breast tissue, and my breasts looked deflated."Fifteen years on, a scan had pointed to a possible rupture in her left breast. Also, after an accident playing soccer, it resulted in my right breast capsulating (where scar tissue forms a tight, constricting capsule around the implant)." Thus, enduring a four-hour surgery to fix the problem; today, Nikki still has silicone in her lymph nodes under one arm. "I have had my implants replaced with the latest Motiva breast implants, and I'm thrilled with them. However, I wish that I had taken better care of the first pair." As far as advice goes for anyone who is considering implants? "Your body, your choice. I love having breast implants, but you need to be aware, they may need removing after ten years, and you must get regular mammograms, ultrasounds, be careful when exercising or playing sports." Nikki says, "Women need to make decisions about what's best for them and what will make them happy, aside from social pressure or judgment." As far as plastic surgeons go, Nikki says, choose wisely. "My surgery more than met my expectations. They feel soft, move like natural breasts and look natural. On my last check-up, my surgical nurse told me that some of their patients don't share they have breast implants, especially if the scars are well hidden like mine."
Explant surgery in New Zealand
While increasing numbers of women worldwide opt for explant surgery, it is also happening here, in New Zealand, says Dr Tristan de Chalain. "While macro-textured implants, popular in Australia and New Zealand, are less likely to shift out of place than smooth (silicone) implants, there are still downsides. Not only can coarse texturing on an implant rub against a breast capsule, causing chronic inflammation, but the texturing means there are more nooks and crannies for the biofilm (different bacteria colonies) to cling to. Whatever the initiating cause, this low-grade inflammation may be implicated in capsular contracture (scar tissue around any breast implant), the development of BIA- ALCL, and even breast implant illness; there is a risk." According to De Chalain, "Many, women, will never need to have their implants replaced. Nowadays, we recommend a careful follow-up and suggest replacement between 10-15 years. Some women just decide to have their breast implants removed. The reasons for doing so vary; having a breast cancer diagnosis, lifestyle changes or complications or breast implant illness."
Why would you need explant surgery?
“There is a checklist. From implant rupture, folding or deflation (if the breast implant is saline) or personal choice. Some women may feel their breast implants are of the wrong shape or size. Or not ethical or natural. Or, over time, they may have moved position because of weight loss, weight gain or pregnancies. Other complications include capsular contracture (as mentioned above), tension bands, asymmetry, displacement, infection and leakage of silicone.”
How complex is explant surgery?
“It's a more complex operation than breast augmentation or implant surgery. Done under general anaesthesia, it usually takes between one to three hours. Typically, implant removal with capsulectomy (abnormally thick, hardened tissue forms around the breast implants) can take three hours, twice as long as implant surgery. After implant removal, all patients need a breast lift. Depending on the native breast tissue present, the size of the implants, and the patient's desire, this can all be done in the same operation. Secondary procedures such as fat transfer from the hips or abdomen can be done immediately or later to help augment the breast. Removing the capsule can be technically challenging and demands a larger incision and a longer scar than the incision used to place the original implant and can produce more bleeding, tissue trauma and secondary inflammation. Consequently, although most women heal without problems, there is an increased risk of a post-operative bleed or a seroma (fluid collection underneath the skin).”
Before and after explant surgery. Breasts re lifted, and the final result, one year on.
What are the risks?
“Infection, bleeding, scarring, soft tissue loss, sensory changes, and asymmetry risks: i.e. a flattened, 'fried- egg' look to the breast. Also, the breast implant capsule (the layer of scar tissue that forms around the implant) is almost always removed; and that comes with a greater risk of bleeding, soft tissue loss, sensory changes with this procedure. Once the breast implants are removed, of course, the breasts initially look deflated. It can take at least two to three weeks or even months for the breasts to regain their volume. Breasts never look the same as before the original breast implant surgery, as the weight of the breast implants stretches the tissue and causes changes in the rib area. Initially, there is likely to be some wrinkling and sagging, which may not disappear completely. The scars will heal and fade over time but will never entirely disappear.”
What’s breast implant illness?
“There are valid concerns over 'breast implant illness' that shows in a cluster of symptoms, such as tiredness, lethargy, vague pains and a general feeling of malaise (a general sense of discomfort, illness, or unease which is difficult to identify), associated with silicone breast implants. This subject has received much attention on social media and mainstream media, yet there is no specific test to prove the condition's existence. When an implant is surgically inserted into the body, contaminant bacteria can induce a biofilm; this can result in a low-grade, undetectable infection that grumbles away until the immune system starts to fight back, creating inflammation. There are also valid concerns over a rare but real issue, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) cancer, which affects one in 10-30000. A type of T-cell lymphoma (cancer of the immune system) develops in the scar tissue capsule and fluid surrounding a breast implant. This chronic inflammation is often the reason for causing thickening and contracture of the natural capsule around the implant and, in rare instances, triggering white blood cells, lymphocytes in that capsule that become cancerous. The contracted thickened capsule around an implant can also cause folds and stress fractures of the implant shell leading to leaking and rupture. Finally, while some surgeons say breast implant illness is unproven. The trend towards implant removal is undeniable. As are my colleagues, I am taking out as many, if not more, implants as we are putting them in.”
What about the cost?
“Performed under general anaesthesia, the costs are between $5000 to $6000 an hour, and this surgery usually takes between one to three hours. The price is time-related, it takes 45-60 minutes per side to put implants in, but one to two hours, per side, to explant them and do a capsulectomy and mastopexy.”
What advice do you give women who want breast surgery?
“Choose your surgeon wisely. Understand the risks and weigh up those risks and benefits of both breast implant and explant procedures. Finally, if you are considering breast implants, have the surgery for yourself and not anyone else.”
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