Total capsulectomy with explantation likely increases the risk of these deformities, as more soft tissue is inevitably removed with the implant. Breast implant explantation alone places the patient at significant risk for resultant breast skin excess with rippling and nipple inversion, as the pocket collapses down to the chest wall. Breast implant removal, or explant, often leaves the breast with a deflated area of central hollowing, significant subsequent breast and skin laxity, loss of projection, loss of conical shape, and proportional excess in the lateral breast. Over the past several years, more patients specifically requested this procedure for a number of reasons, including having calcified Baker Grade IV capsular contractures, silicone implant ruptures, recently recalled textured breast prosthesis, and concerns for BIA-ALCL and BII. 15 Anecdotally, the senior author has seen an ever-increasing number of such patients requesting implant removal specifically total intact capsulectomy, or what social media groups often refer to as an “en bloc” capsulectomy. ![]() 14 The growth of social media has become a well-known and documented initial source of education for patients seeking eventual surgical consultations. Surgeons reported 33,764 breast implant removals among breast augmentation patients in this survey. 12, 13Īccording to the American Society of Plastic Surgeons 2019 Plastic Surgery Statistics Report, breast implant removal among breast augmentation patients is up 15% from 2018. 10, 11 Increased patient communication and advocacy through social media groups has led to an increasing number of patients presenting to plastic surgeons with implant-related systemic illness, now labeled as “breast implant illness” (BII). 9 Silicone gel breast prosthesis rupture rates have been reported between 8.7% and 24.2% at 10 years. One recent survey demonstrated that 66.7% of patients with breast implants reported concerns regarding BIA-ALCL and 35% strongly considered removing their implants due to this. ![]() 7 Since the discovery of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) in 1997, 8 there has been more significant media exposure and a greater public awareness. 6 An estimated 20% of patients develop problems or complications related to the procedure, including capsular contracture, rippling and wrinkling, implant displacement, asymmetry, late hematomas, and neoplasm. 3-5 breast implants are associated with a significant rate of local complications requiring reoperation. 2 Although breast augmentation has high percentages of patient satisfaction. 1 More than 1,800,000 breast augmentations were reported worldwide in 2018 by the International Society of Aesthetic Plastic Surgery. ![]() Implant-based breast augmentation was the second most popular cosmetic procedure performed by members of the American Society of Aesthetic Plastic Surgery in 2021, according to the National Plastic Surgery Statistics.
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