What does capsular contracture feel like?

Most people notice the breast becoming firmer than it was, sometimes with a change in shape, position or symmetry. At higher grades it can be tender or painful. Because the change is often gradual, it is frequently picked up at a routine review rather than noticed suddenly.

Can capsular contracture happen years after surgery?

Yes. It can develop within the first year or many years later, and it can affect one breast and not the other. This is one of the reasons ongoing review after augmentation is recommended rather than assuming no news is good news.

Do all the capsular contracture grades need treatment?

No. Grade I is the normal state after augmentation. Grade II, where the breast feels firm but looks normal and is not painful, is usually monitored. Surgery is generally considered at Grades III and IV, where shape has changed or there is discomfort.

Can a hard breast implant be treated without surgery?

The evidence for the non-surgical approaches sometimes described elsewhere is limited, and whether any has a role in a particular case is a matter for consultation. Where firmness is mild and there is no distortion or pain, monitoring rather than intervention is often the appropriate course.

Can capsular contracture come back after revision surgery?

Yes. Patients who have had it once are at higher risk of it recurring, and revision surgery does not eliminate that possibility. This is discussed as part of planning, including what the arrangements would be if further surgery were needed.

Breast Implant Removal Without Replacement: What to Expect

breast implant revision sydney

Some patients decide they no longer want implants and choose removal without putting new ones in. The question that follows is a practical one: what will the breast look and feel like afterwards. It is worth answering honestly, because the result depends on factors that differ from person to person and cannot be predicted precisely in advance. This article covers what explant surgery involves, what happens to the tissue afterwards, and how breast implant revision in Sydney approaches it.

What Explant Surgery Involves

Breast implant removal is the removal of the implant from the pocket in which it sits. In most cases breast implant removal in Sydney is performed through the original scar. The operation is usually shorter and less involved than the original augmentation when the implant alone is removed, though it becomes more substantial when the capsule is addressed or a lift is carried out at the same time.

Reasons patients seek breast implant removal vary. They include implant rupture, capsular contracture, changes in shape or position over time, discomfort, a wish to be smaller, changes in body shape after pregnancy or weight loss, and simply not wanting implants any longer. Some patients seek removal because of symptoms they attribute to their implants. This is an area of ongoing clinical discussion, and the appropriate response is an individual assessment rather than a general claim in either direction.

What Happens to the Breast Tissue and Skin

Skin retraction

The skin has been stretched by the implant, sometimes for many years. After removal it retracts to some degree, and how much it retracts is the single biggest factor in the outcome. Younger patients, those who had smaller implants, and those with good skin elasticity generally see more retraction. Older patients, those who had large implants for a long period, and those whose skin has been affected by pregnancy, weight change or sun damage tend to see less.

Volume and shape

The breast returns to the volume of the remaining natural tissue, which may be less than it was before the original surgery. Breast tissue can thin over time under an implant, and pregnancy, breastfeeding, weight change and age will all have had their own effect in the intervening years. The result is the current tissue, not the tissue as it was.

Position of the nipple

Where the skin envelope has been stretched significantly, the nipple may sit lower than the patient expects once the volume filling that envelope is gone. This is one of the main reasons a lift is discussed.

Time

The immediate appearance is not the final one. Swelling settles over weeks, and skin retraction continues over months. Surgeons ordinarily advise waiting several months before judging the result or deciding on any further surgery.

What Happens to the Capsule

The capsule is the layer of scar tissue the body formed around the implant. Where it is thin, soft and healthy, it is often left in place and reabsorbs over time. Where it is thickened, contracted, calcified, or where the implant has ruptured, it is generally removed. Removal of part of the capsule is a partial capsulectomy and removal of the whole capsule is a total capsulectomy.

Capsulectomy adds time, dissection and risk to the operation, so it is done where there is a clinical reason rather than routinely. Which approach applies is determined by what is found at examination, on any imaging, and at the time of surgery. The decision-making around removal, exchange and lift is set out in more detail in this article on choosing between implant exchange, explantation or a lift.

When a Lift Is Discussed at the Same Time

Breast implant removal and lift, performed together, is considered where the skin envelope is unlikely to retract enough on its own and where the nipple position would otherwise sit low. Combining the two means one operation and one recovery, but it also means longer scars and a longer, more complex procedure with a correspondingly higher risk of wound healing problems.

The alternative to breast implant removal and lift in one sitting is staging: removing the implants, allowing several months for retraction to occur, then reassessing whether a lift is wanted at all. Some patients are satisfied without one. Which approach is appropriate depends on skin quality, the size of the implants being removed, tissue thickness and the patient’s own priorities.

Recovery

Recovery from implant removal alone is generally quicker than from the original augmentation. Expect a supportive garment, restrictions on lifting and upper body exercise for a period, and a graduated return to normal activity over several weeks. Where a capsulectomy or a lift is performed at the same time, recovery is longer and drains are sometimes used. Ongoing considerations for patients who have had implants are covered in this article on long-term considerations after breast augmentation.

Risks and Considerations

Explant surgery carries the general risks of surgery and anaesthesia along with procedure-specific risks. These include bleeding or collection of blood, fluid collection, infection, altered or reduced nipple sensation, wound healing problems, contour irregularity or rippling of the skin, asymmetry between the two sides, permanent scarring, dissatisfaction with the resulting size or shape, and the possibility of further surgery. Where a lift is performed at the same time, the risks of that procedure apply as well.

Results vary between individuals and cannot be guaranteed. A referral is required before proceeding, and a cooling-off period applies between consultation and the decision to proceed. Suitability is determined through an individual consultation with a Registered Specialist Plastic Surgeon.

What to Discuss at Consultation

Useful questions include how much skin retraction is realistic in your case, whether the capsule is likely to be removed and why, whether a lift is recommended now or after a period of waiting, what the scars would be in each scenario, how long to wait before judging the result, and what the arrangements are if further surgery is wanted later.

Pure Aesthetics consults from two locations: Sydney City (Level 6, 149 Macquarie Street, Sydney NSW 2000) and Macquarie University (Suite 302, 2 Technology Place, Macquarie University NSW 2109). Individual results vary, all surgery carries risks, and a second opinion should be sought before proceeding.

Frequently Asked Questions

Will my breasts look the way they did before implants?

Usually not exactly. The breast returns to the volume of the natural tissue present now, which may differ from what was there before the original surgery because of the intervening years, pregnancy, weight change and age. Skin that has been stretched may not retract fully.

Do I need a lift when the implants come out?

Not always. It depends on skin elasticity, how large the implants were, how long they were in place and where the nipple sits once the volume is gone. Some patients are satisfied without one, and some prefer to wait several months and reassess before deciding.

Is the capsule always removed?

No. A thin, soft, healthy capsule is often left in place and reabsorbs over time. Removal is generally reserved for capsules that are thickened, contracted or calcified, or where the implant has ruptured, because capsulectomy adds dissection and risk to the operation.

How long until the final result is visible?

Swelling settles over several weeks, but skin retraction continues for months. Most surgeons advise waiting several months before assessing the outcome or making a decision about any further surgery.

Is recovery easier than the original surgery?

Removal of the implant alone is generally a shorter operation with a quicker recovery than the original augmentation. Where a capsulectomy or a lift is carried out at the same time, recovery takes longer and the procedure is more involved.

Breast Implant Removal Without Replacement: What Happens to the Breast Afterwards