|Duration of Surgery||2 hours|
|Scars||Under the nipple or under the breast|
|Final Results||6-12 months|
|Return to regular activity||1-2 weeks|
|Resume Exercise||4 weeks|
Millions of women in the United States have breast implants, and an implant is a device that has given millions of patients’ great satisfaction and self-image enhancement. Breast implants, and the patient’s decision to have a breast augmentation, are not infallible, so it is not surprising to know that some patients are not happy with the implants for one reason or another and would like them removed or removed and replaced. The reasons vary from an implant rupture, to having a capsular contracture to “I just got tired of them”. The decision to remove a breast implant should be thoroughly discussed between the patient and the surgeon, just as seriously as discussing having a breast augmentation operation. It is important to state that we perform all the above procedures at the same time as the implant removal if those are the patient’s wishes.
Usually, women who would like to have breast implants removed fall into one of the following categories:
An initial consultation is set-up where we will discuss the implant removal and all the above listed options to decide whether you are a good candidate for the surgery. If you elect to have your implants replaced, we will have an additional discussion regarding selection of your new implants. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery, as well as getting a mammogram. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The patient is given antibiotics and anesthetized in the operating room. The incision is made at the crease at the bottom of the breast or along the lower areola border, and the old implant is removed. Since any implant will be surrounded by scar tissue, some of it may need to be removed at the same time. Next, a drain to empty the fluid that builds up in the empty pocket is placed, and the skin is closed. The breasts are wrapped to provide some pressure, so the pocket will close nicely. The drain is removed in the office the following week.
The patient is given antibiotics and anesthetized in the operating room. The incision is made at the crease at the bottom of the breast or along the lower areola border, and the old implant is removed. Since any implant will be surrounded by scar tissue, some of it may need to be removed at the same time. If the capsule needs to be adjusted with sutures, it is typically done at this stage. An implant sizer – think of it as a disposable implant- is placed in the pocket and inflated to the volume desired by the patient. The patient is then sat up and checked for symmetry. Once the optimal result is achieved, the sizers are removed, and the new implants are placed into the pocket and rechecked. The incisions are then closed.
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center, with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after breast implant removal is minimal. Sometimes, a small amount of bleeding can be observed, but if the bleeding in a breast after a breast implant removal becomes significant, then the patient needs to have the bleeding removed in the operating room in a usually straight-forward procedure. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. We use tumescent solution, similar to that used in liposuction, before starting the procedure to decrease the amount of bleeding.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the actual surgery and afterwards. During the surgery, the skin surface of the patient is cleaned properly. If implants are replaced, the doctor changes gloves, and he is the only one who handles the implant in the operating room to ensure total sterility and avoidance of infection. After the procedure, our patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, our infection rate is minimal.
Ability to Breastfeed
Women are sometimes concerned that if they have a breast surgery, they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed is rare. During implant removal and replacement, if desired, there is minimal dissection into the breast gland, so the milk ducts are not disrupted. The inability to breastfeed after a breast implant removal that we have performed has not occurred with any of our patients to our knowledge.
Loss of Nipple Sensation or Nipple / Areolar skin
Similar to what has been said about ability to breastfeed, loss of nipple sensation is a potential complication because of the minimum amount of additional dissection, the chance of injuring the nerves to the nipple is rare. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks.
Smoking is an absolute contraindication for breast implant removal with or without exchange. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure. We also offer scar creams at an additional cost to optimize results.
To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.
At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.
There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.
We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.
We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.
Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.
For more information, call our office at 703-206-0506.
Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.