Joshua Lampert, M.D.
May 2, 2023- A recently published paper in Aesthetic Surgery Journal Open Forum explains a new approach to breast explant (the removal of breast implants) surgery. The paper, titled “Safely Shaping the Breast After Implant Removal and Total Intact Capsulectomy Using the Mammary Imbrication Lift and Fixation Technique” shows that this breast lift and explant technique can be safely performed simultaneously to allow total intact capsulectomy, preservation of the breast tissue and blood supply to the nipple, and a more pleasing aesthetic result.
While current scientific literature is riddled with various approaches for breast implant placement and replacement, there is very little research or publication describing safe aesthetic approaches to breast explant surgery.
“I developed the mammary imbrication lift and fixation technique in order to treat the ever-increasing number of explant patients I have seen in my practice over the last 12 years,” says study author Joshua Lampert, M.D., plastic and reconstructive surgeon. “I searched through textbooks, journal articles, and scientific literature and could not find an adequate prior solution.”
In this approach, the technique allows the surgeon to safely remove the entire breast implant capsule with total complete intact capsulectomy. This is also often referred to on line as “en bloc”, which is where the breast implant is removed as well as the scar tissue capsule that forms around the implant. This is ideal in a number of instances, and especially if a patient had ruptured silicone implants and does not want silicone spilling within the breast cavity.
The major advantage of Dr. Lampert’s technique is that is allows safe removal of breast implant and capsule and also preserves maximum breast tissue and blood supply to the nipple. This preserved breast tissue is then shaped into a better aesthetic breast mound by “imbricating” the tissues and lifting the breast. Dr. Lampert believes his technique is a simple series of steps that any plastic surgeon can complete when trying to help treat patients with breast implant problems who are trying “quit breast implants”.
Approximately 20 percent of patients report some sort of complication related to their breast implants which can include rippling and wrinkling, implant displacement, asymmetry, late hematomas, and neoplasm. However, starting around 1997, a much greater discussion began to draw public awareness of breast implant associated illness (BII). BII can include symptoms such as joint and muscle pain, chronic fatigue, concentration issues, rashes and skin problems, anxiety, and more. A recent survey demonstrated that 66.7 percent of patients with breast implants report concerns with their implants, and 35 percent strongly consider removing their implants as a result. This has led to a “mass exodus” of women who have opted to “quit” breast implants.
“When an implant is removed, the breast is often left with excessively thin and stretched skin which can be difficult to manage. I found that the resultant skin excess left after explant surgery was similar to what I’ve seen in my prior experience with massive weight loss after bariatric surgery,” says Dr. Lampert who is also a clinical assistant professor at Florida International University’s Herbert Wertheim College of Medicine.
In addition, breast explant surgery can leave the breast with a deflated area of central hollowing, loss of conical shape, and rippling and nipple inversion as the pocket collapses down to the chest wall.
In this study, 64 patients underwent the mammary imbrication lift and fixation technique with bilateral breast implant removal and total capsulectomy. The average age of the patients was 42.95 years. Mean follow up was 6.5 months. A limitation of the study is the lack of a formal patient satisfaction survey.
Overall, results showed that this technique has low complication rates, preserves breast tissue and blood supply to the nipple and should be considered for subsequent breast shaping in women who elect to remove their implants.
Additional authors include Alexandra Townsend, BS; Sunny Shah, M.D.; Antoun Bouz, M.D., and Natasha Nichols, APRN, FNP.
