Breast Implant Removal in Miami, FL

Breast explant surgery should be safer than driving your car when performed by an experienced, board-certified plastic surgeon and overseen by an equally competent doctor of anesthesia.

En Bloc Capsulectomy

Safe en bloc capsulectomy takes more time and skill than simple breast implant removal or partial capsule removal. En-bloc capsulectomy often requires a breast lift incision or a larger breast fold incision when performed in order to adequately visualize important surrounding structures during capsule separation and in order to get out the en-bloc capsule and implant "in one piece without rupture." En bloc capsulectomy is ideal if there is any question of silicone implant rupture, significant fluid accumulation, extensive calcification, or a breast implant illness diagnosis. Many patients request this as well for various reasons. Many surgeons have voiced and even published their concerns about total en bloc capsulectomy safety, especially in submuscular breast implant patients.

The Mammary Imbrication Lift And Fixation Technique

Fortunately, Dr. Lampert has extensive breast reconstruction education and experience to fall back on. Utilizing this, he was able to develop the Mammary Imbrication Lift and Fixation Technique, which is his current method to safely perform en bloc total capsulectomy with implant removal and subsequent skin tailoring to shape the breast. The Mammary Imbrication Lift and Fixation Technique that he invented to deal with this problem allows safe total en bloc capsulectomy with submuscular breast implants and can be combined with simultaneous fat grafting, should the patient desire.

Simultaneous Breast Lift

After breast implant removal, the breast is often significantly deflated with loose skin. This is of higher risk with small-breasted patients who are removing larger implants. In these patients, collapse of the lower pole can occur, leading to rippled, irregular breast skin and even inversion or indentation at or near the nipple and areola. Breast fold deformity can occur as well. The most powerful maneuver to decrease deformity risk after implant removal in these patients is often a simultaneous breast lift.

Fat Transfer

Adjunct low-pressure liposuction with fat grafting to the breast provides another useful tool for the surgeon to optimize the breast aesthetic without an implant. In order to visualize the patient's breast tissue and any post-explant breast droop, Dr. Lampert always sits the explant and breast lift patient up in the OR several times during the surgery. He does this in order to see how the breast will look when standing. He places a drain to collapse the large pocket or space left behind when the implant and capsule have been removed. He then tailors any excess skin and tries to visualize regions of the breast that will require fat transfer, when applicable. He is also constantly referencing the nipple and areola position while the patient is upright. These steps take significant time but should not be skipped if the surgeon wants to best control the final aesthetic result.

Evaluating Patient Safety

Patient safety must always be evaluated and assessed perpetually. Every measure should be taken to always improve it. No cost should be spared when it comes to patient safety. It is expensive to afford the safest equipment, best medications, and most experienced doctors, nurses, surgical assistants, and medical professionals. But frequently in life, you get what you pay for. Explant and breast revision surgery is no exception!

Dr. Lampert’s Federally Certified Asc

Dr. Lampert performs all of his procedures at the hospital or his Ambulatory Surgery Center (ASC), Miami Surgery, LLC, which is Federally Certified by the Florida Agency for Health Care Administration (AHCA), the same agency that licenses all of the best hospitals in the state. It is currently one of only three other plastic surgery ASCs in Miami-Dade County Certified by AHCA, and as such, Dr. Lampert is held to the highest standards. Having control of his own ambulatory surgery center, he is able to provide patients the advantage of many surgical technologies and a higher quality of equipment that is not available at the hospital. Dr. Lampert has equipped his facility with the latest breast surgery and safety equipment, including a smoke evacuation system, high-definition imaging devices, LED lighting and visualization technology, power-assisted liposuction, video laryngoscopy, and much more. See the following link for details: https://www.lampertmd.com/

Choosing The Right Plastic Surgeon

Aesthetic results and safety metrics are ultimately the best when the given surgeon takes their time to ensure they did their best, remained detail-oriented, and cut no corners to get there. The fast procedure is often not the right procedure, although it may be the cheaper one. When interviewing a plastic surgeon, ask them how many times they sit you up during surgery. Ask them how much time they typically spend performing a procedure. If they pride themselves on sheer numbers, volume, and being fast, then they might not be the right surgeon for you! As with every creative, detail-oriented process, good work takes time.

Breast Lift

When seeing a breast explant patient for the first time, Dr. Lampert always discusses the potential for a simultaneous breast lift (or mastopexy) and areola reduction surgery, if indicated. Breast droop, the amount of breast tissue, and the size of the breast implant being removed are all taken into account when making this decision. During the exam, any breast droop is measured and demonstrated to the patient in the mirror. Simultaneous breast lift, or mastopexy, is probably the most common ancillary procedure performed with breast explant surgery. This typically includes an areola reduction with the mastopexy design. Dr. Lampert likes to keep the breast lift scars "as small as possible" and is always trying to keep them within a patient's triangle-shaped bikini line, as these garments are very popular for the beaches and pool parties year-round in South Florida! Dr. Lampert typically prefers to use the lollipop or his "mini anchor" scar as part of his Mammary Imbrication Lift and Fixation Technique, which is the current method he invented to safely perform en bloc total capsulectomy with implant removal and subsequent skin tailoring to shape the breast. He always wants to keep scars hidden while in a bikini or low-plunging dress!

Fat Transfer

Some patients elect to undergo fat transfer or fat grafting to the breast at the same time, which is a helpful tool to further shape and contour the area. Some of the fat grafted to the breast develops a blood supply and survives for the lifetime of the patient. Other grafted fat cells are absorbed by the body and disappear. Current estimates range from 40-60% fat graft survival when grafted by an experienced, board-certified plastic surgeon. Breast fat transfer (or fat grafting to the breast) can be performed the same day of surgery or in a staged fashion several months later after scars mature and heal. There is a limit to how much fat grafting each breast "will hold." Trying to graft too much fat at once can lead to increased risk of fat necrosis or areas of fat that die. Fat necrosis can cause lumps, infection, and pain, so judicious fat transfer by an experienced surgeon is important. Some patients have little fat deposits or desire to only harvest fat for breast shaping. Other patients desire entire body contouring procedures like 360-degree liposuction. For some of these patients, a significant excess of fat may be harvested. These patients must be made aware that excess fat harvested cannot be saved and refrigerated and often must be thrown out as biohazard. Studies have shown that banked, frozen, and refrigerated fat currently will not survive compared to fresh and immediately grafted fat cells, which have a much higher survival rate. Bigger breasts and larger breast augmentation volumes with more fat graft survival can be obtained with repeat (or staged) fat grafting surgeries spread apart by at least 3 months. The patient comes back and has a repeat fat graft surgery after the initial surgery. Fat transfer is performed repeatedly to augment the breast and replace the fat that was absorbed by the body. If approximately 50% of the fat is lost every time, in theory then 75% of the volume can be achieved with a second session of fat grafting. A third session of fat grafting can potentially yield even more, so the staged approach with multiple smaller surgeries is sometimes the best when patients are motivated to have larger breasts without using breast implants. Ultimately these patients often achieve amazing improvements in body contour, but it is a more gradual approach. Often in breast explant reconstructive surgery, multiple staged surgeries can help provide patients with the best possible end result.

Other Procedures

Many patients decide to "take advantage" of the downtime, anesthesia, and surgery day in order to undergo other desired elective surgical procedures at the same time in combination with their breast explant surgery. These include rhinoplasty (nose job), labiaplasty (vaginal rejuvenation), eyelid lifts (blepharoplasty), abdominal etching, and of course, the common mommy makeover, which includes some form of abdominoplasty. A number of procedures can be performed on the same day. Depending on the exact surgical procedures desired and estimated length of time, Dr. Lampert will then make recommendations regarding which procedures can be performed together for that individual. Too much surgery in one day is never a good idea, as Dr. Lampert puts safety first. Each patient is different and must be evaluated individually. A good surgeon will be able to tell the patient how many and what kind of procedures can be combined during the same day of surgery.

Some insurance plans cover the removal of the capsule (total/Capsulectomy) and with that comes the implant. We have had great luck with insurances like United, Aetna and Cigna, PPO and Open Access plans.

Health insurance does not cover total capsulectomy with a BII Diagnosis. The covered diagnosis is Breast Pain and Capsular Contrature.

Health insurance will cover a total capsulectomy when painful capsules/breasts are present. If your breast pain prevents you from doing daily life activities your insurance may cover it!

You can schedule a consultation with Dr. Lampert to assess your symptoms and determine if your insurance will authorize it.

Insurance carriers we have worked with for breast implant removal:

• UHC
• AETNA
• CIGNA

You can also call your insurance and ask if CPT CODE 19371 is a covered benefit!

Insurance will help cover: total capsulectomy and muscle repair. They do not cover the breast lift or fat transfer.