From explantation to breast reconstruction

In an interview with Hellersen Insight, Dr. Petra Scheffer, Chief of Ästhetik Hellersen, tells the impressive story of a patient who found her way to Sportklinik Hellersen after the implant manufacturer issued a recall and her breast implants were subsequently removed. After the implants were removed, the patient suffered from severely deformed and asymmetrical breasts that were marked by deep scarring.

How can such complications be recognized and how are affected patients treated?

Dr. Petra Scheffer: Typical symptoms of a possible complication after implantation include breast swelling, redness, or a feeling of pressure. It is important to rule out infections first, as these occur much more frequently. However, degeneration, i.e., uncontrolled cell change in which cells lose their normal structure and function and become malignant tumors, is extremely rare—the probability is about 1 in 1 million. If there is still suspicion, a standardized procedure is followed: First, an ultrasound or MRI examination is performed. If fluid is present, it is punctured using ultrasound and analyzed comprehensively – around 100 ml of fluid is removed to obtain sufficient material for laboratory analysis. The fluid is examined for cancer markers using immunohistochemistry and for possible bacterial infections.

In the present case, the patient complained of pain in her left breast in 2021. After thorough diagnostics, another hospital decided to remove the implants. Such decisions are made on an individual basis and based on the respective findings. Fortunately, the examinations confirmed that the patient did not have malignant tumor disease.

How did you assess the patient's severely scarred and asymmetrical breasts after the implant removal? What options did you suggest to her?

Dr. Petra Scheffer: First, I examined the patient, felt the scars, and assessed the movement of the breast, for example when she raised her arms. I noticed that the breast was very deformed and asymmetrical. There was almost no volume left, especially in the lower part of the right breast. The breast had completely lost its round shape due to the pronounced scars.

I then explained to the patient step by step how I would proceed, and we discussed it together in front of a mirror so that she could understand it better. My suggestion was to first remove the scars and restore the breast to a round shape. Although it would be possible to insert an implant immediately, this carries a high risk of complications.

Removing scars creates larger wound areas that can bleed more heavily. There is also a risk that a heavily scarred and hardened capsule will form around the implant shell. I therefore recommended that she wait at least six months after scar removal and shape correction before considering implants. During this time, the breast will settle into its natural teardrop shape as the swelling subsides.

I also offered her the option of foregoing implants altogether if she was satisfied with the natural shape of her breasts after healing. The symmetry could be adjusted, for example, with autologous fat on the right side without further surgery on the left. However, implants can achieve a larger overall volume. This approach gives the patient the opportunity to decide at her leisure what is best for her in the long term.

Why were different implant sizes used during the last operation?

Dr. Petra Scheffer: The lower right breast pole was significantly smaller than the left, which is why I chose a larger implant of 425 ml on the right side to balance the shape and volume. On the left side, I used 350 ml to achieve a symmetrical and aesthetically pleasing breast shape. We opted for anatomical teardrop-shaped implants, as these are particularly well suited to compensating for defects in the lower breast area, whereas round implants would tend to emphasize the upper area. Anatomical implants offer a natural breast shape and, when placed correctly, can produce excellent results.