Top News

Post-augmentation pain is common, particularly among women who underwent breast augmentation more than a decade ago. Many continue to suffer from complications such as breast firmness, recurrent ptosis, implant malposition, capsular contracture, pseudocapsule formation, implant displacement, symmastia, tight pockets, or unsightly scarring. Yet, due to psychological concerns and age- surgical risks, they hesitate to seek treatment, despite patient safety being a top priority.

According to Dr. Ho Cao Vu (MD, MSc), who has performed more than 1,000 breast explantation procedures, many women over the age of 50 desire painless surgery, fast recovery, and preservation of overall health, particularly if they have underlying conditions such as diabetes, liver disease, thyroid disorders, coagulation issues, cardiovascular disease, or hypertension.

Potential complications during surgery in elderly patients include hemorrhage, pulmonary embolism, respiratory failure, myocardial infarction, and deep vein thrombosis—factors that can hinder healing and prolong recovery.

For this reason, it’s essential to choose a surgical technique that minimizes bleeding, performed in a general hospital licensed by the Department of Health, with modern infrastructure, experienced surgical teams, and full emergency resuscitation capabilities.

Key concerns from patients undergoing explantation

– Explantation is a major procedure requiring careful evaluation: Breast implant explantation is a significant surgery and should follow standard preoperative and intraoperative protocols. When ultrasonic surgical scalpels are used, intraoperative bleeding is virtually eliminated and soft tissue trauma is minimized. Combined with laryngeal mask airway (LMA) anesthesia or intravenous general anesthesia, most patients can be discharged within four hours post-surgery.

– Quick recovery and no downtime: In most cases involving ultrasonic surgical scalpels, patients do not need postoperative downtime or suture removal and can resume daily activities shortly after recovery from anesthesia. This is especially beneficial for those hesitant to undergo surgery or who live far from the clinic, as they can return to normal life within hours.

– Post-explantation outcomes vary: Results depend on factors such as skin elasticity, dermal aging, glandular tissue condition, implant size, and the state of the implant pocket. Breast retraction timing and extent vary from patient to patient.

– Reimplantation in elderly patients requires expert guidance: For those considering reimplantation, consultation with an experienced surgeon is vital. Long-term stability (over 20 years) depends on appropriate pocket creation, implant size suited to age and body structure, and surgical techniques that minimize trauma and bleeding while maximizing safety.

Removing a ruptured Allergan gel implant. Photo courtesy of Dr. Ho Cao Vu

Laryngeal mask airway (LMA) anesthesia is increasingly favored for both adult and pediatric patients. This technique is not only easier for anesthesiologists to manage but also reduces the risk of laryngeal trauma. Compared to endotracheal intubation, LMA causes less irritation, allows smoother emergence from anesthesia, and results in fewer side effects.

In standard explantation procedures, Dr. Vu combines LMA anesthesia with an ultrasonic surgical scalpel to ensure minimal bleeding, no tissue damage, and an atraumatic experience.

A patient undergoes explantation of Motiva implants six years after augmentation, presenting with recurrent breast ptosis. Photo courtesy of Dr. Ho Cao Vu

Following surgery, patients experience no pain, require no recovery time, and are discharged within 4–6 hours. Analgesics or antibiotics are typically unnecessary. Dr. Vu’s anesthesiology team unanimously agrees that LMA anesthesia offers superior safety and comfort during and after breast implant explantation.

For elderly patients with multiple health conditions, a complete multi-organ screening must be performed in general hospitals with fully equipped specialty departments. These facilities must also have intensive care units (ICUs) that meet emergency standards and a team of experienced physicians prepared to handle complications such as anaphylactic shock, heart attack, or thrombosis.

Explantation of textured implants after 15 years of augmentation. Photo courtesy of Dr. Ho Cao Vu

Mandatory preoperative tests for breast explantation

– Complete Blood Count (CBC): Evaluates red and white blood cell and platelet levels to detect anemia or infection.

– Liver and Renal Function Tests: Includes AST, ALT, creatinine, BUN, and eGFR to ensure organs can metabolize anesthesia effectively.

– Coagulation Profile (PT, APTT, INR): Assesses clotting ability to reduce the risk of bleeding.

– Blood Glucose Test: Detects or monitors diabetes, which can impair wound healing.

– ECG, Chest X-ray, and Echocardiography: Examine lung and heart function to rule out underlying conditions before anesthesia.

– Implant Evaluation: MRI and ultrasound help detect implant rupture, leakage, or deformation and assess soft tissue and pocket conditions.

– Chronic Disease Screening: For patients with hypertension, diabetes, or autoimmune disorders, additional tests (e.g., HbA1c, immunologic assays) may be needed.

By adhering to modern techniques and comprehensive preoperative screening, breast implant explantation can be safely performed, even in elderly patients with complex medical histories.