Implant~Info~Net

According to the American Society of Aesthetic Plastic Surgery, 235,000 women had breast aumentation surgery in 2003; more than 40,000 had breast implant removal surgeries. This procedure, known as explantation.

Reasons for Breast Implant Removal

The three most common reasons for breast implant removal are change of size and shape, implant leakage or rupture, and capsular contracture.

Sometimes, breast implant removal is necessary to treat problems that occur with the implants are:

• deflation or repture
• shifting
• implant wrinkling
• sagging
  
• asymmetry

Other times it may be due to the body's reaction to the implants.

• bleeding
• infection
• diagnosis of breast cancer 
• the formation of scar tissue that tightens around the implant (capsular contractur)
• necrosis, or the formation of dead tissue around the implant, which may prevent wound healing
• calcium deposits

Women who are very ill sometimes find that their health improves dramatically after removal. A study of removed implants that were not replaced by Noreen Aziz and her colleagues found that 97% of women with pain and other rheumatology symptoms felt better after their implants were removed and not replaced. Many symptoms lessened or disappeared over the next few months. In contrast, 96% of the women who did not have their implants removed became even more ill.

Removing intact implants is not always complicated, but it can be very difficult to remove certain kinds of implants, such as foam covered implants (sometimes called the Meme), implants with hard capsules surrounding them, and implants that have ruptured. This kind of explanation sometimes involves removal of not just the implants, but also removal of some of the tissue and muscle surrounding the implant.

Removal of a silicone gel implant is more complicated than having it put in. This is particularly true if the implant is leaking or has ruptured, because it’s very important to ensure that silicone gel from a broken implant does not spill or remain in the body.

The surgeon who performed the original surgery is not necessarily the best choice for removing the implants. Explantation results can be excellent or disastrous. Some plastic or cosmetic surgeons are very experienced at implantation, but not explantation. However, there are some plastic surgeons who are very experienced at removal and are especially skilled at getting the best possible cosmetic result. The surgeon you choose should be experienced with explantation, board certified, and should be willing to show you pictures of many patients' post-explantation results, or better still, offer to have former patients talk to you. Find out if they were happy with their doctor and with their results.

Most experts believe that removing the implants ‘en bloc’ is very important. This means that the entire implant and the entire scar tissue capsule surrounding it are all removed together. Although it is more difficult than removing just the implants, it makes it easier to remove any silicone that may have leaked from a broken gel implant, and also helps remove silicone or other chemicals that may have bled from the silicone outer envelope. You should ask your doctor if he/she would use this procedure.

Removing implants en bloc is particularly recommended by experts if you have been sick since receiving your implants. Some experts believe that symptoms such as joint pains, chronic flu-like symptoms, memory loss, confusion, or a burning sensation could be a result of silicone that has leaked from your implant, and perhaps outside the scar tissue capsule. If this is the case, leaving the scar tissue capsules, or part of them, and/or silicone in your body probably isn't going to let you recover as well as you might. It is also possible that while the silicone did not make you sick before, silicone that is left behind after explantation could make you sick later, because your body will respond to this foreign material.

POSSIBLE RISKS OF HAVING A CAPSULECTOMY

1. There is the risk of general anesthesia (possible reactions to anesthesia such as nausea, drowsiness, and fatigue); however, there have been many changes for the good in the types and quantities of drugs that are used during surgery. You can also sit down and discuss your questions and concerns with the anesthesiologist involved in your case.
2. There is more blood loss involved. However, a plastic surgeon who has performed many capsulectomies and works well with the other members of the surgical team in the operating room knows about minimizing blood loss. In addition, blood vessels are cauterized during the procedure. You can talk with the plastic surgeon who performs the capsulectomy about her/his views about potential blood loss. Many implant patients store blood a month ahead just in case.
3. There is the risk of the plastic surgeon cutting more tissue than is absolutely necessary beyond your implants and scar capsules. However, a plastic surgeon who has performed many capsulectomies and performs them routinely with good technical ability will be careful to give you a good surgical result, medically and cosmetically.
4. There is the risk of infection after surgery; however, this risk can be minimized with the use of drains and antibiotics (intravenously and orally) after surgery. You can check with the plastic surgeon performing the capsulectomy about her/his techniques to minimize the risks of infection.
5. There is the risk of the change of sensation and/or coloring of a woman's nipples, areolar, and breast tissue. The most extreme reaction is nipple death due to poor circulation. A well-trained, qualified plastic surgeon will take all precautions to avoid this occurrence. At the same time, there is a very good chance that you may regain sensation in your nipples and areolae once your breast implants and scar capsules are removed.
6. There is, of course, the reality of the pain following the surgery; however, each woman's recovery process is different and each person's experience with pain and pain threshold is different. You can check with the plastic surgeon performing the capsulectomy about the types of pain medicine she/he recommends (intravenously and orally) after surgery.

POSSIBLE RISKS OF NOT HAVING A CAPSULECTOMY

1. There is the risk of leaving the silicone-gel " bleed" comprised of many different chemicals inside the scar capsule in the body.
2. There is the risk that the silicone-gel " bleed" may cause further complications such as infection, pain (because it is a hard fixture), neurological damage (i.e. leaving your nerve endings exposed).
3. There is the risk that the " bleed" may be linked to autoimmune diseases. Whether or not a woman actually develops a specific autoimmune illness, the scar capsule puts a strain on her immune system (i.e. working against her globulins and connective tissue).
4. There is the risk that the scar capsule may shrivel up or " ball up," which, in turn, may put a woman at risk for misdiagnosis by an oncologist or radiologist for " cancer" or a " tumor" in her breasts.
5. There is the risk that the scar capsules may contribute to the implosion (or drawing in) of a woman's breasts.
6. There is the risk that the scar capsules may wind up creating a vaccine against your own immune system because your system is fighting a foreign material and it may eventually generate antibodies against you.

QUESTIONS TO ASK A PLASTIC SURGEON BEFORE PROCEEDING WITH A BREAST EXPLANTATION AND CAPSULECTOMY

1) Ask about the plastic surgeon's education and background (i.e. where s/he did her/his training, etc.). Ask for a copy of her/his Curriculum Vitae.

2) Ask the plastic surgeon about the frequency with which s/he has performed breast explantations/capsulectomies. Over how long a period of time? Ask if there are other women you can talk to who had their explantations and capsulectomies performed by this surgeon.

3) Ask the plastic surgeon is s/he is currently involved in any breast- implant research. If so, what type of research? With whom? Who is gathering and analyzing the data? For what purpose? Ask to see a copy of the study or proposal.

4) Does the plastic surgeon do the procedure on an in-patient or out- patient basis? In which hospital does the plastic surgeon perform the surgery? Ask about the hospital if it is unknown to you.

5) Be sure that you are informed of all possible risks and complications involved with the breast explantation/capsulectomy. Make sure the plastic surgeon outlines everything for you.

6) Upon examination, what are the plastic surgeon's feelings about the injuries and complications to your breasts and what does s/he think about the status of your implants? Ask the surgeon to examine your lymph nodes.

7) If you feel comfortable with the plastic surgeon and decide to proceed with an explantation and capsulectomy, ask the plastic surgeon about the time s/he thinks you will be in the operating room? How does s/he plan to do the procedure? What type of incision will be made? What type of scarring does s/he anticipate? What type of sutures does s/he use (i.e. will they dissolve or will you have to come back to have them removed)?

8) What type of bandaging will s/he use (i.e. cotton or a polyester and synthetic blend--for people who may be allergic to synthetics)? If you are concerned about having a reaction to the dressing, ask about another alternative (i.e. bringing a cotton sports bra to be used after your surgery). How will the plastic surgeon apply your bandaging to minimize swelling?

9) Does the plastic surgeon use drains? If so, what type? Ask to see one, if possible. How long does s/he anticipate that you will have to use the drains after surgery? If the surgeon does use drains, ask her/him to let you know when s/he will remove them. Ask to have them removed as quickly and as painlessly as possible.

10) Does the plastic surgeon use antibiotics (intravenously and orally) to minimize the possibility of infection? If so, what type? When? And for how long does the surgeon believe you will need to take them after your surgery?

11) What type of pain medication does the surgeon recommend for you after surgery (intravenously and orally)? (For example, does the surgeon prescribe a " pain pump" if you are staying overnight in the hospital?) Ask about the pros and cons of different narcotics so that you can make an informed choice.

12) What type of antiseptic precautions in the O.R. does the surgeon take to sterilize your breast tissue and to help to minimize the possibility of infection?

13) Ask the plastic surgeon to feel and look for masses, cysts, or any other possible anomalies once s/he has removed your implants and scar capsules.

14) Ask the plastic surgeon about the type of procedure s/he will perform if s/he discovers your implants are ruptured? Will this delay your time in the O.R.?

15) Ask the plastic surgeon about your anticipated blood loss. Does the surgeon feel an autologous blood transfusion needs to be done ahead of time? Has the plastic surgeon ever had to perform a blood transfusion on a woman during or after surgery?

16) Ask the plastic surgeon if s/he works with one anesthesiologist or several? Ask to speak to one of these MD's before the day of your surgery so that you can discuss the best types of narcotics, pain reducers, etc. for you, particularly if you are concerned about becoming nauseated after surgery. If you would like a specific anesthesiologist to work on your case, call and/or write to the anesthesia department (about two weeks before your surgery, if possible) of the hospital to request that s/he be put on your case.

17) Ask the surgeon what medications you should avoid before and after surgery? Let her/him know what medications you are currently taking. Ask the surgeon if you can have your post-operative prescriptions filled ahead of time so you will already have them when you leave the hospital (so you don't have to go to a pharmacy when you are feeling tired or in pain after your surgery).

18) Ask the plastic surgeon to outline all of the " Do's" and " Don'ts" for you before surgery. (i.e. ask her/him when you need to stop eating and drinking before surgery.) 19) Ask the plastic surgeon to describe for you a realistic picture of what s/he anticipates you will look like after surgery ( your breast size, scarring, drains, sutures, etc.) If s/he replies: " Well, you may not like your appearance," that is her/his projection. Keep asking (if you choose to) so that you will have an idea for your clarification and peace of mind.

20) Ask the surgeon what your immediate post-operative care will be through her/him and the hospital. Ask the surgeon to see you and talk with you after your surgery (not when you are groggy in the recovery room) to let you know how your surgery went. Will s/he see you the morning after surgery? After the surgeon sees you initially, what will the course be of your post- operative follow-up care? Will you see the surgeon again in a week, a month, and will you have follow-ups at three months, etc.?

21) What is the surgeon's fee? What does her/his fee represent? Does it include your pre-operative, operative, and post-operative care? Does the plastic surgeon expect a deposit? Does the surgeon recognize and accept your insurance carrier? Will s/he help you with your insurance (write a letter on your behalf, if necessary)? If your insurance will not pay for your surgery, will the surgeon reduce her/his fee or work out a payment plan with you? Or does s/he want her/his fee up front before your surgery? Does the hospital offer a reduced fee?

22) Will the surgeon help you to send your implants and scar capsules and associated tissues to where you want them to go (i.e. to Pierre Blais)? Or do you have to contact the hospital's pathology/histology departments yourself? (It is important to prepare a letter of directive or an alternative form or letter to outline what you would like the hospital to do with your implants, scar capsules, and associated tissues after your surgery. BE SURE TO READ AND CROSS OUT AND INITIAL ANY PORTIONS OF THE HOSPITAL'S CONSENT FORM THAT ADDRESSES THE DISPOSAL OF YOUR TISSUE. Will the hospital send your implants and tissue directly for you? Or do you need to pick them up and send them yourself?

23) Does the plastic surgeon have a consent form for you to read and sign actually outlining what the surgeon will do before you have your surgery? If so, request to have time to review it before you sign it. Take it home after your first visit if you can.

* It is to your advantage to bring your blood tests, mammograms, and other related medical reports with you, including the original surgeon's post- operative notes and description of how s/he did your original breast implantation, when you have your consultation with a new surgeon. Of course, if the original plastic surgeon agrees to take out your implants and scar capsules and you feel comfortable with this person, it is still a good idea to show the surgeon all of your current tests, mammograms, xeromammography, MRI's and medical reports.

AFTER YOUR SURGERY

1) Ask the surgeon about your immediate dietary (if applicable) and physical limitations. For how long? Can you drive? What types of activities can you do? When can you go back to work?

2) As soon as you are able to, ask the hospital for a copy of all your medical records including any pre-operative testing, your surgical procedure, and any post-operative notes and write-ups about your care. 3) Ask the plastic surgeon for a copy of the consent form you signed, her/his post-operative write-up about your surgery, and a copy of the picture the surgeon took (if applicable) of your implants, scar capsules, and associated tissues. In some cases, the pathology department may photograph your implants, etc. Check with the surgeon.

DISCLAIMER: The opinions expressed here are those of the editor and any contributors and are not to be construed as medical or legal advice. Any articles or information submitted may be edited because of space, content or grammatical errors.

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