Hi, I have had my Mentor silicone implants for 11months and have recently tested positive for scleroderma. I would like to remove them doing the "en bloc" procedure. Would this be to harsh on my body or cause to much trauma that the condition could possibly progress rapidly? What are my chances of coming out of this procedure well? I also have a lump on my right lymph under my arm pit. Could this be a sign of rupture? Any assistance in this matter would be greatly appreciated. Thank you.
"En Bloc" Procedure on a Person with Scleroderma Can It Be Done?
Doctor Answers 2
Removal of breast implants with scleroderma
Removing a silicone or saline implant is normally a simply procedure. It can be done a lot of the time under local and you can be back at light duty work in 2-3 days. Removing a capsule will definitely add significantly to the surgical trauma. If you don’t have a pathological capsule contracture removing the capsule will not be very simple. This is due to the flimsy nature of the capsule. I’m not sure if the risk/benefits will make it worth the aggravation.
Good luck and thank you for the question
Anire Okpaku MD FACS
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Breast Implant Removal, Scleroderma Patient
If you choose to have the implants removed, your options include simple removal, vs. removal along with removal of the periprosthetic capsule.
Implant removal alone is quite a simple procedure, while removing the capsule is a more considerable undertaking. The latter takes longer, causes more discomfort, has a longer recovery period, and has more risk of post-operative complications. As is always the case, this requires a balance of risk and benefits.
Early in the days of the implant scare in the 1990ies, en bloc resection was often recommended. Today, with information that has accumulated from studies, that is not a universal recommendation. In the absence of evidence of leak, many would suggest simple removal.
You mention an enlarged lymph node. This can be suggestive of a leak if the node has silicone. Check with either your surgeon or your rheumatologist as to whether any imaging studies would benefit you in the decision making process. Once you have all the information you need, have a discussion with both the rheumatologist and the plastic surgeon to help decide on the best treatment, if any indeed is recommended.
Although the en-bloc resection has added risks compared to simple implant removal, a well-trained and experienced plastic surgeon can carry out either procedure.