Isn't surgery to remove implants on a 78yr old with dementia, previous stroke from brain aneurysm with pacemaker too high risk?

Thank you for your question.  If the surgery is recommended only due to a misshapen breast, then I would say its not worth it.  If the patient is in severe pain due to encapsulation then surgery could be considered, but a health clearance by the Internist managing her care would be needed.  Best to leave things alone if she is comfortable. 

I would share your concerns. Careful preoperative medical evaluation will need to be carried out to determine the patient's risk profile. In my practice, given your description, I would have to see some real “medical indication” prior to offering breast surgery to this patient. I hope this helps.

If the surgery is for cosmetic purposes only, it would be contraindicated in a patient with such severe medical problems. The silicone probably poses much less risk than the surgery if it is just because the breast is misshapen.

A serious discussion with the health care team for a patient with multiple problems has to be carried out before surgery.  The risks and benefits have to be carefully considered.  Also, the issue of informed consent has to be dealt with by the health care power of attorney.  Specifically, implants can be removed with local anesthesia.  However, can the patient be cooperative without sedation or more advanced anesthesia.  If the only issue with the implants is a misshapen breast, how important is the result of an explanted breast vs. what she looks like now?  Remember while a broken silicone implant presents no health problem, surgery may create additional problems or complications.