Capsules left behind a form of malpractice?

Question

In 2019 I had my breast implants removed as I though I was having symptoms of BII. I specifically requested an enbloc, to have the capsules removed. I requested the pictures taken of my implants and capsules. I received an email specifically saying the dr DID remove the capsules. 2 years later I wasn’t feeling better so I got new implants, and a different dr. He told me the capsules were in fact NOT removed. Is what the first dr did considered mal practice? I’m SO mad I was lied to!

Donald R. Revis Jr, MD · Answer

Good morning,
I do hundreds of revisions a year, and in fact tomorrow I have an en bloc explant. When you remove the capsules that raw surface does scar down, and several years later it would be almost indistinguishable from capsule left behind- because think about it- they are both basically scar tissue created by the body. When I go back in and replace implants that have been out for years, there is always scar tissue present, it is never back to normal and natural the way the breasts came before any surgery. It is impossible to distinguish between old capsule and scar tissue that formed subsequent to capsulectomy. So- did your en bloc surgeon show you photos? If so then there would be your proof that your capsules were removed. That's a simple answer to the yes or no. Maybe your new surgeon isn't that experienced with revisions and wants to be a "hero?"

Connie Hiers, MD, FACS · Answer

Frist, en bloc surgery is used only for cancer patients. For non cancer surgery, other terms and procedures are used. Secondly, sometimes it is too risky to remove all of the capsules, especially on the posterior side. Trying to remove all the capsule in this area could enter into the chamber of your lungs and endanger your lungs.  Third, if you truly had BII you would not have gotten more implants. Fourth, you will have capsules with the new implants. No, there is no malpractice for leaving capsules inside in noncancer procedures. I cannot address what your surgeon did/did not say.  You could request a copy of your operative note to see what was dictated about your capsules.

Joshua B. Hyman, MD · Answer

Great question. I think that a surgeon needs to do the procedure that the patient was consented for unless there is a medical reason not to do it. Sometimes, if part of the capsule is stuck to the rib cage in a thin women, I will need to leave it behind to avoid a pneumothorax. I am not sure how the second surgeon determined he was looking at capsule when there would be scar tissue and a possible seroma cavity from the first explant which would look similar to breast implant capsule. I hope you are feeling better.

Capsules left behind a form of malpractice?

Answers (3)

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