I have stage 1B breast cancer which will be treated with lumpectomy and radiation. Silicone implants will be removed

I had silicone implants put in 40 years ago and both have ruptured, according to my MRI. They will be removed when the lumpectomy is done. How uncomfortable am I going to be? What questions should I ask my surgeons? I was an RN for 45 years, and should know....but this is my body and I am afraid of not being prepared.

Doctor Answers 2

Removing ruptured implants

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It's good that you are removing the implants. It's not great to radiate old implants, and for someone who wants to keep them we use adm in the pocket to prevent contracture. For removal, taking out the actual implant and implant material is pretty easy. If the inside of the pocket has been sitting next to the free silicone, though, it is often calcified and may have silicone in it and must be removed. This is a bit more technically challenging but very do-able, and should always be done by plastic surgeon not your general surgeon doing your lumpectomy. Finally ALWAYS repair the pec muscle if your implants are sub pectoral. Otherwise you get a weird animation deformity. One more thing.... If the lumpectomy is large consider upsizing the implant in an adm pocket, or keep it larger than the other side (by the amount of the lumpectomy). You get it. Good luck.

Beverly Hills Plastic Surgeon
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I have stage 1B breast cancer which will be treated with lumpectomy and radiation. Silicone implants will be removed

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Thank you for your question. These kind of topics can often be complex and would depend on your physical exam characteristics and your goals. I will tell you that patients who have old implants removed and a lumpectomy, followed by no other procedures and then proceed to radiation are often left with distorted breasts and are unhappy with the ultimate aesthetic outcome. Unfortunately, after radiation, these types of problems can be difficult to fix surgically as previously radiated tissue does not heal well after surgery. 

I have a couple of other options you should consider and discuss with your breast surgeon and plastic surgeon (presuming there is one involved). The first option would be a rearrangement of your tissues at the time of the lumpectomy. This can be in the form of a lift or mastopexy/reduction and can re-oriented the remaining breast tissue so that when you proceed to radiation, there is less chance of distortion. A procedure such as this can often be difficult with previous implants as this can limit the amount of blood supply to the remaining tissue and the amount of tissue overall, not leaving much to be reconstructed and increasing risk of complications. 

The other option, and one I think might be worth exploring in your case is formal mastectomy and reconstruction. While you might think that mastectomy for a stage 1B cancer seems drastic, there are a few things to consider. Having a mastectomy rather than a lumpectomy may mean that you can avoid radiation and all the permanent damage to the tissues that radiation causes. At the time of the mastectomy, the implant could be removed and the cavity left behind by the removed breast tissue and implant could be replaced by a tissue expander. This tissue expander would then be replaced in the future by a permanent silicone (or saline) implant. I think this option may provide you with a more satisfactory outcome in the end in terms of overall aesthetic. 

Like I said, these topics can be complex and often require multiple lengthy conversations with your health care providers to discuss what can be best. Hopefully you have a team like this in your corner. 

Hope this helps! All the best to you!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.