I just gave a lecture on explantation to the California Society of Plastic Surgeons meeting. This is a topic that has seldom been talked about or written about. If there is ample breast tissue and the skin is thick and tight and the implant isn't too big, the operation is very straightforward.But if the tissue is thinned, if there is any droopiness or unevenness, if the tissue is damaged or the skin thinned, then making the patient look right is more difficult.Some patients need to have a lift at the same time and deciding whether, when, and how to do the lift following an explant is extremely challenging.There are lots of subtleties in how to manage these, and tricks such as deflating saline implants, deciding whether a lift is necessary, etc.The decision as to what to do with the capsule surrounding the implant - leave it alone, remove part of it, or remove all of it - are complicated decision. So too are the issues about whether to put in a drain, which incision to use to remove the implants, how to reposition breast tissue if it had been shifted with the earlier operation, whether and how to fix an indented scar, etc. These sorts of things can only be made by a plastic surgeon - and one indeed experienced with these particular problems.So if you are sure you have an absolutely straightforward problem you could have the oncologist do it. But here's my question: Why? Why not have an expert do it? If you live in a remote area and there isn't a good plastic surgeon around then that may be a reasonable thing to do.
