During Explant Surgery, How is the Extracapsular Rupture Treated and is All the Leaked Silicone Able to Be Removed?

Question

After an MRI it was discovered that my 12 year old silicone implants were ruptured. I have both intra and extracapsular leakage. I am scheduled to have them removed in a month and will be replacing them with smaller silicone implants. Will all the silicone be able to be removed? Would a "en bloc" removal be better than going through the nipple as the original surgery? Should I schedule an earlier surgery? Thanks for your responses.

Larry S. Nichter, MD, MS, FACS · Answer

En bloc capsulectomy assures the greatest chance at removing all of the free silicone and is generally done through an inframammary crease incision. Periareolar incisions do not allow this to happen and are independantly a risk factor for capsular contracture.

Ronald J. Edelson, MD · Answer

During explanation, most of the silicone if not all should be remove able. It depends on whether there is silicone which has leaked into the surrounding tissue which is much more difficult to remove. Nonetheless, most if not all the silicone can be removed. I almost always go through the original incision when Imperform a capsulectomy.

Gerald Minniti, MD, FACS · Answer

Hello,

	En bloc excision is a potentially mutilating procedure that is the best treatment option for certain breast cancers, not ruptured silicone gel implants, regardless of  extracapsular  leakage. There is no other medical device with more science behind it then the silicone gel implant, and there is no evidence that they cause systemic disease.  Although my personal preference is an inframammary incision, if your incision is already periareolar, then another incision is not indicated.

	It would be appropriate for you to undergo a total capsulectomy and removal of your old implants.  If there is any silicone outside of the capsule, it is always encased in scar tissue, relatively easy to spot, and frequently it comes out with the capsule all in one piece.

	Your timing of the surgery is irrelevant. I have met and operated on women with known extracapsular ruptures for many years, and only decided to have surgery based on aesthetics, not concern about their health.  So when it's convenient for you is just fine.

	Best of luck!

James E. Chappell, MD · Answer

Generally a reasonable surgery to perform is capsulectomy (removal of the scar tissue capsules around the implants) and explantation (removing the ruptured implants), plus/minus replacing the implants (which you are going to do, and that is fine) and removing any breast tissue that is CLEARLY impregnated with gel. If you have any, it is probably the abnormal solid tissue outside of the capsule. Microscopically involved breast (or other) tissue will likely be left behind. This same tissue may turn hard over time even if it is not currently hard. I place drainage tubes in the breasts on which I perform these surgeries, and those I leave in a week usually. No need to schedule an earlier surgery. Going through the nipple will be tough (I assume "through the nipple" means the smiley-faced incision around the lower 1/2 of the areolar edge). Either the capsule will need to be opened so the implant/capsule can be removed or the incision will need to be lengthened. It may be better to have your surgeon use the incision under the breast. Best of luck to you.

Moneer Jaibaji, MD · Answer

Thank you for your question. Regarding your question on the incision site; the surgeon can use the same periareolar incision to do the explantation. Once the capsule is reached, it should be dissected out and sent for histopathology. Any residual silicone gel or granuloma can be excised and again sent for histopathology. The pocket is then irrigated with saline. A new implant can be placed. You will need a drain placed during surgery, since capsulectomy increase the risk of bleeding after surgery. I hope this is helpful.

David A. Lickstein, MD · Answer

Implant ruptures occur rarely. When they do, the typical treatment is to remove the implants and the capsules. This is best done through an incision beneath the breast. All visible silicone is removed, and the pockets are washed thoroughly. Microscopic silicone particles may remain, and these can lead to future granulomas, but this is very rare as well.

Chen Lee, MD · Answer

En bloc removal of implants implies complete excision of the implant with surrounding layer of normal tissue. This usually requires a longer scar in the infra mammary crease and might entail more bleeding when implants are submuscular. With extensive extracapsular ruptures, an en bloc removal might be indicated. However, with focal extracapsular ruptures I recommend a shorter incision, extensive capsulectomy, and removal of as much of the affected tisuses as is technically reasonable. While not en bloc, often near complete excision is possible with a shorter incision and lower complications.

Howard N. Robinson, MD (retired) · Answer

Extracapsular silicone is very difficult to remove and can cause some deformity, if removal is too aggressive. It can also wind up in the axillary lymph nodes and lymph node dissection is usally not indicated and difficult to perform through the usual breast incisions. My practice is to remove as much as possible without creatinga thin area or deformity.

During Explant Surgery, How is the Extracapsular Rupture Treated and is All the Leaked Silicone Able to Be Removed?

Answers (8)

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