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

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.

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.