I've had silicone implants since 2004. Implants are hard and causing breathing problems. Is en bloc the way to go?

Question

Should I get explant surgery where implants and capsule are removed altogether. What type of surgeon should I use for the removal. Only one surgeon in my area is listed as 'explant surgeon' but he has malpractic history and it does not appear that 'explant surgery' has been performed in recent years. Please help me choose. I am having problems on right side of my right breast along with breathing problems and pain from that area whenever I breathe. Should I get surgery soon? I'm terrified. thanks.

Jed H. Horowitz, MD, FACS · Answer

hello morin909You should seek the advice of a board certified PS, Two choices exist for explantation:
1. Implant removal while leaving the capsule. This is a simple procedure and requires local
anesthesia, IV sedation, or (uncommonly) general anesthesia. It is 
relatively inexpensive. Microscopic amounts of gel may remain in the 
capsule.
2. Capsulectomy: This will enable the surgeon to remove as much 
silicone as reasonable without creating significant deformity. This 
operation may require a larger incision. The surgery and recovery time 
will be longer. General anesthesia is usually necessary and subsequently
 all of the costs associated with this operation will be higher. #options #pre-op

Robert Cohen, MD · Answer

It sounds like you might be dealing with capsular contracture, which is one of the more common complications of breast augmentation.  This could be contributing to your pain and breathing issues, but obviously any serious lung or heart issues need to be ruled out by your primary physician first. Once that is done, any skilled plastic surgeon can perform a complete capsulectomy and implant exchange (or fat grafting, etc.). You do not need to see someone advertising "en bloc" resection.  Any plastic surgeon performing a lot of revision breast surgery should be skilled at removing your scar tissue and cleaning out the pockets (the key for dealing with capsular contracture). If the issue is not contracture, than it is possible you may not need a capsulectomy, but this should be determined with an in-person exam by an experienced board certified plastic surgeon. Good luck!

Thomas Trevisani, MD · Answer

If you are experiencing breathing issues- then I recommend that you see your Family Doctor ASAP. As far as explantation goes- any qualified Board Certified PS is trained and capable of removing breast implants.. Why not returning to your original Surgeon? In person exam is essential

Benjamin J. Cousins, MD · Answer

Thank you for your question. Be sure to see a Board Certified Plastic Surgeon who you can have access to for follow-up and can spend time with you before and after your surgery and answer all questions you may have. When the implants are removed, there is a capsule or layer of scar tissue (thick or thin) around the implant. This capsule does not necessarily have to be removed, but should be if the capsule is irregular, painful, distorting the breast shape, is symptomatic or thickened. Removing very thin capsules may cause excessive bleeding and be associated with risks of injuring the chest wall muscles, ribs or other complications. After the implants are removed, any small capsule that is left will over time soften and dissolved/reabsorb. The breasts will settle into their post implant shape minus the skin stretch and original breast tissue and muscle shrinkage. Best of luck.
  
Dr. Benjamin J. Cousins MD Board Certified Plastic Surgeon Miami Beach/Miami/Broward

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems you are experiencing. Best to have the "breathing problems" evaluated by your primary care or internist;  best not to assume that these concerns are caused by the breast implants. Keep in mind, that there are a variety of different ways to remove breast implants and the en bloc removal is not always necessary or indicated. This procedure does take longer to perform (and is associated with a longer incision);  costs of surgery are generally greater when patients undergo the en bloc removal.
Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en block removal of breast implants is a good procedure.
On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.
 
In regards to outcome of the planned procedure, more important than costs of the procedures will be careful selection of your plastic surgeon. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to SEE lots of examples of their work AND preferably speak/see patients who have had similar procedures done.
 I hope this helps. Best wishes.

Connie Hiers, MD, FACS · Answer

I would suggest meeting with a board certified plastic surgeon and discussing removal of your implants. I would suggest seeing your family doctor and discuss your breathing issues. Your implants are not interfering with your breathing.

Pravin Reddy, MD · Answer

Based on the "hardness" and symptoms you are reporting, you are likely experiencing a severe form of Capsule Contracture of the breast.  This occurs in 4-8% of all cases of Breast Augmentation.
Capsule Contracture is treated by removing the implant and the associated capsule or scar tissue.  If you elect to have the implants replaced, the surgeon may change to a different plane.  Some believe that Singular for 6-months may prevent the return of capsule contracture.
If you elect not to have the implants replaced, you may choose to undergo a breast lift in order to achieve an attractive breast shape.
A Board Certified Plastic Surgeon skilled in reconstructive breast surgery would make an excellent choice for consultation.  I wish you luck in your future treatment.

Camille Cash, MD · Answer

I'm sorry to hear of your issues.  I recommend that you see your primary care physician regarding your breathing problems right away.  For the implant removal you can research board certified plastic surgeons in your area on the internet, look through credentials, and before/after photos.  The ASPS website may also be helpful.  An examination will determine if both the implant and capsule need to be removed, but it is likely based on your description.  Best wishes.

Marc J. Salzman, MD, FACS (retired) · Answer

Thank you for your question. It sounds to me like you have capsular contracture which is where the scar tissue around the implant becomes too tight. A capsulectomy is a standard procedure performed by plastic surgeons who deal with breast implants. Whether or not to replace a new implant, do a lift, or do nothing should be discussed with your chosen plastic surgeon.  Hope that's helpful.

I've had silicone implants since 2004. Implants are hard and causing breathing problems. Is en bloc the way to go?

Answers (9)

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