I had bilateral mastectomy and silicone implant reconstruction in 2006. One of the implants has ruptured. Is explant with enbloc reccommended? Can a saline implant be put in during the same surgery? Can you explain the process for my situation?
My Mastectomy Reconstruction Silicone Implant is Ruptured. Can Explant Enbloc and Saline Replacement Be Done at Same Time?
Doctor Answers 16
Ruptured Silicone implant Removal, Capsulectomy, and Implant Replacement recommended
Enbloc removal of the ruptured silicone implant and overlying capsule, also called capsulectomy, is done to remove all visible silicone from your body. It is possible to replace saline implants during the same surgery.
Yes capsulectomy and replacement with a new implant can be performed at a single surgical setting.
Removing a ruptured silicone implant
The treatment of choice for any ruptured silicone implant is to dissect around the outside of the capsule or scar tissue first. That way the silicone gel can be removed "enbloc" inside of the capsule with less spillage. With ruptured silicone implants the gel remains confined within the capsule usually. Choice of reconstruction needs to be discussed with your plastic surgeon. If silicone was a good idea the first time it probably is still a good idea.
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Replace Ruptured Implant
You should be able to have the ruptured silicone implant removed and a new implant replaced at the same time. Discuss with your surgeon if any attention should be placed on the opposite breast
Ruptured Silicone implant breast reconstruction may best be replaced with your own tissue flap
Typically an en bloc resection is performed with an intact breast. In a reconstructed breast, the amount of tissue which can be resected prior to compromising the wound becomes a critical factor. Alhough I understand your desire to have saline implants, it may be time to consider an autogenous tissue reconstruction.
You can do both operations at once
You will most likely need a capsulectomy (or removal of the scar tissue around your implant) - this can be done at the same time as your implant removal and placement of a new implant. You can use either the new silicone implants or saline at the time of your operation. Good luck!
Replacement of Ruptured Silicone Implant Reconstruction
It is common place to replace the implant after en bloc removal of the ruptured silicone implant. Prior to choosing a saline implant, take time to research the risk to benefit ratio of a saline versus silicone augmentation after mastectomy. The newer silicone implant has a softer, more natural feel compared to saline implants. Although a saline implant after mastectomy will give you the look and feel of a natural breast, a silicone gel implant will give you a more natural feel.
Remove implant and replace in one operation for reconstruction
Most of the time the procedure would be exactly as you describe, en bloc removal and a new implant at the same time. However, there are a number of considerations; for example, was there a capsular contracture? Also, will there be enough tissue for good coverage after en bloc removal? This would be especially important since saline implants are more prone to rippling and may not look as natural. In either case it might make sense to use an alloderm graft to add coverage and support, and it also helps to prevent capsular contracture.
Can a leaking Breast Reconstruction implant be replaced with anothe at Same Time?
Regarding: "My Mastectomy Reconstruction Silicone Implant is Ruptured. Can Explant Enbloc and Saline Replacement Be Done at Same Time? I had bilateral mastectomy and silicone implant reconstruction in 2006. One of the implants has ruptured. Is explant with enbloc reccommended? Can a saline implant be put in during the same surgery? Can you explain the process for my situation?"
With exception of infection, I cannot think of a reason why you leaking silicone implant should not be removed along with its normal scar tissue envelope and be replaced with another breast implant. I would be curious why the implant leaked in only 5 years. Textured surface implants do leak sooner than smooth ones. I would recommend you reconsider your choice of implants. Silicone gel implants are lighter and ripple less than saline implants.
Dr. Peter Aldea
Removal and Replacement- Usually a Single Procedure
In most situations, it is possible to remove ruptured implants and replace them with new implants at the same surgery. Certain circumstances, like the presence of infection, would preclude the placement of new implants. If you want to avoid implants, you could consider replacing your implants with your own tissue (for example with a DIEP flaps).