Do hospitals do pathology on ruptured breast explants when there is known silicone leakage?

Question

I am getting my 30plus old bi-lumens explanted (no replacements) next week but hospital is telling me they will not do pathology on them. Isn't this routine? What if I have bacterial or cancer in the tissue. The mammogram showed leaking silicone and wasn't caught on old mammograms in 2007, 2010 and 2012 from different clinic. What if I demand them back and personally send the to a microbiologist lab following all biohazard safety procedures? Thank you (will send pix later after explant if you want)

Nelson Castillo, MD · Answer

Thank you for your question.  Though the scar tissue surrounding an implant can be sent for pathology, the ruptured implants are sent back to the manufacturer for analysis.  The scar tissue around the implant is sent to pathology when there is a specific area of concern, but otherwise not routinely sent.  If you would like to have any tissue analyzed it is possible, just ask your surgeon about this separate cost.

Anthony Deboni, MD · Answer

Thanks for your question.  Hospital policy varies between institutions.  Many hospitals state that any implant removed needs to go to pathology for evaluation.  This, however, is usually just what is referred to as an"ID only."  In this case, the pathologist just looks at he implant and states on record that it is a ruptured silicone implant, etc.  If a capsulectomy is done, where the surrounding tissue is removed, I always send this for pathological examination.This usually just involves examination microscopically to look for abnormal cells, etc.  Cultures looking for bacteria are usually not done routinely unless a separate culture is performed and sent by the surgeon.  Despite what the hospital says, you should be able to ask you surgeon to send the implant and any tissue for evaluation, if you desire.  Just be aware that there may be costs associated with those tests if your insurance doesn't cover the evaluations. Hope tha this helps.  Best Regards

Jane M. Rowley, MD · Answer

It will be obvious to the surgeon that the implants are leaking.  When I remove these implants I do cultures if I am worried about an infection.  I also biopsy anything that is abnormal to rule out cancer.  The implants and capsule are evaluated as well but usually not microscopically.  Mammograms are not a reliable way to determine leak.  Good luck. Jane

Ciro Adamo, PhD, MD · Answer

Generally, pathology would be done for sample of the tissues surrounding the implants, including the capsule and any fluid collection that may be present, but implants themselves are sent back to the manufacturer for a physical examination and evaluation of the possible causes of rupture.If there is a suspected bacterial infection your surgeon will most likely arrange a culture. A suspect of cancer, which would not be related to silicone gel as far as we know from the available studies, should have been raised by the already performed breast imaging study.

Sean Kelishadi, MD · Answer

Hello BonHeinrich and thank you for your question. The capsule can be sent to pathology if there are any concerns.  Usually for a cosmetic procedure like this, your insurance will not cover the pathology evaluation and you need to discuss this with your surgeon if it is important to you and state that you would be willing to pay out of of pocket for the pathological analysis if your insurance does not cover it.  With respect to the implants, they are usually discarded or sent back to the manufacturer.  Make sure you are having your surgery performed by a board certified plastic surgeon with expertise in breast surgery. I hope this helps and good luck!Sincerely, Dr. Sean Kelishadi

Tom J. Pousti, MD · Answer

You will find that practices will vary from one institution to another (there is no "routine"). For example, in our practice, removed breast implant are not evaluated by pathologists.  if you wish to have a specific evaluation performed, make sure that you discuss your preferences with your plastic surgeon; working together you will come up with the best plan to proceed with. Best wishes.

Robert E. Zaworski, MD (retired) · Answer

Breast implants are not sent to pathology, but many times the capsule is.  Discuss this with your surgeon.

Ronald V. DeMars, MD (Retired) · Answer

Pathology is done on tissue, not on implants. Implants, after removal, are sent to the manufacturer for evaluation.

Do hospitals do pathology on ruptured breast explants when there is known silicone leakage?

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