I have silicone implants with rupture. I want them removed en bloc, without replacement. No lift. Met with a doc, have concerns

Question

1. I was told it may not be possible to remove everything via en bloc but I would still have a full capsulectomy. Is that good enough given I have a rupture to prevent contamination from free silicone to surrounding tissue? 2. I was told there will be no drains because aesthetically everything will heal nicer, because everything wont be be sucked down from the drainage. Is this safe/recommended? Also, is it necessary to be on antibiotics during recovery or is during surgery alone enough?

Michael Cohen, MD · Answer

Thank you for your question.  
1. You were told correctly, it is not always possible to remove the capsule with the ruptured implant en bloc, and it is the surgeon's job to then remove the rest of the capsule and to clear the breast pocket of any free silicone, which is not difficult to do.  Your surgeon was simply being completely honest with you, which is a good thing.
2. The preference for postoperative drains is very surgeon-dependent.  There are no hard rules about drains after breast surgery, and if you trust your surgeon, I would go with his or her plan.  Same goes for postoperative antibiotics: every surgeon has his or her own preference, and I would go with your surgeon's recommendation.  Good luck with your surgery.

Leland Deane, MD, FACS · Answer

Without pregnancies, the muscles usually do not stretch enough to require repair. There CAN be some intra-abdominal fat which acts like a 'pregnant uterus' but this is rare. I usually do not repair muscles in someone like you unless I see a defect during the surgery.Hope this helps.

Gary Lawton, MD, FACS · Answer

For explant surgery, it is almost always best to remove the capsule in its entirety. This will allow the space to heal. If you leave the capsule in place, it does not heal. Fluid can accumulate in the space. The situation that brings the patient to implant removal will have an affect on the decision. This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns. The body does not re-absorb the capsule. Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule. If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower. If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.

Gary M. Horndeski, MD · Answer

Recent studies have
shown that patients that undergo explantation alone without a lift are
dissatisfied and require a lift later.  Removal
en bloc is possible but tears during the removal frequently occur with
retropectoral implants.  Best Wishes,Gary Horndeski, M.D.

Urmen Desai, MD, MPH, FACS · Answer

I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your excellent questions.  For most patients with implants placed below the muscle a subtotal capsulectomy is performed, removing as much of the tissue as possible while maintaining patient safety.  Drains can be used to help reduce the size of the implant pocket and to remove any fluid that develops during the healing process, but is not absolutely necessary.  Typically only antibiotics are needed prior to surgery.  Hope this helps.

Tom J. Pousti, MD · Answer

Thank you for the question.   En bloc breast implant removal refers to a procedure where the breast implant and the surrounding capsule is removed as a single unit.  The procedures is performed such that the contents within the breast implant capsule do not come into contact with the surrounding tissues.  Generally, the procedure requires a longer incision (6-7 centimeter) usually in the inframammary fold, in my experience.  Also, in my experience, the procedure is more successful when capsules are thickened as opposed to when patients are very thin (normal) capsules.  Also,  sometimes complete capsulectomy is not safely possible;  for example, breast implants place in the sub muscular position may have a capsule that can be  densely adherent to the patient's rib cage. Removal of this posterior capsule can be potentially dangerous.
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 bloc removal of breast implants is a good procedure.
On the contrary (again), 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 my practice, I use drains for patients 'sundergoing breast implant removal surgery.  
 Best wishes.

Jeanette Padgett, MD, FACS · Answer

It is best to remove the ruptured implant and the capsule together in one piece, which is called en bloc.   However, it is not always possible to remove en bloc if the implant is rather large even if the incision is lengthened.  At that point, you surgeon will remove all of the ruptured implant and the capsule.  Your surgeon has examined you and is giving you a realistic description of what is possible at surgery in your situation.  Not everyone uses drains. Everyone has their own preference on the use of drains and the length of antibiotic use.  Discuss with your surgeon any questions you may have.  Best wishes.

Camille Cash, MD · Answer

If your surgeon is not able to remove all free silicone via en bloc then he/she will attempt to remove as much remaining free silicone as possible.  The use of drains is done by surgeon preference.  If you are uncomfortable with what the surgeon has described to you, you may wish to seek a second opinion from another board certified plastic surgeon.  You want to be comfortable and confident as you go into surgery.

Susan Buenaventura, MD, FACS · Answer

It is desirable and preferable to remove the implant and capsule en bloc, but sometimes if the implant is large, this can require a longer incision than is desirable.   The free silicone can be safely removed, protecting your tissue, and then a complete capsulectomy would be done as well.  Drains would be important in this setting.  Perioperative antibiotics should be adequate.

I have silicone implants with rupture. I want them removed en bloc, without replacement. No lift. Met with a doc, have concerns

Answers (13)

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