Is It Safe Practical to Have a Breast Lift, Explant and Total Capsulectomy at the Same Time? (photo)

Question

I've Had Meme Implants for 25 Year? Breasts

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jed H. Horowitz, MD, FACS · Answer

Yes, this is 50% of my breast practice at this time.   many women need several steps to get the best resultsCAPSULECTOMY/CAPSULOTOMY

One of
the most common problems with #cosmeticsurgery is #breast #capsularcontracture
or the development of thickening, and contracture of the capsule that exists
around the breast implants. Severe capsule contracture probably occurs in less
than 15% of augmentation patients. Every woman has a breast capsule around
their #implant and this is a normal phenomenon. The capsule itself could be as
thin as Saran Wrap but may also become calcified and thickened. As it thickens
and shrinks, the patient may develop a feeling a firmness of the breasts and in
its worst situation, the breast may become painful and abnormal in appearance,
achieving a very round, hard, and uneven appearance. There may be distortion
and possible breakage and leakage of an older implant, but may also include a
newer implant. Nicotine users, such as smokers, have up to a 30x increased risk
of capsular contracture.

#Salineimplants
may deflate spontaneously. When the patient has significant symptoms, complete
or partial leakage of their saline implant, or concerns regarding silicone
leakage, it is recommended that the implant is removed and exchanged.
Frequently, this is performed on both sides depending upon the age of the
implant. #Capsulotomy or opening of the capsule may be required or frequently #capsulectomy,
which is removal of the scarred capsule, is recommended to ensure adequate
pocket dimensions.

New
implants may then be placed in the same existing position or may undergo a
change of placement frequently from submammary to subpectoral position and, on
occasion, the other way around.

NEOPECTORAL
POCKET

This
is sometimes used as a technique to provide a stronger more secure placement.
In this case, the implant is removed and the capsule is dissected from the
muscle, creating a new or “neo” pocket for the implant.

EXPLANTATION
OF IMPLANTS

Explantation
is the term that has been given to describe the removal of the breast implant.

What
does explantation involve? 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.

Tom J. Pousti, MD · Answer

You are wise in that you are considering the safety of combining the contemplated procedures. Generally speaking, most patients do well with all of the procedures you are thinking about. However, based on intraoperative findings, on occasion it is better to delay the breast lift for a another day.

	 As you know, the main concern here is the amount of dissection and the resulting compromise of blood flow ( necessary for tissue survival and healing). Therefore, sometimes these decisions are best made intraoperatively based on clinical assessment of the blood flow present after each step of the procedure performed.

	 I hope this helps.

Jourdan Gottlieb, MD · Answer

When these were still around and in place for short periods of time, they were quite difficult to removed because of the thickened capsule that formed. But for many patients, after 10 years there would be no remaining polyurethane foam (the coating) and removal can be just as with other implants. If the gel has leaked, the capsule may also be thick 

	If either of these are true, it may be safer to limit the procedure to implant removal and capsulectomy, and to regroup in six months regarding the lift. This should be a contingency plan even if the plan is to do all at once. 

	Best wishes.

Steven Wallach, MD · Answer

Removing the implants is fine and doing the lift maybe OK too. If you do not have a lot of tissue to mold it can be difficult and therefore delaying the lift may be beneficial in that case.

Thomas P. McHugh, MD · Answer

I have found this to be safe when all done at the same time. Conservative elevation of the skin flaps with the lift I have found to be the key. This procedure is very common place with people having their saline implants removed and replaced with silicone. The older silicone implants are also common to remove and lift with capsulectomy with or without placing new implants. Good Luck!

Hilton Becker, MD · Answer

I commonly perform a breast lift at the time of explant  Capsulectomy is done if there is calcification or siliconomas. Often a  capsupotomy ( releasing  of the capsule)  is sufficient

Is It Safe Practical to Have a Breast Lift, Explant and Total Capsulectomy at the Same Time? (photo)

Answers (7)

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