Most Frequently Asked Questions....
01-27-2012, 07:22 PM (This post was last modified: 04-12-2012 09:04 AM by Beth.)
Most Frequently Asked Questions....
This post will outline the most frequently asked question from our members. It is a work in progress so please bear with us while we compose what we feel are the most asked questions by our new members along with the answers to these questions.
Please consult with your doctor. The information here is informational only. You should always check with your doctor.
Our List of Recommended Surgeons can be found here.
List of Questions to ask your explanting surgeon can be found here.
Information for Dr. Blais can be found here. Dr. Blais will analyze your implants for defects. Dr. Blais does not have an email address so you will need to contact him with any question you have. For those with saline implants, please ask if he analyzes the saline for bacteria and/or fungal growth.
Another option would be to send your saline implants to Mycometrics. They will need to destroy the implant in order to analyze the fluid inside and will give you a detailed report of what they find. The information for MycoMetrics can be found here.
What is a capsule?
The capsule (or scar tissue) is tissue that starts to form around the implant immediately following breast augmentation. This is your body's way of fighting off a foreign object. Some capsules become very thick and in turn will form capsular contracture or CC. I have not found any evidence that the capsule will dissolve after removal of the implant, despite some claims to the contrary.
What is Capsular Contracture?
Capsular Contracture or CC is when the capsule becomes thick and in turn, the breasts feel very hard and may hurt. There are different degrees of CC listed below:
Baker Grade I
The breast is normally soft and looks natural.
Baker Grade II
The breast is a little firm but looks normal.
Baker Grade III
The breast is firm and looks abnormal.
Baker Grade IV
The breast is hard, painful, and looks abnormal.
Capsular Contracture may be more common following infection, hematoma, and seroma. However, it is not known for sure why Capsular Contracture happens. The literature also discusses other factors, such as a textured implant surface and submuscular placement of the implant, which may decrease the Capsular Contracture rate. In severe or symptomatic cases, such as grade III or IV, there are different treatment options ranging from cutting or removing the implant capsule tissue (Capsulotomy vs. Capsulectomy) with or without replacement of the implant itself. Capsular Contracture often recurs after this additional procedure.
What is "en bloc" removal and why do I need it?
En bloc is needed for all silicone gel implants and textured saline implants. (Smooth saline implants do not require en bloc removal, but capsulectomy is still recommended.)
En bloc is a type of capsulectomy in which the surgeon removes the capsule and implant together and intact as one unit. This is the best method in order to prevent spillage of silicone into the chest cavity, although there is no guarantee as the capsule can possibly break during removal.
Additionally, it is very important to choose a surgeon who will know when to "throw in the towel" on en bloc removal, rather than risk tearing a hole in the lung (very rare, but possible).
En bloc removal requires a lengthy incision beneath the breast.
Last, not all surgeons use the term "en bloc," and may not know what you're referring to. This is particularly true when speaking with front office staff.
Here is an implant that was removed using the en bloc method.
Terms used and their definition:
Capsulectomy - This is when the surgeon removes the surrounding tissue or capsule and the implant separately. En bloc is not required for smooth saline implants. However, I've heard that some surgeons will remove smooth saline implants using the en bloc procedure. Some surgeons do not use the term 'en bloc' but instead will call it full capsulectomy. Please check with your surgeon for further information on how your implants will be removed.
Open Capsulotomy - This is when the surgeon makes an incision to break the capsule or scar tissue. This is normally done for those with capsular contracture. Not recommended.
Closed Capsulotomy - When the surgeon attempts to break the capsule by putting extreme pressure on the breast. NOT recommeneded as this could break the implant.
Why is it important to have all the capsule removed?
The article that will explain this can be found here.
An exception to capsule removal might be if your implants are very new (less than a few months), in which case the capsule will be very thin, and removing it may cause more trauma to the tissue than it's worth.
How can I tell if I have a rupture?
Unfortunately, there is no certain way to detect a rupture. Ultrasound and MRI may find ruptures or leaks, but they are not foolproof. Also, women with implants are sometimes advised to have a mammogram. We do not recommend this, especially if you suspect a rupture. A mammogram may further crush the implant and exacerbate the rupture. If you must have a mammogram for other reasons, please have your implants removed first.
What will I look like after removal? Will I be deformed? This is a common question and a tough one to answer as it depends on so many factors such as:
How long you've had your implants.
Whether they were placed sub-muscular or sub-glandular.
The skill of your implanting surgeon.
The skill of your explanting surgeon. (It is important to ask your surgeon how many explants - without replacement - he has done! Even a highly regarded plastic surgeon does not necessarily have the skill needed to remove an implant without deformity.)
The size of the implants. Generally, the smaller the implant, the less of a chance you will look deformed if removed properly.
The amount of breast tissue you have.
Whether you've had children.
The general quality of your skin.
The extent of your internal scarring.
From what I have seen, most women look very good after explant. There are many pictures on the internet that are placed there to alarm women so they will continue to replace their implants.
Will I need a lift?
This is only something that your explanting surgeon will be able to answer. It depends on the amount of breast tissue, how long you have had your implants and how large they were (and other factors as listed above). A description of lifts (Mastopexy) can be found here.
How much will my explant cost?
This varies tremendously by surgeon and by region. Women have paid anywhere from $2,500 to $13,000 (USD) for explant. To complicate matters, virtually no surgeon will provide a quote without a personal visit and examination. They're not trying to make things difficult! No two surgeries are the same. Cost depends heavily on how long the doctor expects to need the operating room, and explant can take anywhere from less than an hour to nearly a whole day. The best way to find out is to go on a few consultations. If you have a specific surgeon in mind, you may try sending a private message to members who have used that surgeon, who may be able to give you a broad idea. Some surgeons are notoriously expensive, and others less so. Remember that cost is not the best determinant of surgical skill.
What is the purpose of drains? Do I really need them? How long will I have them?
Drains are normally recommended as they help to prevent the build-up of fluid in the breasts after surgery. They can also allow some of the toxins that were stirred up during removal to drain out. Some women decide they do not want drains and do just fine after explant while others might experience a seroma. A seroma is a build-up of fluids that will need to be aspirated by your surgeon. There is also a possiblity of this happening even with drains although not as common. The amount of time you have the drains will be determined by how long you have fluid flowing into the drains. Normally once this slows, the drains will be removed. This is an easy procedure that will be done in your surgeon's office. It is usually not very painful, but it may feel quite strange. Until the drains are removed, you will have to empty them periodically. Your surgeon will instruct you on this procedure.
Tip: Some women will be instructed to shower the day after surgery and others will be told that they can't. For those that are able to shower with drains, take a tie and tie it around your neck. Then take a large safety pin to attach the drains to the tie. This will keep the drains up and out of the way so that you will be able to shower without someone holding them up for you. Again, each surgeon follows a different protocol so make sure you check with your surgeon before you shower while still having drains.
What do I need on Explant Day and the days following?
You should have a button up the front shirt so you won't have to lift your arms up. Some women purchase hoodies that can simply be zipped up the front.
Ask your surgeon what type of post-surgery bra you should purchase. Some will suggest a zip-up sports bra; others will want you to get a compression bra. You may want to purchase a bra online. Your surgeon may also wrap you in a bandage and not suggest a bra at all.
Plan on having help. There is simply no way to do this completely on your own. You will need someone to to take you to and from the surgical center and someone to stay with you for at least the first 24 hours.
You may not be able to drive anywhere for 48 hours (simple explant) to several days (explant with full anchor lift), post-op. Plan accordingly.
Plenty of pillows as you will want to be propped up after explant. I found it very difficult to lay flat for about a week. A wedge pillow is very helpful and may be found at Bed Bath & Beyond or similar retailer.
Make sure you have stocked up on things you will want to eat afterwards. It's best to start off with clear juices and 7-up, then move onto light food like yogurt, applesauce and the like. Nausea is not uncommon after surgery, but eventually you will want to eat again so be sure you are stocked up on easy meals (or have the numbers of your favorite restaurants on speed dial!).
If you have small children, you may need help for at least the first week or two, but if they are toddlers, try to find new ways of doing routine things that does NOT involve picking them up or carrying them. It's unavoidable with an infant, but with a 2-year old, you can often find different ways of getting into the car, dressing them or feeding them that won't cause you to strain yourself in those first few weeks after explant.
You may want to put hard-to-reach items that you will need on a lower counter.
If you are having a lift, your recovery will take longer. Prepare for this.
Drink plenty of water and rest. Some women feel so much better immediately following explant. So much so that they will resume their normal activities. Remember this is major surgery and although you might feel wonderful, your body still needs time to heal. Rest is very important.
Benadryl is very helpful to control itching.
Where can I see photos?
The best place to see photographs is at your consultation. Results can vary widely, and photos can be misleading. Make sure your surgeon has a good sample of before-and-afters to show you, so you can get an idea of the quality of his or her work, and make sure you're on the same page before you put down a deposit for surgery.
Help! What if none of the recommended surgeons are near me?
First, try using the Search button in the menu bar, and search for your state or city to find posts written by previous members in your area. You may get lucky.
Second, many women have traveled to a recommended surgeon. While this can add a fair amount of expense and stress to the procedure, sometimes it is the best choice if you cannot find an experienced surgeon locally.
If this simply isn't an option, try calling your local hospitals and asking for the breast surgery department. They may be able to refer you to an excellent reconstructive surgeon who is experienced in explant - without replacement. Not all surgeons advertise, so you may need to dig a little.
"There is no agony like bearing an untold story inside of you." ~ Maya Angelou
My Story - Toxic Breast Implants
“Some choices we live not only once but a thousand times over, remembering them for the rest of our lives.” ~Richard Bach
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