Removal of Breast Implants – En Bloc Dissection
Breast Implant Explantation & Concerns
Dr Fedric Barr has 34 years as a board-certified plastic surgeon. He has performed a great number of successful breast enlargement procedures. Of his patients who did request implant removal or exchange, the reasons were primarily, implant rupture, significant scar capsule removal or patients changing cosmetic desire.
In some cases, patients requested removal of their implants because the implants were thought to be making them ill. Thyroid hormone, allergy, or autoimmune issues have been reported. Symptoms include, but are not limited to, fatigue, low energy, brain fog, memory loss, headaches, joint and muscle pain, hair loss, repeated infections, swollen lymph nodes and glands, rashes, gastrointestinal upset, weight loss, insomnia, anxiety and depression.
Breast Implant Associated Anaplastic Large Cell Lymphoma
In 2011, the FDA became aware of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare condition now thought to be related to textured silicone breast implants. BIA-ALCL presents as significant pain and swelling in the implanted breast noted after the incision from the initial procedure has healed, often occurring years after the augmentation procedure. Treatment involves oncologic work-up and an en bloc dissection – complete removal of the implant and surrounding scar capsule tissue. Additional chemotherapy may also be indicated. Recently Australian researchers reported the risk of BIA-ACLC is approximately 1:3,000 and associated with textured silicone implants. It is completely curable if detected and treated early.
En Bloc Dissection
The terminology used when talking about breast implants and scar tissue can be quite confusing:
- Implant – Refers to the breast implant itself – can be saline or silicone.
- Capsulectomy: The capsule around the implant is removed. This procedure is usually done when the capsule feels hard or when an implant is being permanently removed.
- En Bloc Removal: In this procedure, both the capsule and implant are removed in one piece, with the implant remaining contained within the capsule.
The Choice Is Yours
It is important to remember the choice to get implants and to remove them is ultimately the patients. Regardless of future definitive scientific silicone implant adverse associations, it is abundantly clear some women genuinely feel their bodies are being adversely affected by their implants and deserve to have their concerns acknowledged. For this subset of patients, Dr. Barr has advocated for the removal of their implants and surrounding scar tissue in hopes of freeing these women from the adverse reactions they believe their bodies are suffering. Cosmetic options after implant removal are either no further treatment or mastopexy – a procedure where breast tissue is reshaped to give a pleasant cosmetic breast appearance.
Talk to Your Surgeon
Today people are often influenced by the trends and information that is seen on social media. In truth, much of the information being circulated is based on personal opinions and not backed by scientific research. Although we all have a right to form our own opinions, it is a surgeon’s job to listen to a patient’s preferences and wishes and educate them regarding their options. It is also every surgeon’s responsibility to inform patients about possible complications based on the most up-to-date scientific evidence and do the best job possible to avoid any such complications. Every person heals and potentially reacts differently to surgery, and it is impossible to “ guarantee” the avoidance of every possible predictable or unpredictable complication. Patients need to weigh the benefits as well as the potential risks of breast implants and make their own choices. In turn, surgeons should listen carefully to their patients and help guide them with these most personal options.
The Food and Drug Administration (FDA) has been regulating the use of silicone breast implants since 1976. The FDA lifted their previous 14-year ban on silicone gel-filled implants approving the newly created more cohesive gel implants in 2006.
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