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Explantation Surgery: Advice and Information

Preparation for Explantation Surgery

~You're Not Alone~

The Advice in this Page is a Collection of Suggestions, Contributed by Many Women who have had Breast Prosthesis Explantation Surgery. The Purpose of this Site is to Make the Surgerical and Recovery Phases of Your Experience as Uncomplicated and Successful as Possible. **This page has been updated, please refresh using your browser**

Site Index

Choosing a Plastic Surgeon

Questions and Concerns to Discuss with Your Plastic Surgeon

Pre-operative Preparations

Supplements That Should Not be Taken Prior to Surgery

Preparations for the Day of Surgery

Post-operative Suggestions

Mastopexy Reconstruction

SBI Explantation Photogallery: "Before and After" Photographs

Obtaining and Handling Breast Implants After Explantation

Sample Letter: Request for Implants to be Sent to a Specialized Pathologist

Specalized Pathologists

Explantation Abstracts and Articles

Testimonial

Guest Book - Please Leave Comments

Preparation for Surgery

Choosing a Plastic Surgeon

Choosing a Plastic Surgeon

Once you have decided to have your breast implants removed, the next important decision you need to make is to chose a plastic surgeon to do your surgery. It is preferrable that the plastic surgeon you chose have considerable experience in removing breast implants by using the"En Bloc Procedure," since this is the preferred method of removal. En bloc removal refers to removing the implant, and the thick fibrous capsule surrounding it, together and intact. This prevents spillage of contaminants into the chest cavity. It is also preferrable that your plastic surgeon be sympathetic to your preferrence to remove your breast implants because of health concerns. A plastic surgeon should not try to discourage explantation surgery. It is advisable to ask women who have had this surgery if they could provide you with referrals for a plastic surgeon that you could investigate. Ask other women who have used the plastic surgeon you are considering if they were satisified with their results. The plastic surgeon you chose should be accredited with the American Board of Plastic Surgery (ABPS) and the American Society of Plastic and Reconstructive Surgery (ASPRS).

Questions to Ask the Plastic Surgeon

Ask if s(he) is familiar with 'the en block procedure' for removing implants. Ask how many procedures of this nature s(he) has performed, and when the last one was performed.

Have the plastic surgeon explain, step-by-step, how the procedure will take place. Begin with how you will be "prepped." for surgery.

Ask if it would be possible for you to view some "before and after" photos of explantation surgeries s(he) has performed.

If the plastic surgeon did not mention drains in the explanation of how the procedure will be done, ask if s(he) will use drains to prevent accumulation of fluid and infection.

Ask how long the surgery will take.

Ask how long initial recovery will take. Ask the length of time it will be until you are able to function independantly at home. Find out how long you will need someone to stay with you after surgery. It is advisable that someone stay with you for the first 24 hours, and possibly a little longer. depending upon your recovery progress.

Ask how long it will be before you can resume normal activity. Everybody recovers at different rates, but most women are 'out-of-commission' for about two weeks, and cannot raise their arms above their heads for a month or longer. Find out how long you are not to lift anything heavier than three pounds, how long you should not drive, and how long should you wait to participate in any strenuous activities such as jogging, sex, exercising...etc. .

Ask what size (s)he expects you to be after the surgery.

Have the plastic surgeon explain what Mastopexy (breast lift) surgery is, how it is performed, and if you would benefit from it. (Please see the web page, "Mastopexy: Other Options for Breast Reconstruction.")

Ask If (s)he will prescribes antibiotics after surgery to prevent the complication of infection. Discuss all post-op medications he will use and what their purposes are. Ask if it would be possible to fill them the day before surgery to provide the convenience of them being available directly following surgery.

Ask if (s)he will film the surgery on video. If so, request a copy for yourself. Ask whether or not you need to supply a blank tape. If this is not possible, ask if you may provide a camera to have the surgery photographed.

Ask what type of bandage (s)he will use and how long it is to remain on.

Ask when you will need to start wearing the sports bra.

Ask for the phone numbers you will need to get in touch with him after-hours.

Request that any cysts or other suspicious tissue be sent to the pathologist for examination and report. Tell him that you would like to have any removed suspicious tissue and cysts returned to you with your implants. You may wish to have another pathologist examine them at a later date.

Explain that you wish to have your implants returned to you. Ask which pathology service he uses and ask for their contact infomation. Ask him the proper procedure to use to ensure that your implants are returned to you.

Explain that you would like to request copies of the Operative Report and the Pathology Report from this surgery. Ask about proper procedure to ensure that you receive these copies.

Once You Have Selected a Plastic Surgeon and Have Set a Surgery Date, Be Sure to Discuss the Following With Your Doctor:

List all Medications that you take, including the strength and frequency that you take them.Inform your doctor of any drug allergies that you may have. Also, let your doctor know if you are allergic to latex or talc. Make a list of all of any symptoms you may have., and include dates that they began, and how they have progressed since they began. Include a history of all surgeries you have had.Obtain and bring your original operative/surgical report from having your breast augmentation surgery. The original operative report will contain helpful information about your implants, such as: the manufacturer, the model number, the lot number, and the will indicate how the implant was positioned. Also, bring any recent MRI, mammogram, xerommogram, or ultrasound reports. If you have had any recent lab work, bring these results with you, even though, your doctor will probably have them repeated prior to surgery. A comparison of the most recent labwork and the labwork he will do, will be helpful to your doctor.

Preparations for Surgery

Supplements & Herbs that Should Not be Taken Prior to Surgery:

Hidden Dangers or Helpful Medicines?

Herbmed-Six Categories of Definitions for Over a Hundred Different Herbs

FDA Center for Food Safety and Applied Nutrition

Curb Herbs Before Surgery -

Tell Your Surgeon if You're Taking Supplements

Pre-operative Preparations:

Make arrangements for transportation to and from surgery. It is advisable to have someone stay with you for the first 24-48 hours to assist you.

Take care of all personal business that will need attention during your recovery.

Do all heavy cleaning prior to surgery date. Try to make the environment you will be coming home to as sterile as possible to lessen the chance of infection.

Arrange a side table by your bedside where you can keep items you will need while recovering: drinking glass, medications, pen, and writing pad, etc. .

Prepare three pillows to bring for the car-ride home. Place one pillow beneath each armpit to keep arms at a comfortable level. Place one pillow in front of your chest. Sit in the back seat . This is to protect your chest in case of sudden stops.

Keep these pillows available so you may use them to prop your arms while sitting or lying on your side.

Keep your doctor's phone numbers~both during office hours and after office hours~ close to the telephone for easy access should you need to call.

Purchase (if necessary) a sports bra for after surgery. You will have to have one.

Purchase your prescriptions prior to surgery date. Most doctors will let you have them filled the day before surgery as you will not be able to do so after surgery.

Purchase (if necessary) sleepwear that buttons down the front. This will provide you easy access to the drains and are easiest to put on since you cannot raise your hands above your head.

Purchase two "throw-away" cameras~request that pictures be taken of the surgery. Give one camera to the Pathology department and request in a letter that they photograph the implants, the capsules, and any other tissue that was removed. Many doctors videotape the operation. If yours does, request a copy of the video tape.

Write a letter to the pathology department requesting that your implants be returned to you in sealed containers in the proper preservative. Give a copy to your doctor and to the hospital If you are planning to have an additonal pathologist examine your implants at a later date, do not have them put in any perservatives.

To help with meals after your surgery, you can help make this easier by doubling your recipes for several days before your surgery date. Freeze the extra amount your prepare [zip lock baggies are helpful for this] and you will have meals prepared already which can be easily warmed up in a microwave, and will provide you with meals while you are recuperating. To make clean up easy, use disposalable plates and serving ware.

Remember to keep detailed records and to save all receipts of all expenses you incur related to your surgery and office visits. These expenses can be deducted on your tax return if you itemize deductions. Refer to related tax publications for more information.

Preparations for the Day of Surgery:

Follow pre-operative instructions provided by your plastic surgeon.

Remove fingernail polish. This is done so that the nurses and anesthesiologist can view your fingernails as a guide to proper oxygen saturation in your body.

Leave all jewelry and other valuables at home.

Wear or bring a loose top that does not require you to raise your arms to put it on. A loose blouse that buttons down the front.is sufficient.

Confirm transportation arrangements. If you are travelling a long disance to have your surgery done, you should confirm all transportation arrangements well in advance.

Bring three pillows to brace yourself with while you travel home. Place a pillow beneath each arm, and place one in front of your chest. It is advisable to sit in the back seat for the car-ride home.

Post-Operative Suggestions

Follow all of the post-operative instructions provided by your plastic surgeon.

It is extremely important to rest and relax during your recovery. Do not attempt to use your arms for any lifting or heavy movement. It is also advisable to drink plenly of bottled spring water during recovery.

Use pillows to prop your arms up to a comfortable position in bed, after surgery.

Some ladies have found that sleeping in a recliner after surgery is more comfortable than a bed. This, of course, is a personal preference.

Contact your plastic surgeon if you have any complications.

Vitamin E will help fade the scars from the surgery. Aloe and Cocoa Butter are also effective. Apply once incision has begun to heal. As always, check with your doctor prior to applying anything to the incision

Do not attempt to remove your bandages for any reason unless instructed by your plastic surgeon to do so.

Contact the hospital or surgical center and request copies of your Operative and Pathology reports.

Treat your preserved implants with extreme care. Keep them in the container and treat them just as you would any other toxic biohazard material. Do NOT put them in your refrigerator as they may contaminate your food.

Be very patient. You will not recover overnight and it will take some time until you are back doing your normal activities.

Do not shower until after your drains are removed and your doctor gives you approval.

Minimize your activities until your drains are removed. Do not lift anything heavier than three pounds, and do not raise your arms above your head, until the drains are removed and you are comfortable doing so.

Your doctor will generally allow you to resume your normal acivities gradually approximately four to six weeks after surgery. Do not rush your recovery, and do not exercise or overuse your chest muscles during your initial recovery phase.

Mastopexy Repair

Most women are very concerned with how their breasts will look after explantation surgery. Because it is impossible to tell how much tissue wll be lost before the surgery, (especially with silicone gel implants), it is impossible to predict how every woman's breasts will appear after surgery. It is adviseable to have a mastopexy if there is enough breast tissue remaining and it is possible .During this procedure, the sag in the breast is removed by excising slack tissue. Often, the nipples and aerola are removed and relocated which gives the breast a much more appealing, natural appearance.Most insurance companies will not pay for this type of surgery because it is considered cosmetic surgery. It would be wise to check with your insurance company to see what, if any, their coverage would be. Since there are many different procedures for this surgery, it is advisable to research your plastic surgeon's level of expertise. Often, other women who have had thsi surgery performed by this same doctor are the best guide to the quality of surgery you can expect. Ultimately, however, it is difficult to determine how each woman't breasts will appear after explantation before surgery.Please check this web site for more information about Mastopexy surgery. This site also has "before and after" surgery photographs of explantation surgery...some with mastopexy repair, some without. Check the SBI Photogallery for cases that include photographs. The photgallery is under construction and is currently adding more photographs.

Be sure to visit the web page below concerning Mastopexy Surgery:

Mastopexy: Other Options for Breast Reconstruction Surgery

To View "Before" and "After" Photographs of Explantation Surgery, View The SBI Explantation Photogallery Below:

The SBI Explantation Photogallery

Obtaining and Handling Breast Implants After Explantation Surgery

Your implants are yours to keep, and every woman should keep her implants after explantation, especially if litigation is involved.Sometimes, after surgery, a woman's implants are given to her when she leaves. Other times, the doctor will have the implants taken to a pathology laboratory of his choice. If the surgery is done in a hospital, they most likely will be sent to their laboratory. Here, general testing is done...a description is dictated and later written in the operative report. To have specialized testing for microbes and chemical composition done, however, the implants will have to go to a laboratory that does such specialized testing. There are only a few laboratories that are qualified to do such such testing. A few will be listed toward the bottom of this page for your convenience.A woman would want to have her implants analyzed if she were ill with symptomology common to silicone poisoning, bacterial infection, and/or fungal infection. By discovering the particular contaminant, medication can be started to to eliminate them without undergoing many medications on a trial and error basis.To be certain you obtain your breast implants it is advisable that you first discuss this with your plastic surgeon and make your wishes understood. Then, to be certain that there cannot be a misunderstanding, a letter should be sent to the Plastic Surgeon, to The Pathology Laboratory where he will send your implants after surgery, if applicable, and to the Hospital Administator, if it is felt necessary. This letter would provide evidence that these were your wishes that your implants be returned, and would also aid in preventing any miscommunications from occurring. There is a sample letter listed below which may be tailored to fit your individual needs.There have been many instances where breast implants were destroyed as a result of miscommunication. There are different pathologists working in larger pathology laboratories, and it is essential that all are informed of your wishes. It has been suggested that a note pinned to your operating gown would also aid in preventing a mistake from occurring. Once you do receive your implants after all testing is completed, it is important that they be handled as what they are: Biohazard and Toxic Waste. Do NOT put them into your refrigerator for safe keeping as they will contaminate your food. Instead, keeping them in a dry and cool place where they will not be easily found is the best way to store them. If there are small children or curious teen-agers in your home, be certain you put them in a place where they will not be able to contaminate themselves by opening the containers. Always were a pair of latex or plastic gloves when handling your implants and clean the area where you have observed them (counter tops, etc) with a solution of bleach and water: 50:50. Below is the protocol produced by Dr. Saul Puszkin, which details the proper handling procedures for removed implants, tissue samples, and serum samples. Dr. Puszkin is the Professor of Pathology and Director of Molecular Cell Pathology Laboratories at The Mount Sinai Medical Center, New York, NY.

Sample Letter Requesting that Implants be Sent to a Specialized Pathologist or Returned to Patient

January 18, 2002To Whom It May Concern: I am having bilateral saline breast implants removed on Friday, February 8, 2002 My surgeon is Dr. Huang. I would like for my implants to be sent to Dr. Pierre Blais in Canada for evaluation and analysis. It is necessary that the implants to be sent and addressed to Dr. Blais in a certain manner.In the event that you are unable to send them to Dr. Blais, I am requesting that the implants be given to me after surgery so that I can forward them to him. In the event that the implants are to be given to me to send to Dr. Blais, the implants would need to be placed in a sterile specimen bag and given to me after surgery. Dr. Huang is familiar with this procedure. If you are able to send them directly to Dr. Blais, they need to be placed in a specimen bag at room temperature and then placed in a crush-resistant box. The box needs to be labeled in the following manner:On the outside of the box, please print: "FAILED MEDICAL IMPLANT / FOR RESEARCH- -NO COMMERCIAL VALUE--NOT FOR REUSE."The implants need to be sent via UPS or Airborne Express. The implants are to be sent to the following address: Pierre BlaisInnoval496 Westminster Ave.Ottawa, OntarioK2A 2V1 Please do not send these to your pathology department. It is imperative that they NOT be placed in any kind of fixative. They are to be sent directly to Dr. Blais, or given to myself immediately after surgery! Thank you very much.Sincerely,

For Health Professionals:Protocol for Handling Removed Silicone Breast Implants

For Health Professionals: How to Handle Removed Silicone Implant Prosthesis:

Implant should be placed directly into a clean container of appropriate size. It should hold the specimens securely. Do NOT use a fixative.

Ruptured implants should be placed into a ziplock bag prior to insertion in plastic containers. This prevents leakage ig transit.

Use sterile gloves when handling implants and avoid unneccessary handling.

Label containers clearly and include:

-----Name of the patient, doctor, hospital.

-----Date prosthesis was surgically removed.

-----Memo with date submitted for testing.

-----Brief description of the implant. It is important to note whether the implant is ruptured and from right or left breast.

-----Submit relevant information regarding the explanted prosthesis such as the pathology reports, histological slides, biopsies, and paraffin blocks if they are available.

-----Notes regarding clinical histories and device manufacturer (type/date) are useful information.

Tissue Specimens: Submitting and Handling Tissues:

Use a small piece of tissue for fixation in formaldehyde for routine pathology.

The remaining tissue specimens shoudl be place in a clean container of appropriate size to ensure integrity and minimal degradation during transit (fresh or unfixed).

Handle tissue samples gently and with gloves.

Capsule or other tissues attached to silicone bag implants should be kept with the Implant and refrigerated.

If tissues detached from explants are to be kept under long-term storage prior to submission to us, they should be frozen and kept at (-20Oc).

If tissues are shipped for tests immediately after surgery, send them refrigerated (4Oc) iwth icepacks.

Tissue specimens should be placed in sample containers which are clearly labeled (see implants) and firmly shut.

Blood Serum: Submitting and Handling Serum Samples:

If serum is to be kept under long-term storage, keep it frozen (-20Oc).

If serum is drawn one to three days prior to shipping, keep blood samples refrigerated (4 Oc).

Pathologists Specialized in Examination of Silicone/Saline Breast Implants:

Pathologists experienced in examination of silicone gel and saline-filled silicone breast implants are listed below. When contacting the laboratory of your choice, ask about fees, whether or not they accept insurance, length of time it will take until you receive report from pathologist, and what tests will be run on your implants. Contact your insurance carrier and ask about coverage for this laboratory expense.Dr. Saul PuszkinProfessor of PathologyDept. of Pathology Box 1194Mount Sinai Medical Center1 Gustave L. Levy Placenew York, NY 10029-6574(212) 241 - 5635 or Columbia UniversityAudubon Bldg. P & S3960 BroadwayNew York, NY 10032Voice mail - (212) 342 - 7272SaulP2000@...Dr. Pierre Blaisc/o Innoval Ltd.496 Westminster Ave.Ottawa, Ontario K2A2V1Canada(613) 728 - 8688(613) 728 - 0687 faxDr. MiddletonUniversity of California - San DiegoImaging Department410 W. Dickinson St.San Diego, CA 92103Direct Line: (619) 543 - 3913Dept. Line: (619) 543 - 6414

Explantation Abstracts and Articles

To View the Following Abstracts and Articles on Explantation Surgery, Use the LInk Provided Below:

Abstracts and Articles: Explantation Surgery

Explantation Surgery: Articles and Abstracts

*1. Explantation of Silicone Breast Implants

*2. Explant of Breast Implants, Should Your Insurance Company Pay??

*3. Complications Related to Retained Breast Implant Capsules

*4. Breast Implants: New Technique Helps Restroe Aesthetic Breast Contour Following Removal of Implants

*5. Residual Silicone Detection Using MRI Following Previous Breast Implant Removal

*6. Outcome of Mammary Prostheses Explantation : A Patient Perspective

*7. Silicone Gel Breast Implant Rupture, Extracapsular Silicone, and Health Status in a Population of Women

*8. Failure Properties of 352 Explanted Silicone-gel Breast Implants

*9. Calcification of 404 Silicone-gel Breast Implant Capsules

10. Explantation of Trilucent Implant Experience

11. Current Status of Breast Implant Survival Properties and the Management of the Woman with Silicone-gel Breast Implants

12. Failure Properties of Leaf Valve Inflatable Saline Breast Implants

13. An Outcome Analysis of 100 Women Following Explantation of Silicone-gel Breast Implants

Testimonial from the Voice of Experience

These suggestions are based upon my personal experience, and upon the experience of many other women, who have had breast implants removed. In other words, we've "been there." Although post surgical emotions may vary, of course, it is the experience of this explanted author, who has received a great deal of input from other explanted women, during the past ten years, that most women feel relieved after removal of implants that have been a source of pain, embarrassment, worry, and illness. The personal experience of this author was, "Free at last!" Beware of offensive statements, which may be nothing more than scare tactics, from those who usually have vested interests in the breast implant trade! You may be "warned" that removal of breast implants may result in a severe psychological disturbance, loss of interest in sexual relations, or a strong negative impact on your physical appearance. It is the experience and opinion of this author, and of other women, who have had their implants/scar capsules removed, that these "warning" statements are wrong. RE: The Above "warnings" which are contained within the "Breast Implant Removal/Patient Review and Advisory" form: Prior to surgery, our plastic surgeons dutifully presented us with said form, ostensibly from their insurance carriers, that contained, among other statements, the above "warnings," which we were asked to acknowledge, and sign to certify our "understanding" of the "effects" of removal. Suggestions to those who may be presented with said form: You may wish to sign the form, most of us did so; however, you are free to include additional comments on the same form. For example, you may wish to write: "I don't agree with any of the above statements, but it is my understanding that I must sign this Review/Advisory in order to receive treatment and care for explantation of breast implants/scar capsules." As always, initial and date your notation, and request a copy of the form you have signed for your records. Again, thank you so much for providing this excellent source of information for those seeking answers to the many questions that beset them in their quest for a safe and expeditious extrication from breast implant hell.God bless you,

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Dedicated to all Silicone Sisters~

~Together we can learn~ ~~Together we can conquer~~

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