Dealing with Explantation, Marguerite Barnett

[Guest guest]

Dealing With Explantation

Marguerite Barnett, MD, Plastic & Reconstructive Surgeon

Venice, Florida

From AS-IS Newsletter, January 1995

For some, the decision to remove one's implants is an agonizing one, given the uncertainties as to whether one's health will improve and what the physical outcome will be. For others, the real agony is the actual surgery and the physical aftermath. For still others, the difficult times lie in the recovery, piecing together one's physical, emotional and financial health. Whichever way one looks at it, explantation is no picnic - fear, anger, grief, betrayal, uncertainty and anxiety layer with physical incapacity. While it is usually impossible to make the decision to remove one's implants an easy one, it is possible to lessen the negative and magnify the healing aspects.

In my opinion, preparation is a key ingredient to having explantation go smoothly. First you must be prepared mentally. With few exceptions, explant surgery is not an emergency such as removal of the appendix or trauma surgery to stop hemorrhaging. It does not even have the urgency of most cancer surgery This is both good and bad- bad in the sense that the need to proceed is less clear-cut and good in the sense that the time can be taken to fully understand the pros and cons of surgery. One can get second or third opinions, take time to read and research and find a physician with whom one feels comfortable. Some people made the mistake of getting implants assuming that such surgery would solve their problems - it is equally silly to assume that removing implants will do the same. I am not going to cover all aspects of making the decision as this has been well covered in previous issues, but do not be passive and allow the surgeon (or anyone for that matter) to make all decisions for you. His/her job is to present all your options,the risks, costs and expected outcomes. He/she cannot make the decision for you because there is not one right answer - you will have to live with consequences, not the surgeon - and each person is a very unique individual.

Secondly, be prepared emotionally - this is not the time to show everyone what a superwoman you are - able to go through surgery and keep up the duties of mother/wife/caretaker. It is ok to be needy, grieve, or be angry. Call in your chips - this might be the time to involve family members such as children/spouses in the tasks of daily upkeep if you haven't already. Call upon extended family, if available, for support. Support groups can be such an asset in this respect as you will meet women there who have gone through this themselves. I am have seen women helping women and it can be such a beautiful healing.

Thirdly, be prepared physically. Stop smoking, preferably six weeks prior to your surgery. Do not take aspirin containing drugs within nine days of your surgery (be careful, even unexpected sources contain aspirin e.g.: Alka-Seltzer.) If you have a question, check with your physician/nurse about medications.

Avoid excessive alcohol in the immediate pre and post-op period. On the day of surgery and on the first few post-op check ups, wear loose comfortable clothing, preferably something which buttons up the front and avoid white which could be stained. Do not wear make-up or jewelry to the surgery suite, but if the nurse allows it, you might want to have heavy socks as the OR is usually chilly. You will probably want to have some snacks or frozen dinners available for the first few days post-operatively as you will not feel up to cooking. Have dishes/items you need within easy reach as you will probably be too sore to reach for high shelves. Be sure you understand all your physician's post-op instructions; it is best to get them in writing so you understand and can remember when follow-up visits are scheduled, what limitations there are on physical activity and when bathing is allowed. Insure that pets or small children will be restrained so they cannot jump on sore incisions. Have your post-operative support bras available and prescriptions filled. Your physician will specify what is required, but if he/she has no recommendations, it is best to wear a good support bra, day and night, for the six weeks post-operatively. Some prefer to hook-in-front sports bra and others prefer a shaped cup, but the most important criteria is the upward lift to relieve strain on traumatized tissue. Finally, be sure that all the questions regarding disposal of the implants are settled. Under no circumstances should implants/tissue be discarded until all legal issue are settled.

When you are prepared as possible, let go of as much anxiety as you can and relax, trusting in your surgeon to do his/her job and in your body to heal. This can be a very difficult step, but it is vital for your healing. If you have religious beliefs, look to them at this point. This is the meaning of the Serenity Prayer, "Lord grant me the courage to change the things I can; serenity to accept those things I cannot change and wisdeom to know the difference." A concrete exercise to help with letting go is to concentrate on one's breath, breathing deeply and slowly with the diaphragm. These same techniques are utilized in the LaMaze Method of natural childbirth and will work to lessen pain/discomfort. Sometimes, a simple gesture such as taking a favorite stuffed animal into the OR (if allowed) or a Walkman with soothing tape, will make the OR feel more familiar and less scary. Be aware if you are holding shoulder muscles tensely and relax them if you find that you are.

Letting go is the preparation for moving on and as difficult as it may be, it must be done. You have chosen this surgery for many reasons not least of which is the hope of moving on to better things (like your health and peace of mind!) While the former may not be in the cards for everyone who goes through this surgery, the latter can belong to anyone who chooses it. Surgeons who deal with many explant patients are finding that up to 90% of their patients get relief of local pain caused by implants and that anywhere from 1/2 to 2/3 of the patients will have some improvement in symptoms. Be aware that complete resolution of symptoms is rare and also understand the improvement, if it comes, may be slow.

Understand that it is very common to have a period of grieving and allow yourself to do so. It often doesn't show up until a few weeks after surgery. Those that know it is a normal part of the process of healing will get through it faster than those who feel they shouldn't be experiencing any negative emotions. I like to use the analogy of a marriage that didn't work (most of you have had your implants longer than many marriages). You had them for a reason and it didn't work out, like marriages sometimes don't - or worse, it's a bad marriage - he's beating you up, stealing your money and sleeping with your best friend and you know you'll be better off without him. Even so, that first weeks he's gone, the house can seem very empty and the bed very cold.

If you have lost a limb, there is a lot of societal support and sympathy, but for this surgery, often no one knows of your loss unless you share it, so take care of yourself and allow yourself to grieve. (I personally like to get into bed with a good book and chocolate bar!) If you are having problems grieving, seek professional help. Other practical suggestion for getting out of the dumps include taking care of yourself (wash the face, brush one's hair/teeth, even wear make-up, eat right, whether you feel like it or not,) gentle exercise (such as walk on the beach) and service to others (volunteer at your local hospice if your are physically capable - it really puts things in perspective!)

Part of letting go involves letting go of anger and bitterness as well. Do not allow your anger to hinder healing. I am not saying all anger is bad - often it helps one to overcome passivity and act productively. But if anger is eating you up inside, you must let go, no matter how justified it is! If all you can think about is how you have been wronged or who has done you harm, you do not have any kind of life except one that revolves around negativity. Make your life positive outlets - become politically active, for example, fighting legislation that would erode the right of consumers to sue in product liability cases - or join the Fibromyalgia/Chronic Fatigue Syndrome Societies to petition Congress for more research funds for the treatment of these conditions. The slef-help bookshelves are full of suggestions, but you must choose to take them. If you choose to deal with explantation instead of letting it deal with you, you will find the lessons learned from your experience with explantation, as difficult as they may be, will ultimately be worth it!

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