Pre-op appt. today - need advice ASAP!!! Please!!!

[Guest guest]

Pam,

I didn't respond to the other questions because I am not as knowledgable as the other girls about incisions or lifts. Wish I could help more.

Barbara

[Guest guest]

I went to my ps today. He said he will take the implants out if I

want him to. He told me that all the studies show that they are not

the cause of any of the illnesses us women have! He said that the

ones that say they get better have the " placebo effect " and that 90%

do not get better after having them taken out. I told him about all

of you all and he just said well, if that's what you believe, I will

do whatever you want. He wasn't as compassionate as I wanted him to

be, but he does do 2-3 of these surgeries a month, so I feel sure

that he will do a good job. His charge is only $2,000!

On examination, he didn't feel much of a capsule - if any, so he said

he would:

A. go through the old scar around the nipple and remove the implants

B. remove the capsule if it's thicker than Saran Wrap

C. " wash out the area "

D. give me the implants to have analyzed

E. won't do a lift now - need to wait to see if skin shrinks back

(I had a lift originally, so maybe I won't need one at all??? But, I

was only a 36A - a saggy one at that, and now I'm a full 38C.)

Do I need anything else? I can have them done as early as 11/20 or

12-1. I need to tell them which date and they have to have a $500

non-refundable deposit.

Thank you!!!!

Pam

[Guest guest]

Thank you for the article. I may have read it at one point, but I've

read so much info on this site over the last week and a half that my

head hurts! I don't think I feel comfortable enough showing my ps

anything that is contrary to what he thinks he knows. I went in

there today with a folder of info from the FDA hearings, stories of

other women, all the symptoms and illnesses we have in common and a

list of 16 questions to ask him. I never even opened the folder and

the only question I remembered to ask him was about the capsules. I

started to cry and told him how sick I've been and when he didn't

seem to believe me, I just froze and didn't know what to do. I

should have had someone go with me, but my husband doesn't believe me

either. I don't know what to do. I want to get better so bad. I've

been so sick for so long. I'm so tired of it. Sorry, had to vent a

little. I'm glad I can say anything about my illness to you all

here. Thanks for listening!

Pam

> Pam,

> I had my capsules removed and they were only as thick as wax paper.

I dont

> know if you have already read this but I am posting the article by

Dr.Blais

> about capsules and maybe call him and ask him his opinion he is

very nice. I

> think all capsules should be removed.

> Barbara

>

>

> RESIDUAL CAPSULE AND INTERCAPSULAR DEBRIS AS LONG-TERM RISK FACTORS

>

>

>

> By: Dr. Pierre Blais, PhD

> Contamination of the space between the capsule and the implants by

micro-

> organisms, silicone oils, degradation products and gel impurities

constitutes a

> major problem which potentates the risk of implants.  Such problems

include

> inflammation, infection, deposition of mineral debris, as well as

certain

> autoimmune phenomena.  These problems can be present when implants

are in situ (in

> the body) and are often attributable to the implant.

>

> The logical expectation is that, upon removal of the implants,

adverse

> effects will cease. This is an unjustifiably optimistic view.  It

is well documented

> from case histories that removal and or replacement of implants

without

> exhaustive debridement of the prosthetic site leads to failure and

post surgical

> complications.

>

> Plastic surgery procedure lead to favor speed and immediate

cosmetic results.

> For these reasons, leaving or " reusing " tissue from an existing

capsule may

> seem more " gratifying " .  However, adverse effects resulting from

the practice

> are widespread but have not been well documented.  Typically,

patients who

> require removal of faulty implants and undergo immediate re-

implantation in the

> same prosthetic site habitually relapse with the same problem which

motivated

> the previous surgery;  the most common example is exchange of

implants and/or

> sectorizing or bisecting the capsule without removing it

completely.

>

> Such patients rarely achieve a significant capsular correction and

habitually

> return for more similar surgery.  A more illustrative situation is

that where

> patients do not receive replacement implants. They form the basis

of

> knowledge for evaluating the risks that arise from remaining

capsules.  An example is

> described in a paper published in 1993 (Copeland, M., Kessel, A.,

Spiera, H.,

> Hermann, G., Bleiweiss, I. J.; Systemic Inflammatory Disorder

Related To

> Fibrous Breast Capsules After Silicone Implant Removal;  Plastic

and Reconstructive

> Surgery: 92 (6), 1179-1181, 1993): reported problems derived

primarily from

> immune phenomena and inflammatory syndromes with pain, swelling,

serologic

> abnormalities and alarming radiologic presentation.

>

> Numerous similar cases have been noted amongst implant patients but

have not

> been the object of publications.  Some are cited in FDA Reaction

Reports.

> Others appear in the US Pharmacopoeia Reporting

Programs.           

>

> A residual capsule is not a stable entity.  It may collapse upon

completion

> of surgery and remain asymptomatic for some time, however, it will

fill with

> extracellular fluid and remain as a fluid-filled space with added

blood and

> prosthetic debris.  As the wall matures and the breast remodels to

accommodate the

> loss of the prostheses, the capsular tissue shrinks. Water as well

as

> electrolytes are expelled gradually from the pocket or else the

mixture is

> concentrated from leakage of water from the semi-permeable capsular

membrane wall.

>

> In most cases, calcium salts precipitate during that stage and may

render the

> capsule visible as a radiodense and speckled zone in radiographic

> projections. Prosthetic debris is also radiodense and may be imaged

to further complicate

> the presentation.  The average size of the residual capsules after

6-12

> months is in the 2-7 cm range: most are compact, comparatively

small and dense.

> Surgical removal should present no difficulty for most patients if

adequate

> radiographic information is available.

>

> Later stages of maturation include the thickening of the capsule

wall,

> sometimes reaching 0.5-1cm.  Compression of the debris into a

cluster of nodules

> which actually become calcifies follows for some patients.  A few

mimic

> malignancies.  Others appear as small " prostheses " during

mammographic studies.  They

> are alarming to oncologists and are habitually signaled for further

studies or

> biopsies by oncologic radiologists.

>

> In light of the present knowledge and considering the probable

content of the

> residual closed capsules, an open or needle biopsy is not

advisable. The

> risks of releasing significant amounts of hazardous contamination

and possibly

> spreading infective entities outweighs the advantage of the

diagnostic.  At any

> rate, such a capsule requires removal for mitigation of symptoms

and a more

> direct surgical approach appears more economical and less risky. 

>

> In summary, a capsule with a dense fibro-collagenous wall behaves

as a

> bioreactor.  Worse yet, it is fitted with a semi-permeable wall

that may

> periodically open to release its content to the breast.  The

probability of finding the

> space colonized with atypical microorganisms is elevated and the

control of

> infective processes by classic pharmacologic approaches is

difficult if not

> impossible.

>

> Such closed capsular spaces may be comparable to " artificial

organs " of

> unpredictable functions.  Their behavior will depend on the content

and the age of

> the structure, its maturity and the history of the patient.  There

is a high

> probability that these capsules will continue to evolve for many

years, adding

> more layers of fibro-collagenous tissue and possibly granulomatous

material. 

> If bacterial entities are present within the capsule space, they

can culminate

> in large breast abscesses with will resist conservative treatments.

>

> Even with less active capsules containing mostly oily and calcitic

debris,

> the thickening of the wall leads eventually to solid " tumor-like

structures " and

> are, by themselves, alarming on auscultation and self examination. 

At best,

> such structures are unique environments for protein denaturation

and aberrant

> biochemical reactions with unknown long term consequences.

>

>

> Pierre Blais, PhD

> Innoval, 496 Westminster Ave., Ottawa, Ontario, Canada KeA 2V1

> 613.728-8688, Fax: 613.728-0687

>

>

> Pierre Blais, PhD received his undergraduate and graduate degrees

in

> physical- organic polymer chemistry from McGill University in

Montreal, Canada, and a

> Postdoctorate Fellowship in biomaterials engineering at Case

Western

> University in Cleveland, Ohio.  In 1976 he became one of the first

scientists to join

> the medical devices and radiological health program of the

Department of Health

> and Welfare in Canada.  He left the department in 1989 as Senior

Scientific

> Advisor and formed Innoval Consultants, a firm engaged in the

design, testing

> and failure analysis of high risk medical systems.  He has authored

over 250

> publications on medical materials and their interactions with

living tissues.

>

>

>

>

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