A breast implant removal (or breast explant) surgery refers to a procedure in which implants are surgically removed from the body. It may involve:
Simple breast implant removal, without removal of capsule tissue around implant. May include removal of escaped silicone gel in breast tissue.
Removal of some of the tissue surrounding the breast implant (partial capsulectomy).
Removal of all tissue surrounding the breast implant (capsulectomy).
An en bloc capsulectomy involves removal of the breast implant and surrounding capsule as ONE item. Sometimes, the breast implant and capsule can be removed together easily. However, if the capsule is adhered to the surrounding tissue it may require a more extensive surgery. This technique is only indicated if the surrounding breast tissue has shown signs of BIA-ALCL or other infection. It requires the incision to be slightly larger than the base of the implant in order to safely remove the implant and surrounding breast tissue at once without any tearing to the capsule. It is not known before the time of surgery if the capsule is adhered to surrounding tissue, and therefore if a full en bloc capsulectomy is required, this procedure is usually performed in a tertiary facility and requires drains and a hospital stay.
If there are no signs of BIA-ALCL or infection, your surgeon will likely remove the breast implant first, and then perform a partial or full capsulectomy in order to minimise potential complications and scarring.
If patients are opting to have their implants removed due to Breast Implant Illness, current medical guidelines advise against removing the capsule.
A breast explant may not resolve symptoms of Breast Implant Illness. A breast implant may not resolve pain, discomfort, or any other issues related to your breast implants.
If a patient choices to undergo a breast explant, Inigo Cosmetic will NOT perform a breast augmentation at a later stage.
Where all subsequent revision procedures become necessary all subsequent revision procedures provide results lower than results of a primary surgery.
ALTERNATIVE TREATMENTS
Alternative forms of non-surgical management consist of not undergoing a breast implant removal.
Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications. In addition, every procedure has limitations. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications, and consequences.
Breast Implant Associated Anaplastic Large Cell Lymphoma
BIA-ALCL is a rare cancer of the immune system. It is not breast cancer, which forms from cells in the breast, but instead a cancer that grows in the fluid and scar tissue that forms around a breast implant. Less commonly, BIA-ALCL can take the form of a lump in the breast or a lump in the armpit.
BIA-ALCL has been known to occur as soon as one year after the operation and as late as 37 years after the operation. The average time to diagnosis is within 8 years of the operation.
All reported cases of breast implant associated cancer in Australia involve patients who have had a textured implant at some point in their life. Based on current evidence, experts do not think breast implant associated cancer is related to either the contents (saline/silicone) or shape (round/teardrop) of the implant.
The risk of developing BIA-ALCL is approximately 1-in-87,000 (based on data supplied by Mentor). The risk of developing BIA-ALCL increases with increasing texturing of the implant. To date, there have been few recorded cases of BIA-ALCL with smooth implants or implants from the Motiva range.
Most cases of BIA- ALCL are resolved by removal of the implant and the capsule surrounding the implant. Unfortunately over the last 10 years, four Australian women have died from breast implant-associated lymphoma.
It is important to know the symptoms of breast implant associated cancer. The most common symptom is swelling of a breast caused by fluid build-up around the implant, but in some cases it may appear as a lump in the breast or armpit. However, as this is a rare disease, changes in your breast are unlikely to be breast implant associated cancer. For example, swelling immediately after your breast implant surgery is normal. But you should raise all concerns with your surgeon, including the possibility of breast implant associated cancer.
Medical experts do not recommend removing your breast implants if you do not have symptoms of BIA ALCL, even if your implants are no longer supplied in Australia. This is because BIA ALCL is a rare cancer with excellent cure rates if it is detected early.
The risk of developing BIA ALCL is lower than the risks associated with an anaesthetic and surgery. The complication rate of revision surgery involving implant removal or replacement is also higher with each revision procedure.
Read the latest updates from the Therapeutic Goods Administration
BIA-ALCL may still develop if the implants have been removed and there is still traces of the breast implant capsule in the body.
Skin Contour Irregularities
Contour and shape irregularities may occur. Visible and palpable wrinkling may occur. One breast may be smaller than the other. Nipple position and shape may not be identical. Residual skin irregularities at the ends of the incisions or “dog ears” may occur. This may improve with time, or may require additional surgery to correct.
Skin Laxity
Patients with significant skin laxity will continue to have the same lax skin after surgery. The quality or elasticity of the skin will not change after surgery, and will in fact, get worse over time due to the ageing process. This may occur quicker for some than others.
Infection
Any surgical procedure carries a risk of infection, and explantation is no exception. Bacteria can enter the body during the surgery or through the open wound after the procedure.
Bleeding
The surgical site may experience bleeding, which, in some cases, might require additional intervention.
Scar Tissue Formation
After removal, the body may form scar tissue around the implant site, which can lead to discomfort or other issues.
Damage To The Surrounding Tissue:
During the explantation process, nearby tissues or organs might get unintentionally damaged.
Implant-related
Complications:
The reason for explantation might be due to complications related to the original implant, such as device failure or adverse reactions to the material.
Pain and Discomfort:
The process of healing and recovering from an explantation can be painful and uncomfortable.
Change in appearance or function:
Removing certain implants, such as breast implants or joint replacements, may result in a change in appearance or reduced joint function.
Blood clots:
There is a risk of developing blood clots, especially in patients who are immobile during the recovery period.
Delayed healing:
Some patients may experience slow wound healing, especially if they have underlying health issues or if they are on medications that affect healing.
Unsatisfactory Result
Although good results are expected, the precise degree of improvement cannot be guaranteed. There is no warranty expressed or implied, on the results that may be obtained. The outcome’s subjective nature also means dissatisfaction is a possible outcome regardless of the successful outcome of the surgery. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. It may be necessary to perform additional surgery to achieve your desired results.
Surgical Anaesthesia
Both local and general anaesthesia (including sedation) carry risks and complications. These may include injury and even death.
Allergic Reactions
Local allergies to tape, stitches, topical preparations, or injected agents can occur. Serious life-threatening, systemic reactions including shock (anaphylaxis) may occur in response to the drugs used during surgery and/or medication prescribed after surgery. Allergic reactions may require additional treatment.
Cardiac and Pulmonary Complications
Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anaesthesia. Pulmonary emboli can be life-threatening or fatal in some circumstances.
Inactivity and other medical conditions may increase the incidence of blood clots. Notify your surgeon of any history of blood clots or swelling in the legs prior to surgery. Cardiac complications are a risk with any surgery and anaesthesia, even in patients without symptoms.
If you experience shortness of breath, chest pain, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalisation and additional treatment.
Shock
In rare circumstances, surgery can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalisation and additional treatment are required.
Pain
Pain of varying intensity and duration may occur and persist after surgery. Chronic pain may occur as a result of trapped nerves in scar tissue or due to tissue stretching.
After your surgery you will be given a full course of prescription pain medication. We DO NOT provide repeat scripts for schedule 8 narcotics, benzodiazepines, or other drugs of dependence.
If a bleed occur during surgery, it may require emergency transfer to a tertiary facility. A bleed that occurs after surgery is often known as a hematoma; this usually occurs within the first 3 weeks but can occur at any time. It may require emergency intervention to drain accumulated blood.
In breast implant surgery, hematoma may contribute to capsular contracture, infection or other problems.
If a blood transfusion is necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS).
Increased activity too soon after surgery can lead to increased chance of bleeding. It is important to follow pre and postoperative instructions. Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets. Unless cleared by your surgeon, avoid herbal supplements, aspirin, anti-inflammatory medications for at least 14 days before and after surgery.
Healing Issues and Wound Separation
The surgical area may not heal normally or may take a long time to heal. Areas may become necrotic (die). Wounds may separate after surgery. This may result in colour changes, shape changes, swelling, bleeding, or infection. It may require frequent dressing changes or further surgery; resulting in prolonged recovery and additional expense.
Issues with healing are more common in patients who smoke, have used steroid drugs, after chemotherapy/radiation to the treatment area, diabetes or other medical conditions, after massive weight loss, or excessive heat or cold therapy.
Damage to Deeper Structures
There is the potential for injury to deeper structures including nerves, blood vessels, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
Fat Necrosis
Fatty tissue found deep in the skin might die and may result in areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.
Seroma
Although swelling usually occurs after surgery. Excessive fluid may accumulate following surgery, trauma or vigorous exercise. This may require drainage.
Lymphedema
Persistent swelling (lymphedema) can occur in the legs after surgery.
Venous Thrombosis
Thrombosed veins, which resemble cords, occasionally develop in the area of the breast or around IV sites, and usually resolve without medical or surgical treatment. It is important to discuss with your surgeon any birth control pills you are taking. Certain high estrogen pills may increase your risk of thrombosed veins.
Skin Sensitivity
Bruising and swelling normally occurs after surgery. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent. Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be permanent.
Nerve endings may become involved with healing scars during surgery. While there may not be a nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. This can usually be resolved with non-surgical intervention.
Sutures
Most surgeries involve sutures, these may be dissolvable or may require removal by a medical professional. There are usually multiple layers of deep internal sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation.
Scarring
All surgery leaves scars, some are more visible than others. Abnormal scars may occur within the skin and deeper tissues. Internal scarring may result in excessive firmness to the area. Scars may be asymmetrical or a different colour to the surrounding skin. Scars may require additional treatment to correct. This may include, laser, IPL, topical creams, skin needling, or surgical intervention.
Breast Cancer
Even after breast implant removal, it is recommended all women should perform self-examination of their breasts, have regular mammograms, and seek professional care should a lump be detected.
Second-Generation Effects
There is insufficient evidence to suggest children born of mothers who have undergone a breast explant are negatively affected.
Immune and Unknown Risks
A small number of women with breast implants have reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and other arthritis-like conditions – a breast explant may not resolve these issues.
To date, after several large epidemiological studies of women with and without implants, there is no scientific evidence that women with breast implants have an increased risk of these diseases.
These diseases appear no more common in women with implants than those women without implants. The effect of breast implants in individuals with pre-existing immune system and connective-tissue disorders is unknown.
Sentinel Lymph Node Mapping Procedures
Breast surgery procedures that involve cutting through breast tissue, similar to a breast biopsy, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer.
Breast Feeding
Breast implants or removal of breast implants should not affect your ability to breast feed.
Sun Exposure
Surgical incisions are susceptible to damage from UV rays for up to 12 months following surgery (even if covered) and may result in pigmentation issues.
Travel Plans
Any surgery holds the risk of complications that may delay healing and delay your return to normal life. There are no guarantees that you will be able to resume all activities in the desired timeframe.
Long-Term Results
Subsequent alterations in the appearance of your body may occur as the result of ageing, sun exposure, weight loss, weight gain, pregnancy, menopause, smoking, drug & alcohol use, or other circumstances not related to your surgery.
Female Patient Information
Many medications including antibiotics may neutralise the preventive effect of birth control pills, allowing for conception and pregnancy.
Intimate Relations After Surgery
Activity that increases your pulse or heart rate may cause additional bruising, swelling, or bleeding. This may require additional surgery. Refrain from intimate physical activities as instructed on the postop instructions.
Mental Health and Elective Surgery
All patients who undergo elective surgery must have realistic expectations which focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable and stressful. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
Smoking, second-hand smoke, the use of tobacco or nicotine products (patch, gum, or nasal spray), greatly increases the risk of surgical complications. Risks include, tissue necrosis, delayed healing, wound breakdown, infection, scarring, hematoma formation, bleeding, increased or prolonged bruising and skin colour changes. This may require additional surgeries with expense.
Patients must abstain from smoking and/or the use of nicotine products for at least 6 weeks before and after surgery (ideally 12 weeks).
The clinic may request a nicotine test prior to surgery. If the test returns a positive result your surgery will be cancelled, and the total cost of hospital and anaesthetic fees for the scheduled surgery will be forfeited and not returned.
The clinic is able to recognise the signs of poor wound healing which result from smoking/ nicotine products and may request a nicotine test. If a secondary surgery is required, patients are required to pay an additional surgeons’ fee of $1000. This is separate to third-party fees.
Every surgical procedure has associated risks and complications. The practice of medicine and surgery is an art, not an exact science. Although good results are expected, they are not guaranteed. There is no warranty expressed or implied, on the results that may be obtained.
In some situations, it may not be possible to achieve optimal results with a single surgery. Additional surgeries may be necessary at some time in the future and it is impossible to predict when.
When working with tissue and skin, results can be unpredictable and it is unknown how your tissue may respond or how you will heal after your surgery.
Results may depend on: skin quality, genetics, environmental factors, smoking, alcohol & recreational drug use, sun exposure, hormonal influences, general health of your body, ageing, pregnancy, stomach sleeping, implant size, implant texture, implant shape, and patient compliance.
If you develop a complication as a result of your original surgery you may need a revision. This will require further expenditure.
Patients who are not in a good financial position to be able to afford a potential revision should NOT undergo surgery.
Pre and Post Operative Instructions
For a successful outcome – it is vital that you follow the instructions that have been provided to you.
Support Person
It is the patient’s sole responsibility to provide a support person for the ongoing care after surgery. If a support person and a health care professional needs to be arranged this will incur additional fees.
Disclaimer
Informed-consent documents are used to communicate information about the proposed surgical treatment along with disclosure of risks and alternative forms of treatment(s), including no surgery. The informed-consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, informed-consent documents should not be considered all-inclusive in defining other methods of care and risks encountered.
You may be provided with additional or different information that is based on all the facts in your case and the current state of medical knowledge. Informed-consent documents are not intended to define or serve as the standard of medical care.
Standards of medical care are determined based on all the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.
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