Implant removal / explant

WHO IS A GOOD CANDIDATE?

Dr. Kayan sees patients from all over the country seeking a true "en bloc" procedure. While an en bloc is not always possible, a total capsulectomy (removal of all tissue that has come in contact with the implant) is almost always possible. Dr. Kayan feels very comfortable performing en bloc and total capsulectomy procedures, as implant removal can be quite complicated and bridges an area between cosmetic and reconstructive breast surgery.

Some patients find that they no longer want the maintenance involved with breast implants. Others are suffering from symptoms associated with their breast implants, and others simply do not like the feeling of having implants in place. Whatever the reason, patients sometimes decide to have their implants removed. Depending on a patient's preference, implant removal surgery can be as simple as an in-office procedure (in the case of someone who wants a saline or silicone implant removed and is ok with leaving the capsule in place), to a more extensive removal of the entire implant and capsule. If en bloc removal is done, we will remove the entire capsule, including any portions adhered to the ribcage, any tissue that has been in contact with the implant, as well as any abnormal looking tissue or implant material in the case of a ruptured silicone implant in one piece. If a total capsulectomy is done, all tissue that comes in contact with the implant will be removed, and all attempts will be made to prevent the implant itself from touching any of the surrounding tissue if it must be removed separately from the capsule. If the implant was placed under the pectoralis major muscle, Dr. Kayan will almost always repair the muscle back to the chest wall/ribs to ensure that post-operatively, no residual "animation deformities" of the breast occur. Sometimes implant removal is paired with a breast lift, as there may be extra skin and the breast will fall to an undesirable level after the implant is removed. Fat grafting can also be performed simultaneously if the patient wants more volume not in the form of an implant. Each patient is different in their situation and goals, so there are many combinations of procedures that can be done with the implant removal.

ANESTHESIA AND FACILITY

Patients often have questions when it comes to what type of facility their surgery will be done in, and under what type of anesthesia. Dr. Kayan only works in accredited hospitals and ambulatory surgery centers with on-site anesthesiologists. If patients have other major medical problems, we will operate in a hospital where the patient may stay overnight if there are any concerns. During surgery, the patient will be monitored by a nurse anesthetist (CRNA) who is supervised by an anesthesiologist (MD). The anesthesiologist is present for the initiation and end of surgery, and available throughout the surgery, although the CRNA is monitoring the patient minute by minute. Many in-office OR's are accredited, however the technique of anesthesia sometimes differs. Often, a patient under anesthesia will be monitored only by a CRNA in an in-office surgery center, with the overseeing doctor being the plastic surgeon themselves. It is always important to ask who will be present to monitor you during your surgery, and to discuss any questions or concerns with the surgeon.

THE PROCEDURE

Breast implant removal can be easily done under local or sedation in the case of saline implants or unruptured silicone implants. If the implant capsule must be removed either due to silicone implant rupture, capsular contracture or patient preference, this is done under general anesthesia, and usually takes 2 hours or less. Some patients want their pectoralis major muscle repaired to their chest wall to prevent animation deformities of their breast post operatively, and in this case, the procedure must be done under general anesthesia. Drains are often needed if a total capsulectomy is done or if ruptured silicone implants are removed. Drains will need to stay in anywhere from 5-7 days, depending on their output (see further details below). If there are any suspicious findings at the time of implant removal, special tests can be run on the implant and the surrounding tissue. We always send any breast tissue such as the capsule to pathology to be studied on a microscopic level per the patient's preference. We are also able to provide patients with photos of their implants and capsules. Patients may also choose to have their implant returned to them on the day of surgery, or after 1-2 weeks if they choose to have implants sent for pathology. All incisions are closed with dissolvable sutures, and patients go home with padding and a compressive ACE wrap around their chest.

Whenever possible, if patients request an en bloc removal of their implants, Dr. Kayan will try and remove the implant and capsules all in one piece. While this is possible some of the time, there are instances when the capsule is very thin, and this is not possible. It is also not possible if the capsule is adhered to the ribcage/chest wall and en bloc removal poses a danger to the patient's health (such as causing a lung/heart injury or requiring too much removal of the overlying pectoralis muscle). In these cases, as much of the capsule as possible is removed in one piece, and the capsule that is still inside the body is meticulously removed by directly peeling it off the chest wall or by scraping any remaining parts of the capsule out of the body.

PATHOLOGY

Dr. Kayan strives to allow patients freedom to decide whether or not to send their implants and capsules to have a pathologist look at the tissue or send the tissue for special studies. If the capsules or implants look frankly abnormal (such as a cloudy saline implant, obvious mold, or silicone granulomas), Dr. Kayan will often recommend sending the tissue for additional testing. If a patient requests certain tests such as CD30, we can arrange this as well. If the patient is paying out-of-pocket for surgery, do know that the pathology fee is separate from the surgeon's fee and operating room fee, and a separate bill for pathology will be sent after surgery. The amount of that bill depends on which tests are ordered for the implants and capsules, and we will do our best to give an accurate estimate of what the cost will be.

RECOVERY

All dressings can be removed, and showering may be resumed after 24-48 hours. After showering, it is recommended to wear a compressive ACE wrap or sports bra 24/7 for 4-6 weeks, as fluid can accumulate in the space the implant previously occupied. Overhead reaching should be avoided for 1 week and lifting over 5lbs. or high-end exercise should be avoided for 4-6 weeks post operatively if there is no muscle repair, and 6 weeks if the pectoralis major muscle is repaired. The patient's post-operative activity restrictions will depend on which surgery was performed and can sometimes be longer if you combined other procedures such as a breast lift or fat grafting.

In terms of drain removal, the length of time the drains (usually one per side) need to stay in depends on each person's body - sometimes the drains will output very little and be ready to come out in 5 days, and other times they may have a higher output and need to stay in for 7 days or slightly more. They rarely need to stay in for more than 10 days. Dr. Kayan will work out with each patient the most convenient and comfortable plan for drain removal. Some patients choose to stay close by and have their drains removed in clinic by Dr. Kayan, while others have chosen to return home and have their local physician remove the drains. It is also possible to have a family member or friend in the medical community remove the drains. Other times, patients have felt comfortable enough to remove the drains themselves with Dr. Kayan's guidance.