6 Critical Questions You Should Ask Your Plastic Surgeon Before Breast Explant Surgery

BY LISA B. CASSILETH MD, FACS

Breast implant removal is growing in popularity over the years. It can be difficult to find the right plastic surgeon to perform the removal and ensure that your breasts look good after. Board Certified breast specialist, Dr. Lisa Cassileth, tells us the 6 questions you should ask when selecting the right surgeon for your explanation to ensure that your breasts will look full and pretty after surgery, rather than saggy, wrinkled or devoted.

 1.“What can you do to ensure that my breasts look good after explant surgery? Will my breasts look deflated in after my surgery? “

Some explant surgeons get the implant and capsule removed, but not much else. Make sure that they have techniques to make you look better. They should sit you up in the operating room after the removal, and be able to move and repair the damage done by the implant. If they say that your breasts cannot look good, or that their technique is to let the breasts tighten up on their own, this is worrisome and is an indication that the surgeon isn’t skilled in breast explant surgery as there is a good opportunity to improve the appearance at the time of explant.

2. “Do you test the capsule for biofilm?”

You want them to say, yes!  First, a swab from the surface of the implant Is sent for aerobic, anaerobic, mycobacterial, and fungal culture growth as well as a screening gram stain. This allows the bacteria, fungus, or mold to grow in a lab on a petri dish, and tests the sensitivity of any organisms. The second test is PCR, which amplifies bacterial DNA for rapid diagnosis of bacteria on the surface of the implant.

3. “Do you perform fat grafting as an option after implant removal? How many fat grafting cases do you perform each month?”

Fat grafting is a great option after implant removal. Women had their breast augmented for a reason… they wanted to be bigger. So why just put you back as you were before the implant, if that is not your ideal? In addition, the fat helps to fill out the now bigger breast, so that the breast doesn’t seem deflated.

4. “Do you repair the pectoral muscle?”

The pectoral muscle should always be repaired. Not only does it make the muscle stronger, but the breast looks better as it adds lift and bulk to the breast. In addition, unrepaired pecs may have a “pec flex” deformity, where they move too much after the implant is removed.

5. “Do you do a breast lift at the same time as implant removal?

“Breast lifts can be performed, and we use a special technique where the loose hanging tissue after removal is used to fill the old implant space, which makes a full breast shape and fixes the dent created by implant removal.

6. “Is performing the removal en bloc critical?”

“No study has ever found that en bloc vs. complete capsulectomy makes a difference, and we perform it both ways. En bloc is complete removal of the implant and capsule as a single structure. It is performed through a large scar under the breast which goes across the inframammary crease. If a lift is being performed, en bloc can go through the lift scar (usually the vertical portion). We have found that the push for en bloc usually comes from patients, because other surgeons have told patients that they removed the capsule, but left the back wall of the capsule against the ribs. We have found so many biofilms in so many capsules, so much free silicone from supposedly intact implants, so many thickened, calcified, and abnormal capsules, that we never leave capsule in… ever. The question we pose is if it is worth the scar to take it out in one piece? That question is an individual decision that we have with every patient, as we want you to feel confident that you have completely treated, and the possibility of ongoing inflammation from the implant or capsule eradicated. “6

To learn more about surgical treatment options for Breast Implant Removal contact Cassileth Plastic Surgery schedule a consultation with Dr. Cassileth by calling: (310) 278- 8200 or by requesting an appointment online.

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