Breast explantation surgeons- use caution!
I perform a fair number of breast implant explantations. The reasons women chose to remove their implants is varied. In some cases, their implants have aged, failed, ruptured, or developed a contracture which distorts the breast or causes pain. In many cases, the patient’s breasts have changed or grown larger, and they just don’t like them, or feel they are “not needed” anymore. There are also cases of women who have fairly normal breasts and implants who are concerned that their health problems are caused by their breast implants. Possible etiologies reported in the medical literature include a silicone allergy or an autoimmune type reaction that may affect a subset of patients who react to the silicone in all implants (saline and gel). Another possible cause is bacterial or fungal infection of implants introduced at the time of implantation via contamination. There are many reports in the plastic surgery literature of these types of infections occurring. My own experience is this is uncommon, but definitely a possible cause of implant related problems. In fact, there is a consensus among plastic surgeons that some cases of contracture (hardening of the scar around an implant) may be caused by a low grade microbial infection around the implant.
Many women have sought relief of their health issues by addressing their implant. There is a very robust population of women who have banded together via the Internet with social media websites and groups who share their experiences and provide support and encouragement to each other. Many women in these groups advocate removal of breast implants.
In my experience, the majority of women who are convinced their implants are causing health problems achieve relief with explantation. This may be due to removal of the offending silicone. In most cases removal of the implant, which been the source of discomfort, provides physical relief and to some degree relief from anxiety of the uncertainty of whether or not their implants have been the source of their ills.
There is a cottage industry of plastic surgeons that specialize in breast explantation. Many claim expertise in the treatment of breast implant illness. There is no uniform agreement among plastic surgeons about breast implant illness, but I suspect that the majority of Board Certified surgeons do not think that all implants cause problems. Most of us place implants as part of our standard practice so it would be contradictory to claim that they all cause problems. Certainly no one disputes that a ruptured silicone gel implant can cause localized problems and perhaps systemic problems. It is the patient with intact implants who have led to this conflict.
I had the occasion of caring for one patient who was convinced that her implants were responsible for her medical ills. They were saline implants placed over 24 years ago. One side had become firm and somewhat painful. She had a myriad of health issues which prompted her to seek an “expert” on breast implant illness. She felt that something wasn’t right during her consultation when she was told her problems were definitely from her implants and she was recommended to start a detoxification program prior to “en bloc” explantation. She sought me out for a second opinion. She had a report stating that her saline implants had an “internal rupture” on ultrasound. This report was generated by a Board Certified Plastic Surgeon. The report also mentioned enlarged lymph nodes indicative of “possible infection”.
At explantation, her saline implants were completely intact. One side did have a significant contracture with thick scar which was removed in its entirety. The pathology revealed no foreign body reaction or inflammation and no Anaplastic Large Cell Lymphoma (ALCL). All cultures for bacteria and fungus were completely negative. My patient had enormous relief after removal of her implants. She suffered unnecessary anxiety prior to surgery in part caused by the misinformation she received during her initial consultation.
With so many patients now concerned about their implants, patients should be advised that there are many practitioners who may be seeking to exploit your fears rather than having your health and safety as their priority. I urge caution when selecting an explantation surgeon.