Best Oakland California (CA) Capsular Contracture Surgeon

Breast explantation refers to the removal of a breast implant with or without the immediate or later replantation. Reasons for explantation are many, the most commonly sited in my office is the unfavorable complication of a painful capsular contracture.

The incidence of capsular contracture in the United States approximates 12% per patient. It appears that this incidence is lower for saline over jel, textured over smooth and under the muscle over over the pectoral muscle re. implant placement. Not to be forgotten, there is the significantly higher incidence of capsular contractures in women who have breast fed within 6 months of implant placement. Often, patients do not know whether or not they they have a capsular contracture. Some believe it is normal that the implant feels hard and the breast and chest feels tight with shoulder extension. In fact, this is quite abnormal after the first few days following surgery. The American Society of Plastic and Reconstructive Surgery and the two US FDA approved implant companies: Mentor and Allergan both do not endorse attempts to break a capsular contracture using mechanical force across the chest wall. However, early and educated massage of the pocket following augmentation appears to be at least partially preventive in the development of a symptomatic capsular contracture.

The concept of implant replacement because of the age of the implant is controversial. Clearly, most silicone jel implants which were placed in the 70’s and 80’s at some point will rupture and the removal thereafter may be difficult without performing a near-total capsulectomy. Ideally a capsulectomy should not include that portion directly beneath the nipple areola complex for fear of loss of blood supply and sensation to the nipple areola area. Further, once an implant has ruptured there is a higher incidence of capsular contracture. Once a capsular contracture has formed even after capsulectomy the incidence of recurrent capsular contracture has been reported in excess of 30%. If this is true, then the question arises, why wait for this difficult situation. Perhaps, it would be better to replace a jel implant before it ruptures and then place a new implant in the same pocket, providing the pocket is soft, thus avoiding the added surgery, pain, recovery time and cost of a capsulectomy.

Breast Explants, Surgery, Photos, Breast Explantation, Breast Explant Surgeons

However, it is my opinion the same is not true for saline implants. At worse a saline implant might partially deflate. The contents, a salt water solution isotonic to blood, is resorbed without consequence. So, periodic exchange of saline implants, unless there is an unfavorable result, or a specific desire to replace for cosmetic purposes, does not make sense to me.

Chronic pain following augmentation is an important complaint not to be disregarded by the surgeon. A few years ago it was advocated to partially elevate the muscle called the Serratus Anterior at the time of the augmentation or breast reconstruction in order to provide some lateral support to the implant. It has since been discovered that this may lead to pain in the lateral chest wall, which will not subside until the implant is removed.

Insurance company criteria for payment of breast explantation, as a covered benefit, may vary. As a rule, most US insurance carriers will pay for the removal of a cosmetic surgery - related breast implant, providing that the implant is associated with documented chronic pain and suffering. However, replacement of the implant is not a covered benefit except in cases of breast reconstruction for either breast cancer or a congenital malformation of the chest wall.

Aesthetic explantation refers to the removal of an implant with minimizing disfigurement. Typically explantation leads to a flattening and hollow above the nipple and a laxity, sagging narrowing of the breast and skin below the nipple and areola. I have found that by simply performing a breast lift, termed mastopexy, the breast is restored to a better shape and albeit a smaller breast. Then, at a later date, should the patients desire change, a reaugmentation can be performed safely and in a staged fashion.

Useful Resource Links:
http://www.explantation.com/
http://www.breastimplantinfo.org/what_know_3.html
http://www.fda.gov/cdrh/breastimplants/siliconegel.html
http://www.fda.gov/cdrh/breastimplants/labeling/mentor_patient_labeling_5900.html
http://www.fda.gov/cdrh/pdf2/P020056d.pdf

Moulton-Barrett is an Oakland California (CA) Breast Augmentation Surgeon office. Our main offerings include: liposuction doctors and tummy tuck cosmetic surgeries.