Posts Tagged breast implant removal
I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.
The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution.
While removal of your implants for a time with later replacement might improve the problem, this is not a “slam dunk” nor is it guaranteed to completely solve it. The results vary substantially. Usually removal with a good capsulectomy is the best thing for comfort. Implant replacement at times is thwarted by recurrence of the contracture.
Then again if you leave the implants in place things will not likely improve as you have had a trial of capsulectomy and replacement already. It is true however that a woman who has had her implants removed and not replaced frequently has them put in once again down the road due to appearance issues. This is not invariably the case however. Some women actually like the look of their breasts without implants after capsulectomy and explantation. The results of such surgery vary though.
These cases need to be handled individually and with a fair amount of disclosure before surgery is performed, so that everyone comes out satisfied. I don’t have one treatment that goes for all patients on the issue due to their inherent variability.
John Di Saia MD
Originally posted 2011-05-31 07:30:35.
Lela Star is an adult performer who not too long after having breast implants placed had them removed. She reported on her twitter that they were out and she liked the way she looked sans implants:
Nope i need new ones. Im a 32C now back to natural size
No more implants!!!! love em! Stitches out tonmoro!
Then again she talked about “needing new ones.”
I have sent her some messages and she indicated that she would like to guest post. Removing implants without replacement usually means one of two things: She didn’t want them in the first place or they became infected or encapsulated.
At 32C after removal, she looks pretty curvy without them. There is still some swelling to come down, but her result is quite good for removal without replacement.
John Di Saia MD
Originally posted 2011-01-22 09:00:16.
France took a costly and unprecedented leap Friday in offering to pay for 30,000 women to have their breast implants removed because of mounting fears the products could rupture and leak cheap, industrial-grade silicone into the body.Tens of thousands of other women elsewhere in Europe and in South America have the same French-made implants, but authorities there have so far refused to follow suit. The silicone-gel implants in question are not sold in the U.S.
PIP (Poly Implant Prothese) breast implants were of French manufacture, but the company has been shut down by the French government. Their implants had a high leak rate and this unfortunately included their silicone gel implants. Further issues have been brought concerning the low grade silicone gel that these implants apparently contained.
The French government has offered to cover the removal of these potentially more dangerous PIP silicone gel implants for 30,000 French women.
This is, by the way, an interesting case in which the action of the FDA in the US probably kept these implants off the market sparing American women the trouble of worrying about these poorly made French silicone gel implants. To my knowledge the PIP gel implants were never on the market in the US and the saline implants were taken off the market years ago.
John Di Saia MD
Reader Laura’s Comment:
“The Houston woman who had to go to a foreign country to get implants that are said to be the largest in the world has had to have them removed after developing an infection. She contracted a severe staphylococcal infection after her surgery in June 2010 that had spread into both of her breasts.
She had her breasts enlarged to 38KKK even though she is only 5’3″ but has recently had to have the implants removed as well as possibly part or whole of her own breasts removed due to the fear of the infection getting into her blood stream.”
Sheyla Hershey was able to achieve her goal of having the largest breasts in the world when she had M-cup implants put into place. She soon removed them and downgraded to a smaller size when she learned she was pregnant in 2009.
A severe staph infection reached both of Hershey’s breasts.
She had the augmentation surgery in Brazil, but came home to Houston for help. Hershey says the new surgeon told her she should be concerned for her life. Staph infections can enter the bloodstream and be life threatening. Hershey is also very concerned about losing one of her breasts. She has had to give herself infusions of intravenous antibiotics every twelve hours to fight the infection.
The treatment has helped one breast, but doctors say the other one is still in jeopardy. That would mean that she will not only lose both implants, but quite possibly need to have the entire breast removed.
Doctors took Hershey into surgery on Tuesday morning to remove the implants.
There is a reason we aren’t so keen on really large breast implants in the United States. It is called liability. As we have discussed here before the chance for problems with breast implants goes up quite a bit once the implants get beyond a certain size. There isn’t enough tissue to cover them when they get too large.
Hopefully Ms. Hershey will be able to have some breast tissue salvaged such that she can have some kind of reconstruction later. I have never heard of such an infection being fatal, but her case is unusual.
The Morals of this Story:
Limit your size or accept the risk.
When you can’t get a surgeon in the US to do it, there is a definite reason.
John Di Saia MD
Originally posted 2010-07-14 10:00:35.
Reader Laura Comment:
A while back we had discussed the woman (Sheyla Hershey) … She had KKK-cup implants and went out of the country to have them made even larger and contracted a severe infection and had to have all of her implants removed as well as some of her own breast tissue. Now she’s back in the news. After having the implants removed it seems that she fell into a deep depression and tried several times to commit suicide. Her most recent suicide attempt has left her in a coma. Do plastic surgeons ever send their patients to a psychologist after a consult? What would you say are the warning signs that someone is becoming obsessed with plastic surgery or that they have a body disorder?
A Brazilian model who had the biggest breasts in the world is in a coma after allegedly taking a drug overdose. Sheyla Hershey, 30, who lives in Houston, Texas, had to have her KKK-cup implants removed last year after contracting a deadly infection during the operation to make them bigger. Since then, the mother of one has vowed to get her breasts re-done saying she feels ‘so ugly’ without them.
Patients seeking extreme outcomes frequently are emotionally labile. Many American plastic surgeons simply avoid them for fear of liability. I would suggest the woman traveled to Brazil for her “large implant surgery” due to an inability to find a domestic surgeon who would take the case. The term you might have been seeking is “Body Dysmorphic Disorder.” I believe it doesn’t take a psychologist to see that in this case. It is pretty obvious. What a given surgeon will do with such a patient varies with his own philosophy.
While I feel for Ms Hershey’s plight, I look at the story as a point of education for other women considering breast augmentation. Many of the women who have implant surgery do not seek these extremes and do well with their implants for decades. I believe it is a patient’s choice to do what he or she will with his or her body. But as a surgeon, I like lower liability surgery that lasts. When getting into a case in which problems seem too likely, I either avoid it or at least inform the patient of the risks involved.
Yes. Doing the right thing can cost me money.
John Di Saia MD
Originally posted 2011-02-17 07:30:38.
Years ago (around 2005) we discussed the online rumor that Britney Spears had had breast implant surgery.
This image from her @BritneySpears account now in 2011, seems to suggest that she either never had implants or has had them removed. She is a little heavier now than she was five or so years ago and her breasts appear smaller now. A loss in breast volume with weight gain suggests that she may have had breast implant removal without replacement.
Breast implants are not for everyone and removal can be the solution to a problem for many women particularly those who find themselves too busty or develop hardening (capsular contracture.) These women do not always choose to have their implants replaced.
John Di Saia MD
Roughly 30 years ago, Mariel Hemingway, 49, had breast augmentation surgery that jeopardized her health. Now the actress wants to warn others of the potential dangers of plastic surgery. “I actually had silicone in my blood,” said Mariel. “So I did hyperbaric oxygen treatment to turn the silicone into silicone citrate so it could pass, but it took a long time to get that out of my system.”
Entertainers can have kinda unusual ideas about science. Apparently Mariel Hemingway is no exception.
As we have discussed here before, silicone gel breast implants (especially older generation units implanted prior to cohesive gel models) have a tendency to leach silicone into the body. The body reacts to this gel and that reaction can create problems over the long term most often hardening of the breasts and severe capsule formation (capsular contracture.) While I agree that saline-filled implants are safer, some women still want silicone gel implants. I encourage them to get the cohesive gel variety (gummy bear breast implants) as they should have less of this leeching going on, but the jury is still out on the nature of tissue reactions with these newer silicone implants. Will they be any less severe than those of their less viscous predecessors? For women less risk tolerant, this Orange County plastic surgeon recommends saline-filled implants.
On Ms Hemingway’s suggestion that hyperbaric oxygen might help the body rid itself of silicone gel, I would be more prone to recommend a thorough removal of the implants and their scar capsules. While silicone gel can travel to distant sites, this is far more rare than concentration in the local tissues. Hyperbaric oxygen is not a proven treatment for silicone removal.
Scar capsules of older silicone implants (older meaning non cohesive gel units) can look like something from a Sigourney Weaver flick. If you have older silicone implants, my recommendation is usually to remove and/or replace them and certainly have the capsules removed as completely as possible in the process. The safe replacement interval for cohesive gel units has yet to be determined, but ten years would be a reasonable guess-ti-mate.
John Di Saia MD
Breast reduction is misunderstood online. The operation is defined as the reduction and lifting of breasts. This is not the same as removing or reducing the size of breast implants in a woman’s breasts. That is called an implant exchange.
Implants are not usually involved especially when an insurance company is scheduled to pay for it with the possible exception of surgery to reconstruct a woman’s breasts after breast cancer surgery.
It is difficult enough to get most insurers to pay for “clear cut” medically-necessary plastic surgery. Breast reduction surgery is the reduction of naturally enlarged breasts and that is all.
Breast reduction used to be one of the more common insurance-covered procedures in my Orange County plastic surgery practice. With the economy as of late, insurers are not always so quick to approve them, but for the right patient they are still do-able.
Usually we see our patients for a consultation and then apply to their insurers for pre-approval if the cases seems reasonable by insurance company standards. We don’t make the rules on approval, but we do know the game. Appeals are not uncommon.
These days insurers are looking for a certain amount of breast gland to be removed in a certain sized woman in order to allow coverage. In addition they like to see documentation of things like bra strap furrows, the “dents” some larger breasted women get in their shoulders from breasts weighing against them over the day. Insurance pre-approval usually covers surgery for a 90 day period. The exact nature of that coverage varies by the plan.
Insurers don’t tend to like claims is which liposuction has been involved. This can trigger denials on cosmetic grounds at the time of billing. In cases of breast implants in larger breasts, we have staged the surgery to avoid insurance denial. That means taking the implants out in one operation and waiting several months to a year before re-operating for breast reduction. It might sound silly, but again we don’t make the insurer’s rules regarding payment.
John Di Saia MD
This 60 year old lady had had silicone gel breast implants for thirty years. Over this time her breasts changed slowly and she barely noticed the progression to the rock hard things they had become (lower left of our image.) She came for consultation to have the hardened implants removed, but wondered if not replacing them would leave her more deformed.
Her pre-operative image (lower left) shows capsular contracture with high positioning of the implants forced by the scarring that had occurred over the many years they had been in place. Minimal correction in this case involved removing the implants without replacement and also carefully removing the scar capsules themselves so the breasts could appear more natural. Breast lifting could have been added but the patient did not desire it. She had plenty of normal breast tissue to fill in the area without leaving a deformity. She was quite happy afterward with softened normal looking breasts and no implants.
John Di Saia MD
As the story goes Kimberly Stewart had breast implant surgery years ago and later had them removed over “health fears.” As she was smoking at the time and they were large (relative to her slight frame) I’d bet they were affected by capsular contracture and this may have scared her. A short YouTube video I made of a breast implant removal operation in a woman affected by a severe case of this breast hardening is posted below. This seems to affect patients who smoke and patients who have silicone gel implants more commonly.
After her removal operation, Kimberly gave her implants to Jack Osbourne who framed them and put them on his wall. Touching. It looks like she also had a nose job that worked out better for her.
John Di Saia MD
Originally posted 2009-11-04 07:30:02.