Posts Tagged no replacement
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.
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
I had breast implant removal without replacement (250cc after 23 years) five weeks ago, going from 38D to 38 A/B. I also had a lift at the same time. I understand there was some silicone leakage in my right breast, but had a capsulotomy on each breast as well. Both breasts, individually, look pretty good now. My problem is the left breast is at least 1 cup size larger than the right, very noticeable in a bathing suit or camisole. Any swelling reduction seems to have occurred equally so far in both. In your opinion, what are the chances the left one is that much more swollen. I think my surgeon may have closed my left breast before realizing the leakage required additional tissue removal on the right as they were visibly uneven immediately after surgery. Have you ever seen evening out weeks or months out?? I will not get an implant to even it them out and I can’t imagine cutting into the left breast to further reduce it. Please share your opinion. Regards!
Re-operative breast implant surgery can get complicated particularly when it involves leaking silicone gel implants. Leaking silicone gel can encourage a body response involving scarring, inflammation and profound hardening. The individual breasts may react differently to that leakage as well. During redo surgery, this reactive scar tissue must be removed to soften the breast allowing a good result. On the next page I will put up the images you sent, so we can flesh out what likely happened.
Originally posted 2010-02-18 07:30:56.
The world has come to know her well. Sheyla Hershey is known for her striking smile and her large M cup breast implants. She has tried to save them for the past three months, but that fight has come to an end. Hershey had to have her implants removed, along with most of her own breast tissue. Hershey tells FOX 26 News her surgeon realized in surgery that most of her tissue was too damaged to save. She says her surgeon tried to save just enough tissue to attempt reconstructive surgery within three or four months.
When she had the surgery to make her the largest breast implant patient in the World, I said it was risky. Sheyla Hershey ultimately realized some of that risk. When implants so large are placed the pressure stretches, thins and to an extent destroys tissue. There is not enough breast tissue to cover the implants in these types of cases. The implants are too large.
In Sheyla’s case, the implants became involved with infection which undoubtedly further destroyed tissue. She had a Wound Vac put in to help encourage wound healing in the absence of tissue…mainly to close the space the implants had developed. It is doubtful that she will be able to have large implants placed once again as the soft tissue cover has likely been severely compromised.
In essence she has become a reconstructive type case. This is sad. Things will end up looking pretty poorly by the sounds of things. This type of outcome is almost unheard of with the much smaller, more routinely implanted sizes.
“Really big comes with really big risk with breast implants.”
John Di Saia MD
Originally posted 2010-09-10 19:00:29.