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BII and Explants: My experience and impressions after two and a half years.
Posted by Laurence Weider on May 31, 2022
I started doing explants for patients who were concerned about possible Breast Implant Illness in January 2020. Since then, I have treated and taken care of hundreds of patients with concerns about possible Breast Implant Illness. In addition, there have been many patients who haven’t had concerns specifically about BII, but have decided to have their implants removed for other reasons including implant rupture, back pain, or chest pain. After over two years of experience performing explants for BII, I thought this would be a good time to review my experience and my thoughts about BII, explantation, capsulectomy, and associated procedures including breast lifts (mastopexy).
Breast Implant Illness (usually referred to as BII) is a constellation of symptoms that may be related to breast implants. Although there is no medical study that clearly shows a cause and effect relationship between breast implants and the various symptoms that have been attributed to them, studies show that most women who have their implants and the surrounding capsules removed notice improvement in one and often in multiple symptoms. The most common symptoms include fatigue, joint pain, hair loss, dry skin, rashes, and brain fog. However, there are lists of dozens of symptoms that have been attributed to breast implants. In my own practice, over 80% of the women who undergo a capsulectomy and explantation (implant removal) experience at least some improvement in their symptoms. For many of them, the improvement is life-changing.
When I first performed the procedure, I was skeptical that there would be any benefit. This was because there really wasn’t any good scientific data that showed a link between the implants or the surrounding capsules and many of the symptoms that have been described. However, after performing the procedure for over two years, I am convinced that even though the reason for the link may not be known, most of my patients who undergo explantation and capsulectomy experience relief and are glad that they chose to have their implants and capsules removed. Several recent studies looking at implant removal and capsulectomy have also shown that well over 80% of women who undergo the procedure experience significant improvement in the symptoms that are associated with Breast Implant Illness. I have put together a list of Frequently Asked Questions relating to the procedures associated with Breast Implant Illness.
During a capsulectomy, the fibrous tissue capsule, which is essentially scar tissue, is removed from the surrounding tissues. This means it needs to be separated from the muscle on top of and below the implant which are primarily the pectoralis major and pectoralis minor muscles. In addition, if the implant is submuscular then a portion of the capsule will need to be separated from the underlying rib surface. In some cases, the capsule is quite stuck to the rib surface. Separating the capsule from the rib surface as well as from the muscle can cause a fair amount of discomfort or pain in the days after surgery. At Weider Plastic Surgery, we offer Exparel which is a long-acting numbing medicine that can be injected into these adjacent tissues at the time of capsulectomy. Exparel’s effect lasts up to 72 hours. Due to its expense, there is an additional charge for Exparel. While it doesn’t eliminate all of the discomfort associated with the surgery, patients who opt for Exparel generally experience less pain and discomfort in the immediate post-operative period than those who don’t.
In addition, I typically place a drain in each breast pocket at the time of surgery. This aids in the removal of any fluid that could accumulate in the pocket after surgery and helps to minimize swelling. The drains are typically ready to be removed after five to seven days. Most patients feel fine by two to three weeks, but they often still have some soreness for several weeks.
- Why do I still place implants?:
Some patients ask me if I do explants for BII, why do I still place implants? The large majority of the patients I put implants in don’t have any problems and don’t develop BII symptoms. While I don’t know the reason some people develop BII symptoms and others don’t, I view it as being similar to an allergy. Most people aren’t allergic to penicillin for example. However, some people are allergic to it, and for them, it should be avoided. Similarly, most people do fine with breast implants, but a subset of the population for some unknown reason seems to react to them. Unfortunately, we don’t know at the present time who will tolerate them without issues and who won’t.
- What will my breasts look like after explant?:
Well, that depends on how much breast tissue you had prior to breast augmentation. In addition, if you have experienced weight changes since having your implants placed, that may have affected the amount of breast tissue you have. Many of the patients experience expansion (sometimes called “fluffing”) of their breast tissue in the weeks after the implants are removed. If you have breast asymmetry, that can be improved with a lift at the time of implant removal, but it probably won’t be completely correctable.
- What do we do with the implants and the capsules?:
As for the capsules, we typically send them for evaluation by pathology. However, if they don’t have any visible abnormalities and your implants are smooth, you have the option of asking us to discard them. As for the implants, if they are intact, they can be cleaned and returned to you if you wish.
- Different types of capsulectomies:
The capsule is the scar tissue that forms around the implant. Removing the scar tissue allows the pocket to heal. In addition, some people feel that the capsule needs to be completely removed in order to recover from BII. This can be done as a total capsulectomy (removing all of the capsules), a partial capsulectomy (removing some but not all of the capsules), or an en bloc total capsulectomy. Use of the term en bloc is a misnomer because this term is more appropriately used to describe the removal of a cancerous lesion as well as the surrounding normal-appearing tissues. However, an en bloc capsulectomy has come to mean the removal of the entire implant capsule with the implant still inside the capsule. I generally try to perform an en-bloc capsulectomy when it is possible. Some situations such as a very thin capsule or a capsule that is stuck tightly to the adjacent tissue can make it very difficult and sometimes impossible to do so.
- What about a breast lift?:
While a breast lift is never necessary in order to perform a total capsulectomy and explantation, it often allows for a better cosmetic result. Approximately 60% of my explant patients decide to have a breast lift at the same time. A breast lift can help to improve nipple position, remove sagging breast skin, and correct breast asymmetry. While I perform a few types of lifts, most lifts involve incisions that go around the areola, down to the bottom of the breast, and in the crease below the breast. Therefore, it is sometimes called an anchor scar. At the time of consultation, my staff and I will help you decide whether a breast lift is a right decision for you.
- What is the role of fat grafting?:
Some women who undergo explant surgery wish they had a little more breast size after the surgery. One option to achieve this without an implant is with the use of fat grafting. This means taking fat from other parts of the body that has been removed with liposuction and injecting it into the breasts. This can help augment breast size and improve shape as well. Usually, I recommend that fat transfer be delayed until a second stage months after the explant procedure. This will improve fat graft survival and allow time for the tissues to heal. In addition, small asymmetries that might not be apparent at the time of implant removal can be corrected at the time of a second-stage procedure.
If you are interested in learning more about explantation and capsulectomy at Weider Plastic Surgery, please call us at (972) 566-8444 or send us an email at email@example.com.
Dr. Weider, a native of Southern California, is a Board-Certified Plastic Surgeon who has maintained a private practice in Dallas, TX since 1999. After attending Stanford University, he obtained his medical degree (M.D.) from Baylor College of Medicine in Houston. He then completed a one year surgical internship in Los Angeles at Harbor-UCLA Medical Center, followed by a four year general surgery residency in Dallas at Methodist Medical Center, and a two year plastic surgery fellowship in Cleveland at Case Western Reserve University.