Breast Implant Removal and En Bloc Capsulectomy (for Breast Implant Illness/BII)
What is breast implant illness?
Many women choose to have breast implants to increase their breast size in a procedure known as breast augmentation. In a country where there are no legal restrictions on who may perform this surgery, unfortunately, many women have been attracted by cheap prices and advertising to have a serious cosmetic procedure without considering or being informed about potential issues with implants. Some also choose to go overseas combining holidays with the attraction of cheap cosmetic surgery.
Unfortunately, in many cosmetic clinics, many of whom do not have specialist plastic surgeons, side effects of potential complications of implants are not fully disclosed to patients. Implants are made of silicone, and like any foreign body, have a lifespan. Once placed in the body they slowly deteriorate and may last 10-15 years, often longer. However over this time period they may rupture, rotate, ripple, malposition (move to a less than ideal position under the breast), become hard (Capsular contracture), cause pain, and worse cause delayed seroma (a delayed fluid collection), or ALCL (Anaplastic Large Cell Lymphoma).
In some women, a constellation of symptoms of a breast implant has been subjectively associated with implants and health problems such as general tiredness, fatigue, brain fog, hair loss, weight loss (or weight gain), arthritis, malaise, fever, and vasculitis. To date, no evidence exists between silicone implants and these conditions. However, those who have these symptoms (women with implants) strongly feel and believe the silicone breast implants are a cause, and can closely correlate the symptoms to their insertion, and women with breast implants who have it removed feel better with respect to their symptoms after doing so. These constitutional symptoms are known as breast implant illness.
What is En Bloc Capsulectomy?
When an implant is inserted the body produces a natural response in the form of scar tissue around the implant known as a capsule. For patients who suffer complications from implants often have their implants removed (explant surgery) combined with removal of this capsule (called capsulectomy).
When removing implants, it is usually easier for the plastic surgeon technically to remove the implant, and then the capsule. This is because the incision is under the fold of the breast (in the inframammary fold) and to go over the apex of the implant and to the top of the implant gets difficult with this incision. It can also be difficult to remove the capsule in its entirety especially if the implant is under the muscle – this is because the posterior capsule (that behind the implant) is adherent to the underlying rib cage and intercostal muscles.
EN Bloc Capsulectomy has been popularised by sufferers of breast implant illness from plastic surgery, feeling that removal of the capsule and implant as one block (or one piece) is the best treatment of their condition as it reduces further contamination of the body by the implant. There is some evidence that when implants are inserted they can be contaminated by bacteria that can then adhere to the implant surface and produce a low grade ‘bio-film’. This bio-film, over years of research, has come to be associated to risks of capsular contracture and more recently with the risk of ALCL. Perhaps through this en bloc technique ‘spillage’ of the bio-film is reduced.
What is the evidence?
There is currently no scientific evidence behind breast implant illness. However, in the 1990s the United States banned a certain type of implant; silicone implants, as many women were complaining of autoimmune diseases, negative immune response, irritable bowel syndrome and more as a result of their implants. While no association was found the FDA (food and drug administration) felt that the silicone implant was part of elective surgery and therefore the onus was on the manufacturer to prove there was NO association rather than to prove that there was.
Anecdotally we have numerous patients who have had their implants removed for these reasons and virtually all have felt much better for it.
How is breast implant illness diagnosed?
BIA-ALCL is classified as a T-cell lymphoma. It may develop following the surgical insertion of breast implants.
T-cell lymphomas are cancers that form in your T cells, a type of immune system cell. These cancers may be fast or slow growing. The outlook for a person diagnosed with BIA-ALCL depends on the stage of their cancer at diagnosis and how aggressive it is.
Half of all reported cases of BIA-ALCL are reported within 7 to 8 years of the insertion of breast implants. Because the symptoms of BIA-ALCL are relatively nonspecific, experts say these diagnoses may be complicated and delayed. But as scientific knowledge about it has grown in recent years, experts have begun to establish diagnosis standards (sometimes reffered to as tissue disease).
When a doctor suspects BIA-ALCL, they’ll run a variety of tests to rule out any other causes of your symptoms. These tests may include:
- An ultrasound-guided aspiration of fluid that’s collected around your breast implant. An increased T cell count in this fluid can tip off your doctor to BIA-ALCL. Thick scarring that’s apparent around your implant. If an abnormal breast mass is found, your doctor may test the tissue for lymphoma using a biopsy.
What do we advocate?
We suggest that you have a conversation with your specialist plastic surgeon. It is imperative to check that your surgeon is, in fact, a plastic surgeon by visiting the AHPRA website as well as that of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgeons (ASAPS). At Mode, Dr Aggarwal will be happy to speak to you about en bloc capsulectomy and implant removal. This procedure may be combined with a breast lift if it is required. Usually, a drain is necessary and this can stay in for a week or two, and the operation is always performed under a general anaesthetic in an accredited private hospital.
ENSURE YOU’RE IN SAFE HANDS
ASAPS members are fully qualified Specialist Plastic Surgeons from Australia and New Zealand who are Fellows of the Royal Australasian College of Surgeons(FRACS), with expertise, experience and ongoing education in aesthetic surgery. ASAPS members only operate in accredited facilities so you can be assured they will follow the appropriate course of action to minimise the risk of infection short term and long term.
Visit our member’s database to ensure you are in safe hands.
What are the rough costs?
Implant removal with capsulectomy is approximately $9000-10000, and implant removal with capsulectomy and breast lift approximately $15000-16000 inclusive of surgeon, anaesthetic, hospital and theatre fees. These figures are based on an overnight stay and further hospital stay increases the cost.
I want to know more, what do I do?
Please call us on 1300 80 9000 or email email@example.com. We look forward to seeing you.
A story from support groups Trusted Surgeons.com :
Emma had a breast augmentation in a Phuket Hospital 6 months ago, with textured implants. Since that time, she has suffered from numerous ailments that were not present prior to her procedure. Emma is desperate to have her implants explanted and is considering a fat transfer in the future as an alternative means to implants. Most of all, Emma wants to speak to someone who believes her symptoms and is not labelling her as ‘crazy’. When she approached her initial surgeon, her claims were dismissed. Emma knew she had to get the implants out but found most surgeons do not believe in BII and have refused an explant. Emma was introduced to Trusted Surgeons through Facebook messenger via a patient that we had previously helped. Through the correspondence, Emma and her mother poured their heart out to me. The raw emotion, honesty and desperation literally captivated me and triggered my urge to help.
Emma was living in Queensland and that week was moving to Sydney. To add further stress to her situation, her father has stage four cancer and her mother is across the sea in New Zealand. Her poor mother is a nervous wreck and is unable to console or help her daughter from so far away. Her mother explained to me that it felt as though no one wanted to help her daughter. This has led me to ask the question, is our medical system failing these patients? A GP recommends seeing a Plastic Surgeon and a Plastic Surgeon comes at a cost. In Emma’s case the cost was not an issue as her mum was willing to help financially. This made no difference, as every surgeon Emma contacted, had no experience in breast implant illness, did not do explants or did not provide a consultation within a reasonable period. The Plastic Surgeons Emma did speak to, did not believe in breast implant illness and believed the symptoms were psychological (in her head).
After hearing Emma’s story, I recommended many surgeons I knew that performed explant surgery and would be most accommodating and understanding towards her condition. The first thing Emma did (as did her concerned mother) was get onto Google. Even though I had recommended plastic surgeons I have spoken to about BII and assured her they would be understanding, my personal recommendation was not enough. This is common, and why shouldn’t it be? As a mum, would I trust my daughter with a surgeon on one recommendation? Because of the many enquiries we receive on BII, I make a conscious effort to ask surgeons their thoughts on this condition.
After researching, Emma and her mother Jennifer quickly identified who they wanted to see. Whilst progress is being made and I appreciate that currently, BII has no recognised medical diagnosis with any clear treatment pathway (apart from explant), psychologically, this is having a significant impact on Emma and her mother’s lives.
The reality of this is condition is real to many consumers that have had breast augmentations. Without formal diagnosis, this can still be seen as a social issue and the numbers don’t lie.
- Facebook group ‘Breast Implant Illness and Healing by Nicole’ – has 25,617 active Facebook members
- Web, Facebook, and Instagram pages ‘Explant Info’ (owned by Trusted Surgeons) has had 381,859 visitors since 2016 and has 1,661 active Facebook members
- Facebook page ‘Breast Implant Illness (Australia & New Zealand) Awareness and Support’ has 855 members
- Facebook group ‘Breast Implant Victim Advocacy’ has 1,877 active members
- In addition to this, there are at least over 15 more Facebook groups which have hundreds of thousands of members across the world.
I believe that if you were privy to the groups online you would be astonished. Women are hurt, angry and upset, not only by their journey but how their journey has been trivialised and rightfully so. For many, surgery cannot come quick enough and they would sell every asset they own to access a plastic surgeon they can trust. The longer the breast implants stay in, for these women, the more psychological and emotional trauma is caused. The pain varies from implant rupture to lymph nodes pain and heavy metals leaking. Criticism and frivolous commentary from surgeons that don’t understand the illness, silence them. What this minority of academics seem to disregard, is women are the powerhouse of our economy. Mothers are the decision makers in their household, women in business and the workplace are vital to our society and it is women who support the most powerful men in the world. Women do not like to be silenced or disregarded. With this lack of understanding, these surgeons are crucifying their target market but in the same breath, heavily marketing procedures such as Mummy makeovers and new medical devices? Yet it is these same women, whose friend, sister, aunty, or mother require explant surgery.
It is great to see people leading this powerful movement. The greatest marketing in 2017 is a digital word of mouth. I don’t see this changing for 2018, moreover, it will become increasingly more powerful. Topics such as breast implant illness is viral, it is spoken about every day and it is not going away anytime soon. As previously stated, education is key to making informed decisions. Trusted Surgeons will continue to tirelessly work to communicate with our Plastic Surgeons and provide up to date information and guidance to those in need. We will continue to utilise our digital word of mouth through our social platforms to spread the word.