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What is Explant Surgery?

Explant surgery is a surgical procedure performed under general anesthesia in which breast implants and the surrounding scar capsules are completely removed intact. The reasons for having explant surgery can vary from health concerns to aesthetic preferences. Some women decide to remove their implants for personal reasons. In contrast, others decide on surgical removal because of complications such as a rupture, pain, or hardening of the implants due to capsular contracture. Currently, the most common reason women are removing their implants is because of the increasing concerns of Breast Implant Illness (BII).

What are Scar Capsules?

Scar capsule formation is the body's natural response to any injury or surgical placement of a medical device, including breast implants. The presence of a foreign object causes this reaction. The immune system creates a protective layer of collagen fibers around the breast implants. Unfortunately, scar capsules can cause pain, implant hardening, and deformation. When the capsule becomes thick or tight around the implant, it is called a capsular contracture.

Why Do the Scar Capsules Need to be Removed?

Removal of the scar capsules and intact (en bloc capsulectomy) is essential for optimal recovery and reduction of BII symptoms. Several studies have found that 35%-45% of capsules have biofilms, which can be bacterial, fungal, or mycobacterium. Leaving behind a capsule with biofilms will continue to elicit an inflammatory response by the body due to a low-grade bacterial infection. Complete removal of the scar capsule also helps ensure that any silicone or debris from textured implants is completely cleared from the body. Most importantly, although rare, leaving behind capsules that could be hiding breast implant-related cancers such as BIA-ALCL (Breast Implant-Associated - Anaplastic Large Cell Lymphoma or SCC (Squamous Cell Carcinoma) would be detrimental. Dr. Robert Whitfield testified at the FDA hearings directly after a woman whose capsules had not been wholly removed via an en bloc resection. She had BIA-ALCL within the scar capsules, and since the capsules were not completely removed, cancer spread to her ribs, which is a non-recoverable event.

What is the Difference Between an En Bloc Capsulectomy and a Total Capsulectomy? 

Understanding the difference between an en-bloc capsulectomy and a total capsulectomy is essential. While Dr. Whitfield utilizes both procedures, the goal should always be to remove the breast implant and scar capsule via an en-bloc total capsulectomy. En bloc is the French word for “all together.” An en bloc capsulectomy removes the implant and capsule without rips or tears, or as Dr. Robert Whitfield describes it, “an undisturbed Easter egg.” The other surgical removal method is a total capsulectomy. Although the entire capsule is removed, it is not done intact and in one piece. A total capsulectomy often removes the capsules in fragments or pieces. While sometimes this cannot be avoided due to thin paper capsules that rip or tear upon removal, the goal should always be to remove the scar capsules whenever possible to prevent biofilms, implant debris, or silicone from contaminating the breast pocket.

What Happens During Explant Surgery?

Explant surgery is performed under general anesthesia and should take between two to three hours. During the procedure, Dr. Whitfield will make an incision under the breast (inframammary fold) or vertically if performing a lift, or if the implants are small enough, they can sometimes be removed through an incision of the areola. For most explants, the incision needs to be long enough to allow for the removal of the entire capsule but should not extend past the length of the breast. If the implants are placed under the muscle, the surgeon will carefully remove them from the chest wall while keeping the surrounding scar tissue intact. If multiple breast surgeries with implant exchange have occurred, Dr. Whitfield may have to remove other scar capsules that were left behind from previous surgeries. 

What About Drains? 

Why do most surgeons use drains while a select few perform drain-free explant surgery? Drains remove any excess fluid or blood that may accumulate in the area where the surgery has been performed. Drains are small tubes inserted into the skin near the surgical site. These tubes are attached to a bulb-like device that sits outside the body and collects the excess fluid. The patient may have to wear the drains for several days to weeks. The most common downside to using drains is an increased chance of an infection. Drains do not prevent hematomas or seromas, which is a common misconception. The use of drains in a tummy tuck procedure has almost been eliminated because of alterations in technique. For this reason, Dr. Whitfield utilizes techniques to create drainage within the body without drains. Proper bandaging, icing, anti-inflammatory medications, and lymphatic massage are all important steps in a “drain-free” explant.

What is the Recovery Time After Explant Surgery?

Recovery time after explant surgery can vary depending on the individual, the placement of the implants (above or below the muscle), and the extent of the procedure. Generally, patients can expect to experience some discomfort, swelling, and bruising for a few days after surgery. Most people can return to normal activities within two or three weeks, with no heavy lifting or strenuous exercise for a few weeks. Experienced explant surgeons will have techniques such as extended-release numbing and pain management protocols to minimize the need for narcotics. Surgeons understand functional medicine and gut health and will not overly prescribe pharmaceuticals or antibiotics. Overall, explant surgery is a safe and effective procedure, and when performed by an experienced explant surgeon, it can improve a woman's quality of life. If you are experiencing issues with your implants and having symptoms of breast implant illness, or if you simply want to remove them for personal reasons, contact a trusted and experienced surgeon who can guide you through your explant journey.

Are There Other Steps to Recovery from BII? 

While proper removal of the breast implants and scar capsule is one of the most important steps in the recovery process of Breast Implant Illness (BII), it is only the first step. Breast implants are a significant driver of inflammation in the body, and when the immune system is taxed by inflammation, other areas of the body become imbalanced. This imbalance can lead to a reduced ability to detox from mold, heavy metals, environmental toxins, inflammation of the GI tract, dysbiosis of the gut microbiome, increased food sensitivities, hormonal dysfunction, and, depending on genetics, reduced immune detox pathways, and vitamin deficiencies. Working with Dr. Whitfield, who understands the importance of looking for all other root cause issues prevalent in BII patients, is essential for the most successful outcome. This is why Dr. Whitfield created the SHARP program.

Explant and Fat Transfer

Fat transfer to the breast, also known as “natural breast augmentation,” is a safe and effective way to enhance the size and shape of breasts using natural fat cells. Unlike traditional breast augmentation surgery, fat transfer to the breast doesn't involve inserting any foreign objects into your body. The fat transfer process to the breast starts with liposuction – where Dr. Whitfield or Dr. Chung removes excess fat from areas with surpluses such as the stomach, thighs, or flanks. Once the fat cells are harvested and purified, they are carefully injected into the breast tissue. Fat transfer to the breast results is permanent as long as you maintain a stable weight. Fat must be harvested and placed by a highly skilled surgeon since fat cells are very fragile. Surgeons like Dr. Whitfield and Dr. Chung, who specialize in fat transfer, understand the importance of liposuction cannula diameters and sterile closed system collection for proper fat removal and transfer.


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