Breast Implant Illness: Questions To Ask Explant Surgeons
▪️Are you ready to take that step, and start scheduling consultations to find a skilled explant surgeon?
▪️One that believes in Breast Implant Illness?
▪️A surgeon that you can trust to remove the entire capsule?
▪️Never be intimidated into not asking questions. Your health is worth it. Ask the questions.
▪️Do your best to be an informed patient and advocate for yourself.
▪️Here is important information that can help you have the safest explant experience possible.
- Are you a board certified Plastic Surgeon? Do you have hospital privileges? Do you have medical malpractice insurance? If the surgeon has their own surgical suite, but not hospital privileges, find out why. Having hospital privileges is important to ask because it means they are trained and certified in plastic surgery and in good standing with the medical community. Hospital privileges are also important if you were to have a serious complication during surgery that might require entry to a hospital to save your life. A surgeon without hospital privileges cannot help you in these situations. Sometimes surgeons lose their hospital privileges for significant reasons that you should be aware of. You must ask.
- Is the surgical facility accredited? Learn more about this here: http://www.americanboardcosmeticsurgery.org/patient-resources/facility-accreditation/
- You must stress to your surgeon that your breast implants be removed En Bloc if possible, and always with a total capsulectomy. En Bloc is especially important for leaking or bleeding silicone and/or textured implants, to minimize any silicone contamination to your body. I personally recommend getting En Bloc with saline as well, with, or without symptoms. For all explants of breast implants, all of the capsule tissue should be removed from your chest for your best chance of whole body recovery from breast implant symptoms.
- Do you have En Bloc explant skills and experience? How many explants have you done? Do you have Total Capsulectomy skills, and how many have you done? They should preferably have at least 50+ in their experience. Can you provide photos of previous En Bloc/ Total Capsulectomy explanted capsules and implants evidencing entire removal of the capsule tissue? Will you provide photos of my En Bloc/Total Capsulectomy explanted capsules and implants evidencing entire removal of my capsule tissue? Photos are really the lone way that they can prove they removed your implants En Bloc/Total Capsulectomy. *En Bloc/Total Capsulectomy is NOT the same surgery as aesthetic flat closure. If a surgeon tells you that they have only done aesthetic flat closure, find another surgeon. Explant surgery is obviously a completely different surgery and requires experience and expertise.
- Are you committed to removing ALL of the capsule tissue from my chest? Be sure to choose a surgeon that is completely committed to removing all capsule tissue from your chest, because as we know, removing the capsules correlates with our healing from breast implant illness.
- How long will I be in surgery? Proper En Bloc/Total Capsulectomy explant surgery usually requires a general anesthetic and takes approximately 2 to 4 hours or longer.
- Are you dedicated to not draining or removing any fluid from my implants before explanting? I am personally against any draining or removal of fluid during explant. Silicone or saline. Saline can be full of mold bio toxins, silicone particulate, and chemicals, while silicone is full of toxins and chemicals. Any draining of your implants prior to explant is a contamination danger to the patient.
- Demand BIA-ALCL testing upon removal of your implants. Especially if you have textured implants, swelling, seroma, breast mass, or capsular contracture. Ask you surgeon if a seroma/effusion is discovered during explant, will they aspirate and send the fluid and the capsules for CD30 Immunohistochemistry to rule out BIA-ALCL? Never assume that surgeons do this automatically.
- Can I see an advance copy of all presurgery paperwork that must be signed? Do I need to sign a confidentiality agreement or a non-disclosure agreement with this surgeon? I recommend NOT choosing any surgeon that wants to prevent you from sharing your story online, or in any social media group.
- What kind of anesthesia is used during my surgery? What can I expect from having this anesthesia? Is anything else added to my anesthetic? How will that affect me? How will anesthesia effect me post-operatively? What if I have a MTHFR mutation?
- Will I be receiving any other medications? Will I be given an antibiotic, and if so, which one? How will that affect me? Will I receive anti-nausea medication? Will I be given steroids during my surgery? If you have Lyme disease are steroids a contraindication?
- Will you be using cauterization during surgery? Cauterization greatly reduces bleeding. How will they control bleeding or clotting if necessary to do so? Will the stitches be dissolvable? Will any foreign matter materials be used such as staples, mesh, or permanent stitches? I am personally against any foreign materials. Other foreign material besides breast implants can cause many of the same problems in our bodies. I do not recommend using mesh or staples for any associated lift procedures either.
- How will I control pain? What kind of prescriptions, and how might they affect me?
- Are pieces of the capsule tissue being sent to pathology to check for bacterial and fungal infections? Also, the rest of the capsule sent to check for silicone, various immune reactivity cells, cancer, or BIA-ALCL if applicable? Do you send the implants to pathology to document their state and if they are ruptured or leaking? Will you test saline fluid for colonization by microorganisms such as mold if applicable?
- How do you clean out the chest pocket if it becomes contaminated with silicone or microorganisms?
- If you have grossly ruptured silicone implants where silicone has traveled to the lymph nodes do they check lymph nodes for silicone through ultrasound and localization techniques? Do they remove lymph nodes that cannot be saved?
- Do I get pictures and/or video of the explant procedure? It is recommended to have your pictures or videos signed off to you. Many surgeons will gladly download your photos and videos for you. Pictures of you with implants pre-surgery, picture of you after explant without your implants while on the surgery table, pictures of your implants with the capsule intact and still on to prove En Bloc removal, and pictures of the implants and capsule tissue separately are all recommended to document each part of your explant surgery being done En Bloc.
- Do I get a copy of my entire file, including operative reports, pictures, pathology, and any tests performed at our post-op appointment?
- Will they return your implants to you? If you can keep your implants, I recommend having them in clearly marked sealed containers. Wrap said containers in a single plastic bag and put them in the freezer if you want to, or can keep them for future legal purposes. Some states have biohazard rules in place, and consider the implants to be hazardous waste.
- Will you be placing drains, and what should I expect? How do I care for them? Who will remove my drains, and when?
- What signs of infection should I be aware of, and monitoring? What are the signs of a seroma or hematoma after my explant surgery? What is the protocol if I have these symptoms?
- If you are explanting due to rupture, capsular contracture, pain, or infection and your insurance will be covering you for explant, will they work with your insurance or provide you with the letters required for you to apply for insurance coverage reimbursement or refund yourself?
- Is there a deposit required for my explant surgery? What happens to my deposit if I need to cancel or postpone my surgery at any time?
- What are my pre-surgical directions? Supplements and some medications might need to be avoided prior to surgery for up to two weeks. What are my post-surgical instructions? Wound care, compression if needed, sleeping recommendations, massage and therapy, physical limitations, and who to call in case of questions or problems after surgery are all important to know prior to your explant.
- Will they prescribe antibiotics for bacterial infections in the chest cavity and or anti-fungals if the implants are colonized with fungus, and or if you experience an overgrowth of fungus in the gut and body?
- How long is my expected recovery?
- How many follow up appointments, and when?
- What scars should I expect after explant surgery?
- Do you think I will need future revision(s) for any reason?
▪️I hope that these questions help you find the right surgeon for you, personally. Much like I was helped by other BII survivors and warriors before me.
▪️Wishing you the best in luck as you move forward in your journey to explant.