Explant information & resources

QUESTIONS TO ASK YOUR SURGEON

 

This is a list compiled from those of us who have been through Explant Surgery. While it may not totally cover the questions that you have specific to your situation, it is a good starting point. The questions are not in any order of importance.

 

 

PROCEDURE

 

  • How do you remove the implant? Where will my incisions/scars be?

  • Do you remove the capsules? If so, do you do that en bloc (as one unit with the implant) or do you remove them separately (capsulectomy?)

  • Do you remove all of the capsules? If not, what is the reason they would not be completely removed?

  • If other surgeons are able to get the entire capsule out, even in difficult cases, why have you not been able to do that?

  • If there has been more than one set of implants do you remove all capsules if the previous ones were not removed?

  • How long will surgery take? Are there extra charges if it goes over the anticipated time?

  • How do you clean out the chest cavity in general and if there has been a rupture?

  • Will you place drains since the chest wall is a closed space? (meaning blood/fluid has nowhere to go in a closed space)

  • If drains, how long should I expect them to be in place?

  • Will I receive instructions on how to manage/empty the drains?

  • How will they be removed?

  • If you don’t place drains why not?

  • If a seroma (pocket of serous fluid) a hematoma (pocket of blood) or other chest wall complication occurs, how will you handle it?

  • If you traveled for surgery and will be returning home before drains are removed, inquire about whom to contact to have drains removed in your hometown. General surgeon? Breast surgeon? PCP? Surgical PA or Nurse Practitioner?

  • Do you feel I need a lift at the time of explant? If so, how is that done?

  • Does it change where the incisions/scars will be located? Will this add any more time to my recovery?

  • Will I be wrapped or need a compression garment at the time of surgery?

  • Do you provide that or do I need to bring a special type of compression garment/bra with me? How long will I need to be wrapped? When can I wear a regular bra? Are underwire bras permitted?

  • Do I need any testing prior to surgery? Labs, Ultrasound, MRI (without contrast only. Mammo’s are not usually recommended because many ladies have ruptured implants from mammo’s)

 

 

PRe-Op

 

  • Are there any medications/supplements that I should stop before surgery? If so, how long in advance?

  • Do you have a list of items that I should bring (or not bring) on surgery day?

  • Will the facility call me prior to my surgical day to review my surgical time and when I should arrive?

  • When do I stop eating/drinking before surgery?

  • Should I take my usual medications with a sip of water before surgery? (Such as thyroid, BP meds, etc.)

 

 

costs

 

(Most likely this will be handled by the office manager or financial department and not the surgeon.)

 

  • Who will review the costs of surgery/lift with me? Insurance coverage? Pre-authorization? Out of pocket expenses? Do I need proper codes for insurance or will your office provide those for me?

  • Do I make a deposit before surgery? If so, how much? If I cancel my surgery will I receive all/any of my deposit back?

  • Do you take Care Credit or do you offer options to finance?

  • Are my post-op visits covered in the cost of surgery or will they be an extra charge?

 

 

testing

 

  • What will you send to pathology for testing? Implants, capsules, fluid?

  • Will a culture be done to determine if I have an infection in my chest?

  • (For textured implants) Will you send capsules and fluid for CD30 testing for BIA-ALCL? (Breast Implant-Associated Acute Large Cell Lymphoma)

  • Do you check for silicone in lymph nodes? Do you remove if indicated?

  • Will you take pictures of the implants and capsules once they are removed? Do you take a picture of the pocket so I know the capsules are fully removed? Who will get these photos to me and when can I expect them?

  • How will I receive my OR Report and Pathology report? Will I be called with the results? Will someone explain the results to me? Will a hard copy be mailed/emailed to me to keep for my personal records? How long does this usually take?

  • Will I receive my implants back after they have been inspected/tested?

 

 

anesthesia 

 

  • When will I speak to the anesthesiologist?

  • What type of anesthesia is typically used?

  • Will I receive antibiotics and/or steroids in my IV? If so, what kind of antibiotic? (Fluoroquinolone antibiotics come with black box warnings. Try to avoid!) Will I need to take oral antibiotics after surgery? If I prefer not to have antibiotics or steroids, can I refuse them?

 

 

facility

 

  • Where will my surgery be done? Hospital OR? Hospital Surgi-Center or Outpatient Facility? Freestanding Surgi-Center at your office or close by?

  • If freestanding, is it accredited? What hospital would I be transferred to in the event of an unforeseen emergency?

  • Is there a place for my family to wait while I’m in surgery?

  • Who will let them know when my surgery is over and how it went? Will I go to a recovery room? If so, for how long?

  • At what point will I be able to see my family?

  • When will I be discharged?

  • Will I receive post-op instructions at the facility regarding incision/drain care, activity level, driving restrictions, work restrictions, lifting, exercising, etc. Who will review these instructions with me? Will they be written down?

 

 

post-op

 

  • How long do you expect my recovery to take?

  • How will my pain be managed in the facility and after I go home?

  • When will I be able to bathe in the tub or shower?

  • When do I return for a post op visit? Do I need any further visits?

  • If you traveled and are returning home before a post-op visit is scheduled, who should I see for follow-up locally? General surgeon, Breast Surgeon, Plastic Surgeon, PCP, Surgical PA or Nurse Practitioner?

  • Will my sutures need removed or will they dissolve? If they need removed, how many days post-surgery? Is this done at the post-op visit?

  • If drains, are they removed at the same time as the sutures? Is it painful?

  • How do I care for the drain hole area?

  • Whom do I call if I have post-op questions or issues once I’m home?

  • Should I put any type of lotion or cream on my scars? Should I massage the area? Should I message if I’ve had a rupture?

 

 

general

 

  • Are you board certified in plastic surgery?

  • Who else might be in the OR with you? Any other surgeons, residents, medical students?

  • How many explants do you do per year?

  • Do you believe that implants can cause illness? If not, will you perform my procedure to eliminate as many toxins as possible so that I have the best chance for recovery?

 

 

 

more information

We no longer provide a list of explant surgeons on this website. Surgery is not an exact science and outcomes are not guaranteed. All surgeons will have patients who have had positive experiences and those who have had negative experiences. Select a surgeon that is best for you and your needs. If you follow the questions given above, you should have a very good assessment of which surgeon is right for you. 

 

For best recovery from breast implant illness it is highly recommend that your capsules (scar tissue that forms around the implant) be completely removed via enbloc (implants and capsules removed as one unit) or total capsulectomy (both removed but not necessarily as one unit.)  

 

If you reside in the United States, we highly advise that you NOT leave the country for surgery. While the lower cost may initially be attractive, there have been many reported drawbacks. 

 

Some surgeons on the “lists” have become so popular that the wait for surgery is months. If you are severely ill from your implants, please do not wait months for removal. There are many surgeons on the lists (and not on the lists) who do a proper explant. 

 

It is rumored in the breast implant community that some “lists” are padded with surgeons who have paid to be included on the list. Please proceed with caution if you choose to follow a list.