We know from personal experience that when you begin the process of contemplating breast implant removal, the experience can be more than overwhelming.
Following is a list of questions we have put together to assist you on your journey. The number of breast implant removal surgeries are on the rise. Remember that the amount of questions and the way you approach a plastic surgeon is equally as important. Your health is most important and you would like to achieve the best results possible, however, you do not want to begin your meeting by putting a plastic surgeon on the defensive. The relationship between your plastic surgeon and yourself should have a mutual level of comfort.
Certifications & Facility
Are you certified and what are your credentials? Note: this will vary for each country. For example: Certification by the American Board of Plastic Surgery (ABPS) in the U.S., and the Royal College of Physicians and Surgeons of Canada in Canada, ensures in-depth surgical training in all aspects of plastic surgery. Anyone can claim to be a cosmetic surgeon, plastic surgeon, or doctor. It is extremely important to verify these claims with a reliable and independent source.
Were you trained specifically in the field of plastic surgery?
What specific training do you have in breast implant revision techniques?
How many years of plastic surgery training have you had?
Do you have hospital admitting privileges to perform this procedure in case of complications after surgery? If so, at which hospitals? Call the hospital to verify the information.
Is the office-based surgical facility accredited by a nationally or state/province-recognized accrediting agency, or is it state/province-licensed?
Where and how will you perform my procedure?
Can I have a tour of the facility? If the doctor has an in-office operating suite, ask if it is certified. Always consider the setting. You should be cautious about receiving any surgical procedures outside of a medical setting. If undergoing a surgical procedure outside the hospital, the facility should be accredited by a recognized national agency and should be state/province licensed. Do not be confused by other official-sounding boards and certifications.
Do you have medical malpractice insurance? Canadian physicians and surgeons carry medical malpractice insurance through the Canadian Medical Protective.
We recommend you do your homework on all of the above questions prior to meeting with any plastic surgeon. This will assist in narrowing down your choices ahead of time allowing your initial consultation to focus more time on the surgical procedure questions below.
Surgical Technique
Outline your surgical goals. Be prepared to discuss if you have any medical conditions, drug allergies, current medications, previous surgeries, family history, medical results, and concerns. If you are prone to infections or harbor Methicillin-resistant Staphylococcus aureus (MRSA), make the surgeon aware so you can discuss antibiotic treatment prior to or on the day of surgery.
What surgical technique is recommended for me? Am I a good candidate for this procedure i.e. explant only or explant and mastopexy (breast lift)? What type of incisions will be used and what size will they be?
If you also elect to get mastopexy, ask if the surgeon uses any foreign materials. Newer techniques use biological or synthetic mesh. There is limited high-quality evidence to support their safety or effectiveness. For example GalaFlex mesh - the insertion of a bioresorbable mesh called GalaFlex constructed from poly-4-hydroxybutyrate (P4HB), extruded into monofilament fibers and knitted into a strong, bioresorbable scaffold. It is important to note "Galatea scaffolds have not been studied for use in breast reconstructive surgeries. The safety and effectiveness of Galatea scaffold in neural tissue and in cardiovascular tissue has not been established" as of July 30, 2019 as per Galatea's website. Using mesh will also cause scar tissue and some surgeons have already expressed their concerns with cancer forming in the scar tissue caused by the mesh.
Does he/she perform Enbloc/Total Capsulectomy? Ensure that he/she is committed to obtaining the best results possible. Be cautious of surgeons who "guarantees" your surgery. Outcomes from any surgery can never be 100% guaranteed.
How many Enbloc/Total Capsulectomy has he/she performed and do they have photos of the explanted capsules?
How long will the surgery be? Both Enbloc/Total Capsulectomy surgeries are usually performed under general anesthesia and typically a minimum of 2 hours in length but will vary for each patient.
Ask if the surgeon drains or removes fluid before or during explant surgery. Issues can arise if this is done due to potential toxins, bacteria, silicone residue, and more. Draining fluid is only recommended for a needle biopsy if fluid or a lump is found during an ultrasound or magnetic resonance imaging (MRI). A needle biopsy with drainage of the fluid is necessary to test for BIA-ALCL. Otherwise, it should not be necessary as you need to prevent potential contamination that can arise with explant surgery.
How does the surgeon handle fluid, bacteria and fungal infections if discovered during surgery?
Electrocauterization (electrocautery) is often used in surgery to remove unwanted or harmful tissue. It can also be used to burn and seal blood vessels. If the surgeon cannot remove all of the capsules due to potential health risks to you, how do they handle the remaining portions of the capsule including controlled bleeding? Will they cauterize the remaining portions? And how do they determine the overall success percentage i.e. 90% capsulectomy removed (how does he/she determine what is considered a 90% value)?
Removal of silicone gel from surrounding tissues after implant rupture is difficult. Local inflammation, infection, and silicone granulomas warrant thorough removal of the silicone gel. Ask the surgeon what is the procedure should the breast pocket be contaminated?
Silicone lymphadenopathy is a well-known rare complication of implant insertion. Silicone leakage from a rupture or silicone bleeding can accumulate in lymph nodes. Ask the surgeon what is the procedure should he/she detect this?
What types of stitches will be used - dissolvable, non-dissolvable, or both? If non-dissolvable, how and when will they be removed?
Drains are typically used when there is fluid accumulation, pus, and/or infection. Typically the surgeon will make judgment during the actual surgical procedure. Ask the surgeon if he/she uses drains, what you should expect, and how you maintain them, when they are typically removed. Note - you may not take a shower until your drains have been removed (only sponge bathing).
Does the surgeon provide photos of both the front and back of the implants with capsules properly marked with your identification i.e your initials? In addition, will there be a minimum of2 sets of photos: 1) Front & back with capsules on, and 2) Front & back with capsules removed? Additional sets may include surgical markups/guidelines on your body prior to the surgery commencing. Some surgeons may also provide video. Will you get an electronic copy of the photos and/or videos? It is important to note that most of the explant capsule photos we have seen to date are of the front side only causing great concern for why the other side is not provided.
Does the surgeon automatically send both capsules to pathology for testing? If so, what tests will be completed by pathology? Is testing for CD30 (required for BIA-ALCL diagnosis) done automatically or does the surgeon need to request specifically for this test? Will pathology tests be included in the price of surgery? In addition, will the fluid within the saline implants also be tested, and what tests will be completed i.e fungus colonization?
What does the surgeon do with the actual implants after surgery? Note: many surgeons admit that the actual breast implant is considered a biohazard (yes - we put biohazards in our bodies!) and use proper medical disposal techniques. Some are returned to the manufacturer if they are under warranty. Some patients ask for the cleaned implants to take home with them.
Verify that the individual giving the general anesthesia is properly certified. Your anesthesiologist or nurse anesthetist, along with your doctor, will recommend the best anesthesia option for you based on your surgery you are having, your overall health, any allergies, and your individual preferences.
Verify that you will receive electronically signed copies of all surgical details including operative report, photos and/or videos (as mentioned above), pathology tests, and any additional testing results including bloodwork, ultrasound, mammogram, MRI, etc.)
Pre-Surgery Requirements
If you are concerned about your breast health and are concerned that you may have the same breast implants that are in questions or have been recalled, patients with BIA-ALCL symptoms may receive an ultrasound or a magnetic resonance imaging (MRI) of the symptomatic breast to evaluate for fluid or lumps around the implant and in the lymph nodes. According to ASPS, "If fluid or a mass is found, patients will require a needle biopsy with drainage of the fluid to test for BIA-ALCL. This fluid will be tested for CD30 immune staining (CD30IHC) performed by a pathologist. Testing for CD30IHC is required to confirm a diagnosis or rule out BIA-ALCL. Fluid collections ruled out by CD30IHC for BIA-ALCL will be treated as typical seromas by a physician. Specimens not testing for CD30 may miss the diagnosis of BIA-ALCL." Ensure that your surgeon will complete the above steps outlined by American Society of Plastic Surgeons (ASPS). Note that the FDA has confirmed that both silicone gel and saline implants have been reported in cases of BIA-ALCL.
Will your surgeon send your capsules for pathology testing automatically?
Informed consent. Ask for a copy of the patient consent form prior to making your decision so you can take it home to review. Make sure you have a thorough evaluation and fully understand all aspects of the procedure. Before any medical procedure, patients should provide their medical history, and be examined and evaluated for the specific treatment or procedure. You should receive detailed information about the procedure’s benefits and risks as well as any post-surgical care requirements. Some surgeons may also require a signed confidentiality agreement and/or a Non-Disclosure Agreement (NDA). Be sure to read it carefully before signing.
What if I have booked surgery and I become sick prior to my surgery appointment?
What pre-operative testing needs to be completed prior to surgery? Typically your family doctor will need to schedule testing 4-6 weeks prior to your surgery. This may include pre-operations history, physical, bloodwork, EKG/ECG, ultrasound, mammogram, MRI, stress tests, etc. depending on your situation.
What does the pre-operative appointment consist of and when is it completed? Typically this appointment is 1-2 hours in length with a pre-operative nurse. At this appointment will you receive a detailed patient instruction package complete with to-dos on a timeline i.e. 2 weeks prior, 1 week prior, the night of, aftercare, etc. Photos will also be taken, any breast measurements, and prescriptions will be given. Ask your surgeon what prescriptions will be prescribed and discuss your concerns with the surgeon.
Post Surgery and Recovery Expectations
What is the average length of stay after surgery?
How many follow up appointments are scheduled and when do they occur? Typically if all goes well, you will have a follow-up 1-week post-op, another 6-week post-op, and another at the 3-month mark.
Do you offer overnight accommodation for the day of surgery? If so, what are the details and associated costs?
Do you offer post-operative nursing in-home care services? If not, are you able to recommend any service providers?
Will you provide a compression bra for me or do I need to purchase one ahead of time?
After the surgical tape is removed, what type of scarring treatment product can I use to prevent scarring?
What will be expected of me to get the best results?
How long of a recovery period can I expect, and what kind of help will I need during my recovery?
What are the risks and complications associated with my procedure?
How are complications handled and what type of patient support do you provide? Do you have an after-hours number that I can speak directly to someone should I have any questions or if a complication arises?
How can I expect my breast implant removal procedure to look over time?
What are my options if I am dissatisfied with the outcome?
Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me?
If my capsule pathology tests come back as positive for BIA-ALCL what are the next steps?
Cost
Prices for breast implant surgery can vary. The surgeon's cost may be based on experience, the procedure used, and the location of the office.
What is included in the cost? Some costs may include: anesthesia fees, hospital or surgical facility costs, medical tests, post-surgery garment/compression bra, prescriptions for medication, surgeon's fee.
What is the total cost of this procedure?
How much is the deposit?
When is the deposit required?
When is the balance required?
Do you have a patient financing program?
Will any portion be covered by the national healthcare program ie. OHIP (in Canada)?
Do you have a Patient Loyalty discount (for those who use the same plastic surgeon for implant and explant)?
Can part of your surgery be covered by insurance? Most health insurance plans will not cover breast lift or explant surgery. You must carefully review your own personal health insurance policy. Should your insurance policy cover your explant surgery or partial coverage, will the surgeon work with the insurance company? Some countries may also have coverage for the explant portion of your surgery. In Canada, OHIP has been known to cover certain circumstances i.e. explant due to capsular contracture, pain, infection, etc. It is worth researching your health coverage options with your local government and medical professional.
What is your cancellation policy? What happens to your deposit, should you choose to cancel?
Remember your satisfaction involves more than a fee. When choosing a surgeon, experience and your comfort level also play an important role.
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All posts are intended strictly for educational purposes. It is not intended to make any representations or warranties about the outcome of any procedure. It is not a substitute for a thorough in-person consultation with a medical professional. If you have questions about your personal medical situation, please call your healthcare provider.
If you have any additional questions you think we should add to our list, let us know.
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