Re: Link to Dr. Melmed's Response

[Guest guest]

I ran into problems accessing the message, so I'm

copying it to - Rogene

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--- MollyBloom54 <jawlaw93@...> wrote:

> Here is a link to Dr. Melmed's Response. It is on

> " Explantation.com " ./

> http://forums.delphiforums.com/explantation/messages

>

As a physican who is totally opposed to the present

implants, and one with very extensive experience in

removal of both saline and gel implants, I thought I

would address some of the fears, myths and

misinformation that is going on in chat rooms about

this topic. I was the only plastic surgeon who

testified at the FDA hearings in opposition to

allowing the return of silicone on the market

ALL foreign material gets encapsulated. With breast

implants, this is called a capsule. It happens around

sutures, shrapnel, and of course with implants. This

is a reaction by the body to wall off the foreign

material. In its crudest form, this is what happens

with a splinter - the area gets hard until the

splinter is removed. It is akin to a fly getting

caught in a spiders web - it gets cocoon by layers of

material that isolates it.

GEL implants leak from day one. Silicone oils leach

through the walls of the shell and this can be seen by

placing a gel implant on a mirror - you can see the

oils coming out as a residue on the glass. Inside the

body, these oils continue to seep and when implants

are older - anything from 7-10 years on - the wall of

the implants start to break down and the gel escapes

into the peri-prosthetic space. In older days, hard

breasts were " popped " (closed capsulotomy) and this

often ruptured the implant. A secondary capsule then

formed around the escaped gel. The silicone gel is

trapped by the capsule and keeps the majority of the

gel within this space and in the wall. In the walls of

the capsule, the gel will gradually work its way

through the capsule to get into the breast tissue

surrounding the capsule. Where it goes to from there

is uncertain. For sure some of the silicone goes to

the lymph glands, but after that we do not know.

So it is obvious that all of the wall of the capsule

in gel implants must be removed.

With saline implants there is no leaching of silicone

oil. There is NO silicone in the wall of the capsule.

It is always highly desirable to remove all of the

capsule with either type of implant. " En bloc " means

that the implant and capsule are removed in one piece

and there is no chance for silicone to leak on

removal. While this is the ideal, many times the scar

tissue is so adherent that tears occur. It is not

possible to remove en bloc through a very small

incision or via the axilla when this was the original

approach. It is still possible to remove all silicone

and after all this is the objective.

There are important differences in the capsules that

form after gel and saline implants. The longer any

implant is in the body, generally speaking the thicker

the capsule. With gel implants, this is what causes

the hardness, and reaches a Baker class 3 or 4 over

50% of the time by 10 years. The longer a gel implant

is in the body, the easier it is to dissect and remove

en bloc. These capsules are much thicker and not as

adherent to the surrounding tissues. Saline implants

stay softer because the capsule is thinner, and only

get very hard about 14% of the time. The capsule that

forms is much thinner and very much more adherent and

early on much more friable. This means when removing

the capsule, these capsules tear very easily. Often it

is like trying to pick up a wet Kleenex off a glass

table with a tweezers. There are times when removal is

impossible. A surgeon may spend many hours, cause a

lot of damage to the pectoralis muscles, and

intercostal muscles, have significant bleeding and

place the women at great risk for hematoma and seroma

and infection. This is particularly true when placed

under the muscle. Having explanted many saline

implants. I can assure you that any surgeon who

promises an en bloc with saline implants cannot always

deliver, and any surgeon who promises removal of all

the capsules in saline implants in every patient can

never achieve this.

There has been a lot of discussion about infections

and contaminants inside saline implants. The lab at

our hospital has examined all of our explanted saline

implants and find no fungi, bacteria or other

contaminants. In theory, IV saline has an expiration

date. And thus it is troubling when this is put into

an implant that stays in the body for years. But this

does not appear to be a clinical or real life problem.

There are no reports of women suffering massive

infections and other diseases from intraliminal

bacterial or fungal infections.

I contacted Dr Maharaj, an expert who testified at the

FDA hearings against reintroduction of silicone

implants. She said that as yet, there is no evidence

of significant platinum levels in the capsule walls.

We are pursuing this further.

Microscopic evaluation of capsule walls always shows

silicone (or polyurethane with Meme or Natural Y

implants), with vaculolated areas with gel implants.

This is never present with saline implants.

Scientific reports (ls of Plastic Surgery April

2001) have show in laboratory experiments that thin

capsules from saline implants dissipate with time and

are gone within one year. The authors argue that

removal of saline capsules is not (absolutely)

essential. Why are they removed? It is desirable to

return tissues to normal with no residual foreign

material. There is also less likelihood of adhesions,

though these are rare and generally only occur when

implants are placed under the muscle. There are

anecdotal reports that cysts can form, though I have

not personally encountered this. There are no

documented reports that capsule remnants pose any long

term health risks. The Internet has outcries and dire

warnings from women who attribute their problems to

capsules from saline implants. However there is no

scientific evidence to support this. More importantly,

when the saline implants are removed, most women show

significant improvement in their health status. In

clinical experience with over 800 explantations, and

over 300 saline explantations, those very few women in

whom total removal was impossible and/or dangerous,

there were minimal significant issues. It is important

to stress that every endeavor is made to remove ALL of

the capsules, saline or gel, and it is rare when this

is not achieved. There are no surgeons who can remove

of every shred of capsule in every patient.

Not every health issue can be attributed to implants.

Not every health issue can be attributed to capsules.

The " syndrome " of memory loss, fatigue, joint & muscle

pains, hair loss, dry eyes, cognitive disorders, skin

rashes and depression and sleep disturbances are

common to most women who react to silicone. But it

must be remembered that there are other causes that

need to be investigated and eliminated.

I will be happy to address and answer any questions.

Sincerely,

P. Melmed, MD,

Medical City Hospital, Dallas TX

--- MollyBloom54 <jawlaw93@...> wrote:

> Here is a link to Dr. Melmed's Response. It is on

> " Explantation.com " ./

> http://forums.delphiforums.com/explantation/messages

>

>

>

[Guest guest]

Thank you Rogene!!

>

> > Here is a link to Dr. Melmed's Response. It is on

> > " Explantation.com " ./

> > http://forums.delphiforums.com/explantation/messages

> >

> >

> >

[Guest guest]

That is so odd...seems his thoughts about saline capsules contradict

what Dr. Kolb says about saline capsules having biotoxins in them.

Wonder what Dr. Kolb would say about his response?

[Guest guest]

I do not know. Someone else told me that Dr. Melmed's response was consistent

with what

Dr. Feng told her.

> That is so odd...seems his thoughts about saline capsules contradict

> what Dr. Kolb says about saline capsules having biotoxins in them.

> Wonder what Dr. Kolb would say about his response?