Explant questions

[Guest guest]

Have any of you had your implants removed but left the capsules? Did

you still get better? Do you think it takes longer to get better when

there left in? Did the doctor give any medication after the operation

that helped? Also about the drain tubes are those a must? I have to

meet with my doctor next week and I'm not sure what he will do. My

options are very limited right now but my insurance is paying for the

explant. So I wanted to know what I should fight for and what i can

take at face value. This is the only doctor I can go to for my

insurance to cover so I want to make sure I know what to request and

what to demand from him. If just having the implants out alone won't

make any difference in my health and he won't do anything else then

I'm not going to put myself through this. If getting the implants out

and going through detox will make a difference then I'm going into

surgery in three weeks. I just need to know where to stand through all

this!

Thanks a Bunch,

[Guest guest]

,

Nobody can predict what will happen in your case. Every woman is

different, but here's my two cents, based on the things I've heard

in the 7+ years that I have been involved in breast implant issues.

As simply as I can put it in your situation:

For best healing and recovery prognosis,

1) you MUST have the capsules removed.

2)Drains are also highly recommended, though healing can happen

without them. It may just take longer as your body has to fight to

clear up all the fluids remaining that would be better off out of

you through drainage. If you have a total capsulectomy alone, your

healing will still be a good possibility.

If the capsules are NOT removed, you might have to 1) live with the

health challenges that may remain or 2) go through another surgery

to get all the capsule tissue out. It is probable that you would

have to pay for this out of pocket, and it can be as costly as an

explant itself.

Nobody can make the final decision but you. I would seriously

request that this doctor do a total capsulectomy and make sure he

understands how much you are desiring this for your health's sake.

He doesn't have to live with the health issues....you do. And your

best chance at healing (notice I am not saying your ONLY chance, but

your BEST chance) comes from getting all remnants of the implants

and scar tissue out.

And let me point out that this would be particularly true if you

plan on carrying a baby in the future. Your immune system can still

respond to particles and whatnot left over from the implants. We

have studies you can show your doctor regarding this, to make sure

he understands how important this is to you.

This is a case of better safe than sorry. And when you are talking

about the rest of your life here, I would say make every effort to

get everything out, not just do what is expedient at the moment,

based on insurance. You only have one chance to do this

right....make sure that the one doing the explant is on your side,

and cares about your outcome!

Patty

--- In , " Mike " <iceman18152000@y...>

wrote:

>

> Have any of you had your implants removed but left the capsules?

Did

> you still get better? Do you think it takes longer to get better

when

> there left in? Did the doctor give any medication after the

operation

> that helped? Also about the drain tubes are those a must? I have

to

> meet with my doctor next week and I'm not sure what he will do. My

> options are very limited right now but my insurance is paying for

the

> explant. So I wanted to know what I should fight for and what i

can

> take at face value. This is the only doctor I can go to for my

> insurance to cover so I want to make sure I know what to request

and

> what to demand from him. If just having the implants out alone

won't

> make any difference in my health and he won't do anything else

then

> I'm not going to put myself through this. If getting the implants

out

> and going through detox will make a difference then I'm going into

> surgery in three weeks. I just need to know where to stand through

all

> this!

> Thanks a Bunch,

>

>

[Guest guest]

,

Here is some info you can take to your doctor. These are from our

files section, the folder on explant. The first part is snipped from

a letter to an insurance company and discusses the logical need for

total capsulectomy. The second is a letter written by Dr. Blais that

talks about the LONG TERM risk factors of leaving a capsule in the

body:

+++++++++++++++++++++++++++++

There is a remarkably large body of medical and scientific

literature on

these matters which emphatically shows the capsule is the site of

the illness.

It is one thing to debunk the patient of silicone load by

explantation but

unless the capsules come out at the same time the immunopathic

process will

continue unabated. The standard is not whether something is usual our

customary, but whether it is the correct and logical thing to do.

Please reexamine your policy on this matter. In the long run, the

better health of these patients will be well served by doing the

right thing: explantation with capsulectomy, a continuous and

coherent procedure appropriate to the underlying pathology. A

rational policy of this sort will also serve the financial fiduciary

requirements of your firm over time. Such has been the experience of

this clinic.

Sincerely Yours,

DOUGLAS R. SHANKLIN, M. D., F.R.S.M.

Professor of Pathology and of

Obstetrics and Gynecology

Dr. Shanklin: 1-901-227-7695

+++++++++++++++++++++++++++++++++++++++++++++++++++

RESIDUAL CAPSULE AND INTERCAPSULAR DEBRIS

AS LONG-TERM RISK FACTORS

By: Dr. Pierre Blais, PhD

Contamination of the space between the capsule and the implants by

micro- organisms, silicone oils, degradation products and gel

impurities

constitutes a major problem which potentates the risk of implants.

Such

problems include inflammation, infection, deposition of mineral

debris, as

well as certain autoimmune phenomena. These problems can be present

when

implants are in situ (in the body) and are often attributable to the

implant.

The logical expectation is that, upon removal of the implants,

adverse

effects will cease. This is an unjustifiably optimistic view. It is

well

documented from case histories that removal and or replacement of

implants

without exhaustive debridement of the prosthetic site leads to

failure and

post surgical complications.

Plastic surgery procedure lead to favor speed and immediate cosmetic

results. For these reasons, leaving or " reusing " tissue from an

existing

capsule may seem more " gratifying " . However, adverse effects

resulting from

the practice are widespread but have not been well documented.

Typically,

patients who require removal of faulty implants and undergo

immediate re-

implantation in the same prosthetic site habitually relapse with the

same

problem which motivated the previous surgery; the most common

example is

exchange of implants and/or sectorizing or bisecting the capsule

without

removing it completely.

Such patients rarely achieve a significant capsular correction and

habitually return for more similar surgery. A more illustrative

situation is

that where patients do not receive replacement implants. They form

the basis

of knowledge for evaluating the risks that arise from remaining

capsules. An

example is described in a paper published in 1993 (Copeland, M.,

Kessel, A.,

Spiera, H., Hermann, G., Bleiweiss, I. J.; Systemic Inflammatory

Disorder

Related To Fibrous Breast Capsules After Silicone Implant Removal;

Plastic

and Reconstructive Surgery: 92 (6), 1179-1181, 1993): reported

problems

derived primarily from immune phenomena and inflammatory syndromes

with pain,

swelling, serologic abnormalities and alarming radiologic

presentation.

Numerous similar cases have been noted amongst implant patients but

have not been the object of publications. Some are cited in FDA

Reaction

Reports. Others appear in the US Pharmacopoeia Reporting Programs.

A residual capsule is not a stable entity. It may collapse upon

completion of surgery and remain asymptomatic for some time,

however, it will

fill with extracellular fluid and remain as a fluid-filled space

with added

blood and prosthetic debris. As the wall matures and the breast

remodels to

accommodate the loss of the prostheses, the capsular tissue shrinks.

Water as

well as electrolytes are expelled gradually from the pocket or else

the

mixture is concentrated from leakage of water from the semi-

permeable capsular

membrane wall.

In most cases, calcium salts precipitate during that stage and may

render the

capsule visible as a radiodense and speckled zone in radiographic

projections.

Prosthetic debris is also radiodense and may be imaged to further

complicate

the presentation. The average size of the residual capsules after 6-

12 months

is in the 2-7 cm range: most are compact, comparatively small and

dense.

Surgical removal should present no difficulty for most patients if

adequate

radiographic information is available.

Later stages of maturation include the thickening of the capsule

wall,

sometimes reaching 0.5-1cm. Compression of the debris into a cluster

of

nodules which actually become calcifies follows for some patients. A

few

mimic malignancies. Others appear as small " prostheses " during

mammographic

studies. They are alarming to oncologists and are habitually

signaled for

further studies or biopsies by oncologic radiologists.

In light of the present knowledge and considering the probable

content

of the residual closed capsules, an open or needle biopsy is not

advisable.

The risks of releasing significant amounts of hazardous

contamination and

possibly spreading infective entities outweighs the advantage of the

diagnostic. At any rate, such a capsule requires removal for

mitigation of

symptoms and a more direct surgical approach appears more economical

and less

risky.

In summary, a capsule with a dense fibro-collagenous wall behaves as

a

bioreactor. Worse yet, it is fitted with a semi-permeable wall that

may

periodically open to release its content to the breast. The

probability of

finding the space colonized with atypical microorganisms is elevated

and the

control of infective processes by classic pharmacologic approaches is

difficult if not impossible.

Such closed capsular spaces may be comparable to " artificial organs "

of unpredictable functions. Their behavior will depend on the

content and the

age of the structure, its maturity and the history of the patient.

There is a

high probability that these capsules will continue to evolve for

many years,

adding more layers of fibro-collagenous tissue and possibly

granulomatous

material. If bacterial entities are present within the capsule

space, they

can culminate in large breast abscesses with

will resist conservative treatments.

Even with less active capsules containing mostly oily and calcitic

debris, the thickening of the wall leads eventually to solid " tumor-

like

structures " and are, by themselves, alarming on auscultation and self

examination. At best, such structures are unique environments for

protein

denaturation and aberrant biochemical reactions with unknown long

term

consequences.

Pierre Blais, PhD

Innoval,

496 Westminster Ave.,

Ottawa, Ontario, Canada K2A 2V1

613.728-8688,

Fax: 613.728-0687

Pierre Blais, PhD received his undergraduate and graduate degrees in

physical-

organic polymer chemistry from McGill University in Montreal,

Canada, and a

Postdoctorate Fellowship in biomaterials engineering at Case Western

University in Cleveland, Ohio. In 1976 he became one of the first

scientists

to join the medical devices and radiological health program of the

Department

of Health and Welfare in Canada. He left the department in 1989 as

Senior

Scientific Advisor and formed Innoval Consultants, a firm engaged in

the

design, testing and failure analysis of high risk medical systems.

He has

authored over 250 publications on medical materials and their

interactions

with living tissues.

> >

> > Have any of you had your implants removed but left the capsules?

> Did

> > you still get better? Do you think it takes longer to get better

> when

> > there left in? Did the doctor give any medication after the

> operation

> > that helped? Also about the drain tubes are those a must? I have

> to

> > meet with my doctor next week and I'm not sure what he will do.

My

> > options are very limited right now but my insurance is paying

for

> the

> > explant. So I wanted to know what I should fight for and what i

> can

> > take at face value. This is the only doctor I can go to for my

> > insurance to cover so I want to make sure I know what to request

> and

> > what to demand from him. If just having the implants out alone

> won't

> > make any difference in my health and he won't do anything else

> then

> > I'm not going to put myself through this. If getting the

implants

> out

> > and going through detox will make a difference then I'm going

into

> > surgery in three weeks. I just need to know where to stand

through

> all

> > this!

> > Thanks a Bunch,

> >

> >

>

[Guest guest]

Hi , it is so important that you have your implants

removed " enbloc " which means the capsules are removed as well as the

implant. Many women don't get the capsules removed and they still

feel just as bad. I understand that you need your insurance to cover

it but if they aren't going to do it correctly I would try and see

if there is any one else that you can go to that will do the enbloc

for you. I know it is soooo very important for your health. There

are some women who have actually had to have a second surgery

performed after there explant because the capsules were left in. As

for the drainage tubes I know this is important to have as well. You

can bleed internally and have serious complications. I understand

that you need to have this all covered thru insurance. i went thru

the same thing and mine is still pending thru Dr. Kolb ( i think the

explant will be covered and the lift will not be) but I believe that

your health is more important. If you decide to keep them in you are

only going to get more sick and eventually you are going to have to

have them replaced or taken out...implants don't last forever! I had

to take out a loan for the surgery and we are not in the financial

situtation to do that but it had to be done! Your health is so

important and I hope that you can some how come up with the money to

get it done correctly. Hope this helps!

--- In , " Mike " <iceman18152000@y...>

wrote:

>

> Have any of you had your implants removed but left the capsules?

Did

> you still get better? Do you think it takes longer to get better

when

> there left in? Did the doctor give any medication after the

operation

> that helped? Also about the drain tubes are those a must? I have

to

> meet with my doctor next week and I'm not sure what he will do. My

> options are very limited right now but my insurance is paying for

the

> explant. So I wanted to know what I should fight for and what i

can

> take at face value. This is the only doctor I can go to for my

> insurance to cover so I want to make sure I know what to request

and

> what to demand from him. If just having the implants out alone

won't

> make any difference in my health and he won't do anything else

then

> I'm not going to put myself through this. If getting the implants

out

> and going through detox will make a difference then I'm going into

> surgery in three weeks. I just need to know where to stand through

all

> this!

> Thanks a Bunch,

>

>

[Guest guest]

Patty thank you! Do you off hand have any of that information I can

show the doctor? I saw him this morning and he is very willing to

remove but I know he thinks I'm crazy. I'm pushing to get him to

understand what I'm talking about but without any information it's

just talk to him! Now I had a different PS tell me they don't remove

the Capsules in Saline implants because ones the implant is removed

the capsules will disolve????? I thought she was crazy since the

last time I checked Scar tissue doesn't just go away on it's own!

Was she just being lazy or is she talking about something else? I

don't know so that's why I ended up see this other PS. I just don't

know how to make him see how important it is to remove the capsules?

Maybe if I could show him something on paper he'll understand

better! Let me know where I can get the information or if you have

it I would love for you to email it to me.

Again Thank you very much,

> >

> > Have any of you had your implants removed but left the capsules?

> Did

> > you still get better? Do you think it takes longer to get better

> when

> > there left in? Did the doctor give any medication after the

> operation

> > that helped? Also about the drain tubes are those a must? I have

> to

> > meet with my doctor next week and I'm not sure what he will do.

My

> > options are very limited right now but my insurance is paying

for

> the

> > explant. So I wanted to know what I should fight for and what i

> can

> > take at face value. This is the only doctor I can go to for my

> > insurance to cover so I want to make sure I know what to request

> and

> > what to demand from him. If just having the implants out alone

> won't

> > make any difference in my health and he won't do anything else

> then

> > I'm not going to put myself through this. If getting the

implants

> out

> > and going through detox will make a difference then I'm going

into

> > surgery in three weeks. I just need to know where to stand

through

> all

> > this!

> > Thanks a Bunch,

> >

> >

>