Hi everyone, this is Dr. Effie Politis and I’d like to talk about a great article on the April edition of the PRS called contemporary strategies in breast explantation surgery.
So, what is explantation surgery? It is a surgery in which someone proceeds with removing their implants and not replacing them. I’m seeing quite a few patients that are interested in this surgery for various reasons. We all know that implants are man-made devices.
The first reason that women would opt to undergo the surgery is because of implant rupture. I tell women that breast implants are not a “one and done” device, they are a prosthetic that is placed in your body so you need surveillance and you likely will need one or several surgeries in the future if you opt for breast implants. There is a small chance of them rupturing. We can discuss more the difference between saline and silicone ruptures in the future.
Number two is Breast Implant-Associated ALCL (anaplastic large cell lymphoma), this is a rare lymphoma associated with textured implants which I do not use. So it’s not really an issue with my practice but I do see some patients with prior history of textured implants.
Number three is breast implant illness. This is a large topic that’s often discussed on social media. It’s a name given to patients for a wide range of symptoms. The current data shows that there is no cause and effect relationship between implants and these symptoms, however, we certainly are proponents of what women want to do with their bodies. So if they want their implants removed they certainly have the right to have that done. However, the data based on long term studies does not show whether explantation surgery reliably reduces these symptoms.
The last reason women want their implants removed is for non-medical reasons like effects of aging, weight changes, pregnancy, and shifting perspective in aesthetic beauty, as we know there is a movement towards smaller breasts. So women seeking explantation surgery just need to be aware of the risks and benefits in any adjunct surgeries that can be done to enhance their breasts. We look at each woman on an individual basis. It’s a woman’s choice to have their implants removed and we consider the patient’s risk profile, patient preference as well as safety when guiding them on whether explantation surgery is the right surgery for them. I would advise you all to always consult with a board-certified plastic surgeon with a specialty in breast surgery when considering these types of procedures. You can always DM me or look at my website as I’ll have more information. Thank you so much.
This patient is 5’7″ and 166lbs. She is a massive weight loss patient and had a mastopexy when she was younger. After having 5 children, she wanted to correct the deflation in her breast and restore upper pole fullness. She underwent bilateral breast augmentation with Sientra smooth round HSC+ silicone implants, 355cc, moderate profile. This was a quick turn-over, 24-hour recovery breast augmentation procedure. A massive weight loss patient who had a mastopexy or breast lift in the past likely has week tissues and ligaments that require internal support or scaffold for stable and optimal long-term results. I had Galaflex placed to support her lower breast pole, so the implants do not bottom out. Each patient is evaluated whether there is a need for the Galaflex “internal bra”. Post-op photo is 5 days after. [Tap to view in full on IGTV!] Are you a candidate for this procedure? Your best bet is to come in for a consultation to determine whether you are an ideal candidate, but typically, the ideal candidate is relatively healthy and maintains a healthy weight. If you are a candidate for traditional breast augmentation, you are likely a candidate for this procedure too. For more info on our 24-hour breast augmentation procedure, check the link in our bio.
Whether your reasons are for the enhancement of your appearance, correction of uneven breasts, or following a mastectomy procedure, there are several things you have to keep in mind.
When considering breast augmentation, it is important to speak with a plastic surgeon who will help you decide whether the procedure is right for you. At Politis Plastic Surgery, we will conduct a physical exam, get your medical history, listen to your concerns, consider your aesthetic goals, and offer options for how to proceed. We only recommend this surgical procedure to patients in good health who have realistic expectations. This is why the consultation is critical.
While your surgeon may use implants, fat transfer, or both to augment your breasts, the decision primarily depends on your existing breast tissue, body mass, and frame, as well as your desired body shape. The surgeon will create a personalized plan and provide you with pre-operative instructions to ensure the experience is as easy, safe, and comfortable as possible.
According to Dr. Malluci of the Royal Free and University College London Hospitals, it is the relative size of the upper and lower halves of breasts that holds the secret of the perfect bust.
He believes the most-appealing female breasts should be only slightly smaller above the nipple than below.
To support his hypothesis, he asked more than 1,300 people to rank four breast types with different proportions. Board-certified plastic surgeons have championed the adoption of this aesthetic principal.
This golden ratio for breasts is not just a modern phenomenon.
Throughout history, from the earliest representations of women to the statues of antiquity, from Renaissance masters to modern photographers, artists have chosen the same proportions.
During your consultation, an important question that you need to ask your surgeon is whether or not they follow the 14-Point-Plan.
What is the 14-Point Plan
The 14-Point-Plan is designed to minimize the number of bacteria that can contaminate breast implants at the time of surgery. It was first published in 2013 and has since been widely adopted all around the world. Bacterial contamination of breast implants at the time of surgery has been shown to cause capsular contracture – hardening, pain, and deformity following breast implant surgery. The 14-Point-Plan outlines strategies that can be incorporated into breast implant surgery that reduce the number of bacteria that can contaminate the breast implant surface.
Here you can see a funnel is being used to place the breast implant into the dissected pocket.
Whether your breasts are sagging, asymmetrical or too small for your body size, breast augmentation can help you regain a feeling of attractiveness, positive self-image and confidence. But the success of the procedure depends on good communication and the expertise of your plastic surgeon. A skilled surgeon will not only enlarge your breasts to the desired size, but also apply measures and techniques that minimize the risks and complications of the procedure.
What makes someone the right surgeon for breast augmentation?
Board certification indicates that the surgeon has undergone rigorous training and testing. It is also proof that the surgeon is competent and experienced enough in performing the procedure. Find a surgeon certified by the American Board of Plastic Surgery (ABPS) or the American Board of Cosmetic Surgery (ABCS) and check the status of his or her license before you schedule a consultation.
Your breast augmentation surgery is more likely to be successful when performed by a plastic surgeon who conducts the procedure on a regular basis. Remember, the right surgeon will not only determine the type and shape of breast implants to use, but will also align the procedure to meet your goals. Plastic surgeons get better at the procedure with time and frequency.
3. Runs an accredited facility
While breast augmentation is typically an outpatient surgery, it should be done in a facility with the highest standards of safety, quality and patient care. Accreditation is proof that the facility is committed to best practices, and a qualified surgeon will work at or run an accredited and accommodating facility.
4. Candid and compassionate
Breast augmentation is a cosmetic procedure that should be tailored to the needs of the patient. To find a surgeon who can perform the surgery in a way that is in line with your goals and expectations, look for someone who takes the time to get to know you.
At the same time, a surgeon should give you correct, straightforward guidance on the best approach to achieving your aesthetic goals—and tell you the honest truth, not what you want to hear. Pick a surgeon who is open, frank and caring.
So how do you find the right surgeon?
1. Get recommendations
Recommendations by people you trust are a great way to find a competent plastic surgeon. Speak with friends, relatives or colleagues who have had the surgery to give you some references. Ask them to share their experiences with their surgeons, what they liked about the experience, and whether their procedures met their aesthetic goals and expectations.
2. Use the internet
Searching the internet is an easy way to find plastic surgeons performing breast augmentation in your local area. For instance, if you reside in Tampa, type keywords such as “plastic surgeon in Tampa,” “best breast augmentation surgeon in Tampa,” “breast implant surgery Tampa,” or “breast augmentation center in Tampa” and see what comes up in your search results. Open the links that appear in your search results and check out details like names and addresses of the surgeons.
3. Narrow down your options
From the recommendations and internet searches, you should have around 5-10 options to choose from. Further research will help you identify the top 2-3 surgeons. To narrow down your options, check out patient reviews posted on patient forums. You might also look for patient testimonials, before and after photos, gallery of patient cases, and case studies to help you get a clearer picture of the work and outcomes achieved by every surgeon in your list.
4. Book an appointment
Now that you have found 2-3 surgeons you believe can perform breast augmentation that meets your aesthetic goals, you should schedule a consultation session with each of them before choosing one. The meeting should help you determine if you are comfortable with and trust the surgeon, and to get a sense of whether or not the surgeon understands what you want from the surgery.
During consultation, the surgeon will thoroughly explain all aspects of the procedure and answer all your questions. This is when you should ask questions, raise your concerns, and find out what to expect before, during and after the procedure. You can also ask to look at before and after photos, patient testimonials, reference to previous patients, and case studies from the surgeon.
5. Make your decision
From your list of 2-3 plastic surgeons, consider choosing the one with whom you most easily communicated and established a rapport during consultation. The right surgeon is the one who made you feel more confident about your surgery through an open and honest discussion about your overall health, lifestyle, aesthetic goals, and your questions and concerns.
At Politis Plastic Surgery, we believe that working with a skilled and experienced board-certified surgeon is the best way to achieve your aesthetic goals through breast augmentation. Dr. Effie Politis is a candid and compassionate surgeon who can help you on your journey to a happier, more confident you. She performs breast augmentation frequently and with remarkable outcomes for her patients. For more information about plastic surgery, visit the site Politis Plastic Surgery website.
I was first introduced to the concept of “bioengineered breast” in 2009 by Dr. Pat Maxwell and colleagues. He originally coined this term to describe an enhanced breast form consisting of a combination of cohesive gel breast implant, regenerative scaffold, and regenerative cells.
The implant and the soft tissue covering it can both be enhanced to achieve the optimal female breast form.
Enhancing the soft-tissue cover not only supplements volume and shape but also further alters how the recipient’s host tissue responds to the foreign body implant.
This powerful combination of constructs better allows us to achieve the ultimate goal of breast reconstruction: to recreate a breast that appears and feels like the natural breast.
This patient had large breasts and underwent bilateral skin-sparing mastectomies. She opted for one-stage reconstruction to minimize downtime. This was achieved using a hybrid concept after the mastectomy flap perfusion was evaluated.
I was able to pair an anterior acellular dermal matrix sheet with a posterior stable Galaflex base to provide the patient with both softness and stability.
She plans on having fat grafting during her nipple-areolar reconstruction to further augment her soft tissue envelope and soften her breast borders.
Breast implants do not cause or increase the risk of breast cancer, but they have been linked with Anaplastic Large-Cell Lymphoma (ALCL), a rare cancer of the immune system. According to the Food and Drug Administration (FDA), the use of breast implants with textured surfaces and polyurethane outer shells has a very low but increased risk of ALCL. The cancer is also called Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) because of its link with certain breast implants.
What is BIA-ALCL?
Breast Implant-Associated Lymphoma is not breast cancer. It is a type of non-Hodgkin’s lymphoma, a cancer of the immune system. Most cases of the cancer occur around the scar tissue and fluid near the breast implant. However, in some cases, it can spread throughout the body. Though the risk of developing BIA-ALCL is very low, the cancer is serious and can lead to death, particularly if not treated early.
How is BIA-ALCL associated with breast implants?
While the link between breast implants and Anaplastic Large-Cell Lymphoma is still unclear, it is believed that the growth of bacteria on the surfaces of breast implants can, eventually, result in increased stimulation of lymphocytes. The stimulated lymphocytes may then trigger an immune response that leads to BIA-ALCL. Since only 1 in 50,000 women with breast implants develop the disease, the chance of BIA-ALCL being triggered by implants is considered very low. Also, the risk does not increase with either silicone or saline-filled implants. Because the immune response that causes BIA-ALCL depends on the growth and proliferation of bacteria, the risk of cancer is related to the surface area of the implant. Textured implants and expanders have a higher surface area compared to smooth implants, resulting in a higher risk of BIA-ALCL compared to smooth surface implants. In fact, up to 96% of cases of the cancer are reported in patients with breast implants with textured (bumpy) surfaces and polyurethane outer shells.
What are the warning signs?
When BIA-ALCL occurs, it tends to arise more than one year after breast augmentation surgery. Patients develop chronic swelling, a mass (lump), pain, or fluid buildup around the implant. The breast may harden, have new scar tissue, or may be painful around the vicinity of the implant. Plus, there may be hair loss, skin rash near the breast, and exhaustion (a sign of a weakened immune system).
Is BIA-ALCL curable?
ALCL is curable, particularly when discovered early. To diagnose ALCL, the doctor will perform a needle biopsy and an imaging test (mammogram or ultrasound). Early treatment typically involves the removal of the implant and the surrounding scar tissue. But, in some cases, chemotherapy and radiotherapy may be necessary.
What should you do?
If you are considering breast augmentation, reconstruction, or replacement (revision) with breast implants, you should discuss your goals and expectations with your plastic surgeon. Your surgeon will also explain the benefits and risks of having breast implants, the need to monitor implants for complications, and their eventual replacement or removal. If you already have breast implants, concerns related to BIA-ALCL should not mean you remove them. If there are no symptoms, no need to worry. Instead, you should speak with your plastic surgeon about the risk of developing the cancer. But if you do have symptoms, talk to your doctor about further evaluation, confirmation, and treatment of the cancer. At Politis Plastic Surgery, we do not use breast implants and tissue expanders that the FDA has listed as a potential cause of BIA-ALCL. During the consultation, we inform our patients about the risks associated with breast implants, including BIA-ALCL. When treating patients with suspected BIA-ALCL, we develop individualized treatment plans in coordination with experts in the diagnosis and treatment of the cancer. Do you have questions or concerns about the use of breast implants in breast augmentation or reconstruction? Dr. Effie Politis will answer your specific questions and help you make an informed decision about cosmetic surgery. For more information on breast implants and associated risks and complications, visit the Politis Plastic Surgery website.
Breast augmentation is a surgical procedure to make breasts appear larger and fuller. Performed using either special implants or by fat transfer from a different area of the body, the procedure helps to restore breast fullness after pregnancy or weight loss, correct asymmetrical breasts, or enlarge smaller breasts. It is also valuable as reconstructive surgery after a mastectomy or other breast surgery.
A safe, effective procedure
When done by a skilled and experienced board-certified plastic surgeon, breast augmentation is a safe and effective procedure. The surgeon takes the necessary measures to minimize the risks of the operation, and the majority of women have no issues after the surgery. In fact, among millions of women with breast implants, complications have been observed in fewer than 1% of patients.
However, like every surgery, the procedure has general surgical risks, including temporary pain, swelling, bruising, tightness in the chest, bleeding, infection, poor scarring, allergic reaction to anesthesia, hematoma, changes in breast or nipple sensation, or need for revision surgery.
Besides, breast implants are designed to be temporary devices which wear out, degrade chemically, and release their content. So when getting breast implants, women should know that they are temporary devices that will need removing or replacing at a later date—the longer you have the implants, the higher the chances of complications.
What are the specific risks and complications of breast augmentation?
You will experience some pain or contraction for a while after the operation. Your surgeon can prescribe pain-relieving medication to help you manage pain which should be gone after 7-10 days. Do not take any other medication apart from the painkillers and additional medications prescribed by your doctor.
Seroma — a buildup of fluid under the skin surface—may occur after the procedure, often at the site of the incision. The fluid is called serum and may begin to accumulate soon after surgery or several weeks later. Seromas pose a risk of infection and are resolved by draining the fluid buildup, especially when they are large.
3. Breast Implant-Associated Illness
Breast implant illness (BII or BIAI) is a self-reported complication and not an official medical diagnosis. Patients who believe they have the condition have reported a number of common symptoms, including fatigue, chest pain, hair loss, chills, headaches, chronic pain, rash, anxiety, photosensitivity, brain fog, and sleep disturbance.
There is still a need for research to find out why the symptoms occur and how they can be remedied. Many patients reporting these symptoms have also reported that the removal of breast implants alleviates the symptoms.
4. Implant rupture and deflation
Although breast implants have changed significantly since their inception and are now more durable than before, they can still rupture or burst under trauma or extra pressure. Most implant ruptures occur between 10-15 years after initial surgery, but this depends on the type of implant.
Silicone gel-filled implants have thicker liquid, so they do not deflate completely after rupture. But a hole or tear in saline-filled implants can cause a complete deflation, as the fluid escapes into the surrounding tissue.
Silicone implant rupture comes with risks such as pain, lumps, tenderness, and swelling. The breasts are also deflated in a manner visible to the eyes. Therefore, for patients with silicone gel-filled implants, it is advisable to have regular MRI scans after the procedure to detect possible rupture. If rupture is found, the implants are removed and replaced to prevent infections, discomfort, and cosmetic deformities.
5. Capsular contracture
The natural tissue of the body may react to the breast implants through an immune response. When this occurs, the collagen fiber around the implant forms a scar tissue (membrane) around the implant, resulting in hardening, stiffness, implant deformity, and pain in the breast over time.
Capsular contracture is classified into four grades: I to IV. Grade I contracture can go away with massaging and usually does not need treatment as it causes minimal problems. Grade II contracture creates more firmness in the breast and requires ultrasonic massage instruments. Grade III and IV contracture makes the breast hard and unnatural and requires surgery to remove and replace the implant.
6. Hypertrophic scarring
Breast augmentation is associated with a severe form of scarring, called hypertrophic scarring. It is a small but notable risk—only observed in 5% of patients. It is characterized by a thick, red-colored scar that is raised above the skin. Surgical scars tend to occur around the nipple and the lower part of the nipple. Your plastic surgeon may carry out renovation procedures to eliminate or reduce these scars.
7. Breast Implant-Associated Anaplastic Large-Cell Lymphoma
Though there is a low risk of Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) occurring after breast augmentation, patients should still be aware of the risk. BIA-ALCL is a cancer of the immune system and is not related to breast cancer.
The condition is curable, with early detection offering patients the best chance for a quick recovery. Women considering breast augmentation should speak with their plastic surgeons about the risk of BIA-ALCL.
8. Surgical site infections
Infection may develop in or around the surgical site if bacteria enter the surgical wound either from the skin or in a contaminated saline solution or implant. The infection may be mild or severe, with the potential of infiltrating into deeper layers of the skin. Symptoms include pain in the surgical area and high fever. The implant may need to be removed to allow for the treatment of the infection before it is eventually replaced.
At Politis Plastic Surgery, we understand that the possible risks and complications of breast augmentation vary depending on your medical history, body type, allergies, medication, and other individual factors. We uphold the highest standards of medical care and take the necessary steps during the procedure to minimize the risks associated with the surgery. And after the procedure, we will keep in touch with you to ensure that any issues are promptly resolved.
Want to meet with a plastic surgeon to have your specific questions and concerns addressed? Dr. Effie Politis will listen to your cosmetic goals, explain available options, and guide you through your preparation for the surgery and your post-surgical journey. For more information on breast augmentation, visit the site Politis Plastic Surgery website.
Breast augmentation is a great way to regain breast fullness, enlarge smaller breasts, or correct asymmetrical breasts. If you are healthy, you will tolerate the surgery quite well and enjoy more self-confidence after the procedure.
Good rapport with your plastic surgeon
A successful recovery begins with a good relationship with your plastic surgeon. Like any other surgery, breast augmentation has risks and possible complications. As a patient, you need as much support and information as possible to minimize the risk of complications after the procedure.
Finding a skilled and experienced board-certified plastic surgeon is advisable. You should also look for a surgeon with whom you feel comfortable so that you can communicate honestly and know what to expect. At Politis Plastic Surgery, we have a compassionate, patient-centered approach to breast augmentation. This allows our patients to quickly establish a good rapport with their surgeon, something that is valuable during and after the procedure.
What should you expect soon after surgery?
Breast augmentation is typically an outpatient procedure. You can expect it to be completed within 1 to 3 hours. Once the surgery is done, you will be moved to the recovery area and monitored for a while. If your plastic surgeon is satisfied with your response to the procedure, you will be allowed to go home the same day.
You can expect some pain and soreness after the anesthesia wears off. Gauze, a surgical bra, or an elastic bandage will be wrapped around your chest. You may also have drainage tubes attached to your breasts for three days. Prescriptions for pain-relieving medication help ease the pain, and antibiotics can prevent infection. You will be provided with instructions to follow during the recovery period until the follow up visit.
How long will it take to recover?
The recovery period varies from one person to another. Generally, if you do not experience complications after the procedure, then you should expect a full recovery in six weeks, but your plastic surgeon will assess your overall health and give you a personalized recovery timeline. Make sure to speak with your surgeon about this before the procedure. At home, eating a balanced diet and drinking plenty of water is essential for good healing and faster recovery.
How much discomfort occurs during recovery?
It is normal to have some discomfort and disrupted sleep during the first few days or weeks after breast augmentation. Actually, the first three to five days can be quite uncomfortable, and you may need prescription pain medication. After the first week, the discomfort should be minimal, allowing you to slowly ease back into a normal daily routine with light exercise.
While residual discomfort and breast scar incisions may take months to improve, be aware that severe pain, redness and swelling need immediate medical attention. To minimize post-surgical pain and speed up your recovery, avoid strenuous or jarring activity such as running or rigorous workouts. If you have a labor-intensive job, you should remain out of work for at least three weeks.
Follow your surgeon’s instructions
The incision wound will need proper care. During the first week after surgery, all bandages and dressings remain intact, and you will need to follow your surgeon’s instructions on caring for the wounds. At Politis Plastic Surgery, we remove dressings to check your healing progress after one week. At that time, we will show you how to care for the wounds to achieve the best healing and minimal scarring.
As you follow these instructions, make sure to listen to your body, particularly to warning signs. For instance, a manageable amount of pain and nausea tend to occur after breast augmentation, but extreme pain and nausea may be a warning sign of complications. Make sure to always speak with your surgeon whenever something unusual or extreme occurs.
When should you expect to resume normal activities?
Two weeks is the usual amount of time away from work, but that depends on the physical demands of your job. Speak with your surgeon for details on what you can do to speed up your recovery. As a rule, it is best to have your surgeon’s approval before resuming normal activities, especially strenuous exercise, high-impact sports or saunas.
At Politis Plastic Surgery, we will customize your breast augmentation procedure to best suit your needs and desired surgical outcomes. Working with Dr. Effie Politis, you can expect natural-looking cosmetic surgery results and a comprehensive guide to recovery.
If you are considering breast augmentation, we encourage you to schedule your consultation session well in advance. The one-on-one session with a plastic surgeon allows you to discuss all of your concerns and become informed about what to expect. For more information about breast augmentation, visit the Politis Plastic Surgery website.