SILICONE GEL BREAST IMPLANT REMOVAL

Silicone gel breast implants are not lifelong and so must be expected to leak at some stage. Leaking or ruptured implants can give rise to various symptoms including breast pain (burning), distortion and hardness. The relationship between silicone and chronic fatigue, generalised pain and various other symptoms remains controversial.

Removing implants can lead to improvement, or even complete resolution of symptoms related to breast implant leakage, although this can never be guaranteed.

The aim of surgery is to remove the implant with its surrounding block of scar capsule in one piece and so prevent spillage of silicone into the body tissues. It is necessary to make a longer incision than the original used for insertion of the implant and this can be up to 10 cm in length. This incision is made in the fold underneath the breast and if your original scar is in this position it is removed at the time of surgery.

There can be no guarantee that the implant and surrounding scar capsule will be removed in one piece but every attempt is made to achieve this. In the event of scar capsule rupture silicone may be spilt into the operation site but this will be removed at the time of surgery.

Although capsular contracture leads to thickening of the scar tissue it is not necessary, at the time of surgery, to remove normal breast tissue. However the procedure is time consuming and difficult. It produces a large, raw area inside the breast, which tends to bleed. Drains, inserted through the armpit, are necessary to reduce the chance of a haematoma (blood clot) forming in the breast.

Obviously removing breast implants will make the breasts smaller. The breasts will be swollen immediately after the operation and at first may not appear very different from before the operation.

Swelling and bruising take a few weeks to settle after which the breasts can be distorted. Characteristically this shows as a dent in the central part of the breast behind the nipple. There may also be more breast droop than before implants were inserted.

Photographs will be taken of your breasts before the operation as part of the clinical record. These photographs remain confidential and are kept securely.

Your GP will be given full details of your surgery and progress.

The hospital holds a pre-assessment clinic (PAC) which is run by the nursing staff. You will be invited to attend one of these clinics a week or two before the operation. They are intended as a medical screen to identify problems and carry out any necessary tests before the day of your surgery. Sometimes it will be arranged for you to see the anaesthetist at this clinic.

DISCHARGE

When you get home take life very slowly and carefully at first. An absorbable, running stitch is used to close the wound and this is covered with paper tape. This is waterproof and so you can bath and shower at will. Normally an appointment is made for you to be seen in the clinic one week after surgery for removal of the dressing and wound inspection.

The scars will initially be very pink but with time (more than six months) they will fade to a paler colour. However narrow the scar is to start with it might stretch widely and may also thicken and irritate. Skin scars should be protected from the sun for at least a year to prevent permanent colour change. Remember that some swimwear allows ultra violet rays to reach the skin and so a good sunscreen (minimum of factor 25) should be applied when sunbathing.

Before leaving hospital you will be given an outpatient appointment but if you have any problems, worries or concerns after discharge from hospital please feel free to telephone me for advice. I can generally be contacted on 07850 484 672 but if I cannot be reached immediately a message can be left on my office answerphone (0208 463 0019) and I will get back to you as soon as possible.

COMPLICATIONS

This list is intended to inform rather than frighten and it does not cover every thing that can go wrong.
1. Anaesthesia. The small risk of an anaesthetic applies as in any operation. Smoking increases this risk.
2. Sensation. The nipples and breast may be numb after the operation, possibly going through a phase of increased sensitivity before returning to normal over a period of six months or so. In rare cases numbness can be permanent.
4. Scarring. The scar, although "hairline" to start with, will go through a phase of redness and thickening which should settle after a few months leaving a pale line. In rare cases thickening and itching can get out of hand and require treatment.
6. Bleeding. Rarely, despite drainage tubes, bleeding continues around the implant. When this happens, an emergency operation is sometimes required to stop the bleeding and remove blood clot.

30/05/05