Q-A from clee's blog

Q: Explant of Ruptured Sub-muscular Cohesive Gel Implant: is En Bloc Necessary?

Submitted by Q-A from clee on Sat, 05/14/2011 - 09:27

Hi- I recently discovered, and confirmed through MRI, an intracapsular rupture of my sub-muscular 410 cohesive gel implants. They are about four years old. My surgeon is recommending en bloc removal, however this also seems to be this doctor's standard operating procedure.

Is en bloc necessary with cohesives, and are the potential health risks significant either way? I would be extremely grateful for professional input.

A: Would favor removal

I favor removal with complete capsulectomy if possible. En Bloc sounds very severe but is not really more than a complete capsulectomy since this is still an intracapsular rupture. En bloc is much more substantial procedure for extracapsular rupture into the breast parenchyma.

While it remains an intracapsular rupture, risks of any problems are minimal. The problem is that we do not know when it may progress to an extracapsular disruption. For this reason, I favor removal while it is a relatively simple and easy procedure.

Q: Breast Explantation Due to Intracapsular Rupture with Fluid Build

Submitted by Q-A from clee on Sat, 05/14/2011 - 09:07

fluid build up in my right breast, ultrasound showed there is a thick film of capsular around my implant. Look swollen but no pain. I went to 2 surgeons, one said to remove implant without removing any capsules nor stitch up the implant pocket. While the other one will remove all capsules, stitch up pocket.

My implants are under the skin and they're saline. I have them for 7 yrs. Which one should i go with? Will the fluid goes away so i can leave them in since I have no pain? Please advise.Thx

A: Not really understanding some points...your clarification necessary

You mentioned that you have saline implants for 7 years, yet they are ruptured with fluid and swelling. Saline ruptures lead to deflation and their treatment is by replacement usually with assistance of the manufacturer provided the parameter of the warranty are followed.

Silicone is a different matter. 7 years ago there was a moratorium on their placement. Ruptures silicones should probably be removed.

If you are having exchange of implant, then either a pocket exchange or capsulectomy would be wise since the capsules are thick according to your imaging studies.

Q: Should I Feel my Breast Implant Move at This Stage& Why Does my Breast Look This Way?

Submitted by Q-A from clee on Sat, 05/14/2011 - 08:56

I am 22 days out of BA surg texture silicone cohesive submuscular.Before sugery I was completely flat chest no cup at all I was hoping to be a small C Highest B cup but it doesnt seem that I am. My left breast is very soft and feel fine but my right breast is very high and slightly firmer. I am not in pain at all but I am right handed and not understanding why that breast isnt doing the same as left breast I am worried because the swelling is gone but right breast is so diff from left breast.

A: 22 days is still early

22 days is still early. Without preoperative photos it is difficult to know your starting point regarding symmetry. For now I would just let time work for you to let things settle.

Q: Reconstruction After Breast Cancer: Will Medicare Pay to Replace Ruptured Implants?

Submitted by Q-A from clee on Sat, 05/14/2011 - 08:46

I had breast cancer 23 years ago with reconstruction. My implants have been replaced once, 12 years ago, and these are now leaking. Will Medicare pay for replacement? I was not on Medicare when they were replaced 12 yrs. ago. I have no photos but had a breast MRI which showed the leakage.

A: Yes, by law insurance companies must cover

Medicare and private insurance cover must by law cover treatment for the reconstruction of a breast cancer patient. This includes the opposite normal breast to obtain symmetry.

Q: Why Do Natrelle Saline Implant Shell Have a Small Amount of Cc Fill Comparing to Mentor?

Submitted by Q-A from clee on Sat, 05/14/2011 - 08:40

Mentor seems to have around 80cc's where as natrelle only has 20cc fill. Anything over that is considered overfill. I'm getting 320 natrelle HP implants. my doctor wants to either fill it up to 350 or fill it up to 370. I'm a little worried filling it to 370 to make the implant feel more firm and look too fake. I am opting for the natural look but want around 375 cc's Would getting a 330 mentor HP implant and filling it to 370 make a difference? (in look and firmness)

A: Staying within the manufacturer’s parameters is a good idea

Staying within the manufacturer’s parameters is a good idea as it will preserve your warranty. I would not worry about the range difference between the two companies as all these implants are over engineered to be filled multiple times beyond their designated volumes. What usually fails is the shell from cracks at folds or from valves that leak. The footprint design and projection are what matter to your look and not the degree to which implants are overfilled. So probably not such a good plan to choose the lower designated volume Mentor to overfill. Overfilling to prevent ripples is overrated.

Q: Doctor Recommendation for Breast Augmentation Revision in Montreal

Submitted by Q-A from clee on Fri, 05/13/2011 - 23:34

can anyone recommend a skilled redo surgeon in Montreal for Breast augmentation?

A: Montreal has a plethora of wonderful plastic surgeons

Montreal has a plethora of wonderful plastic surgeons. Useful resources to jump start your research include 1) Association des Spécialistes en Chirurgie Plastique et Esthétique du Québec 2) Collège des médecins du Québec 3 )Royal College of Surgeons, Canada 4) Canadian Society of Plastic Surgeons.

Q: Breast Augmentation Revision: How Long Until They Feel Real?

Submitted by Q-A from clee on Fri, 05/13/2011 - 15:09

I had salines put in about 4 months ago and did not like them so I had them exchanged for smaller 250 cc silicones through the aerola.They dont seem swollen now 3 weeks after surgery and the incision is healing really well but i can feel the implant in my breast just as much as I did my saline and it is hard and tender at the bottom of my breast.Will they soften up more just like they did before or are they pretty much the final result wen u hav a revision? (I was a small c before implants)

A: 3wks is very early after surgery breast-they will feel different

3wks is very early after surgery, especially if a capsulectomy was performed. You can be sure to that it will change. I have attached an information page on healing following breast augmentation at my website detailing what to expect with tips that might help. Wishing you the best.

Q: How Swollen Will I Be After Breast Augmentation?

Submitted by Q-A from clee on Fri, 05/13/2011 - 14:57

I am a 20 year old college student and after the spring semester I plan on having both breast augmentation (smooth, round, saline under the muscle, inserted through nipple) and septo rhinoplasty (he will be breaking the bones). Two weeks later summer school starts and I'm wondering if I will look like a wreck when I go back to school with only a 2 week recovery.

A: Your breasts should look good by the time you return to school

Your breasts should look good by the time you return to school. The nose might be more of a problem with swelling and bruising. However, with your clothing over your breasts (even if bruised) your new figure should show beautifully.

Things to know... definitely more painful when placed under the muscle so you might want to avoid gym at beginning of the semester.... with clothes off, your breast bruising still might be noticeable for several weeks into school.

I have attached some of the details to expect with tips on healing at informational website. Hope you find it helpful.

Q: Doctor Recommendation for Breast Augmentation Revision

Submitted by Q-A from clee on Fri, 05/13/2011 - 14:51

I had a breast augmentation 21 days ago and my surgeon now says that my breast tissue is falling over my implants and the correction is a breast lift.As this problem is due to my original surgeon not providing the proper treatment,I am beginning a search for a new surgeon for the revision.

I am willing to travel on the eastern coast of the US or between Montreal and Toronto in Canada for the most experienced surgeon.I need an idea of cost and experience with this kind of deformity that you have.

A: I am sorry you have had this poor experience.

I am sorry you have had this poor experience. In Montreal we have wonderful Plastic Surgeons. Perhaps you should start your search for a reputable plastic surgeon by way of plastic surgery societies in Quebec, Canada, and US.