QUESTIONS TO ASK SURGEONS AT EXPLANT CONSULTS

  1.  Are you a board certified Plastic Surgeon?  Do you have hospital privileges?  Do you have medical malpractice insurance?  If a doctor has their own surgical suite but does not have hospital privileges, do not use them.  Having hospital privileges is the key question to ask as it means they are trained and certified in plastic surgery and in good standing with the medical community.  Also hospital privileges is important  especially if you were to get an infection or have any complication that would require entry to the hospital to save your life.  A doctor without hospital privileges cannot help you in those circumstances.  Doctors lose their hospital privileges for significant reasons and you should be aware of those reasons but you may not have access to details of why they lost their privileges on line unless you know where to look.   Doctors lose their malpractice insurance too for serious reasons such as multiple malpractice suits being filed and you may not have access to that information unless you ask this question.
  2.  Is their surgical facility accredited?  Learn about surgical facility accreditation here:  http://www.americanboardcosmeticsurgery.org/patient-resources/facility-accreditation/
  3. You want your implants removed En Bloc/Total Capsulectomy. En Bloc/Total Capsulectomy in particular for silicone and for textured implants to minimize contamination to you. Total Capsulectomy for saline implants. For all kinds of implants all capsule tissue should be removed from your chest for your best and highest recovery.  Ask the surgeon directly if they have En Bloc explant skills and have removed implants En Bloc and how many explants they have done En Bloc?  Do they have Total Capsulectomy skills and how many Total Capsulectomies have they done?  They should have at least 50 or more under their belt.  Can they provide photos of previous En Bloc/Total Capsulectomy explants?  Photos are really the only way they can prove to you their skills in doing proper En Bloc/Total Capsulectomy explants.  Are they committed to removing all capsule tissue from your chest?  Choose a surgeon that is committed to removing all capsule tissue from your chest so you don’t waste your money and have to have a second surgery to remove left over capsule in order to finally recover.  How long will the surgery take?  Proper En Bloc/Total Capsulectomy explants usually require a general anesthetic and take approximately two hours or longer of surgery time.
  4. Will the surgeon drain or remove any fluid from your implants before explanting you or during explanting you?  We highly suggest against draining or removing any fluid as saline fluid can be full of mold or other fungus, mold biotoxins and silicone chemicals and silicone particulate and draining any fluid from your implants prior to your explant or at the time of explant risks contamination to you.    Just say NO to draining or removing fluid from implants when explanting.
  5. Very Important – In regard to BIA-ALCL – If you have swelling, seroma, breast mass or capsular contracture and especially if you have textured implants, please push for BIA-ALCL testing upon removal of your implants.  Ask your surgeon if a seroma/effusion is discovered during explant will they aspirate and send the fluid and capsules for CD30 Immunohistochemistry to rule out BIA~ALCL? Please do not assume that the surgeons automatically know to do this; many do not know and discard the fluid. We have to start educating explanting surgeons to do the CD30 test and to follow proper testing procedures for BIA-ALCL which is now thought to be more widespread that the medical community knows or acknowledges.
  6.  Ask to see an advance copy of all the presurgery paperwork that must be signed.  Do you have to sign a confidentiality agreement or a non-disclosure agreement with this surgeon?  This is a relatively new angle that a surgeon came up with well after the consult and well after the deposit was paid and right before the surgery they attempted to force patients to sign a nondisclosure/confidentiality agreement so the patient cannot report their surgery experience and results including price on the internet, social media including our facebook group and review sites on line.  We suggest walking away from any surgeon requesting or insisting patients sign a nondisclosure/confidentiality agreement.
  7. What kind of anesthetic is used during surgery and what to expect with it? Is anything else added to the anesthetic and if so how will it affect you?   If you are MTHFR positive will your condition affect your anesthesia procedures?  MTHFR people are recommended to avoid Nitrous Oxide as it greatly depletes our B12 levels which low B12 causes many symptoms.
  8. Will you receive antibiotics during the surgery, what kind will be used and how will it affect you?  Will you receive any other medication such as anti-nausea medication?  Some surgeons use steriods during surgery.  Lyme ladies should be cautious about steroids as they can worsen Lyme.
  9. Will the surgeon use cautery during surgery which greatly reduces bleeding?  How will they control bleeding or blood clotting if necessary to do so?  Will the stitches be dissolvable or do they have to be removed?  Will any foreign materials be used such as staples, permanent stitches, mesh etc?  We highly suggest against all foreign materials because these cause problems too especially mesh and metal staples clamps etc.  Some lift procedures use mesh and we highly advise against mesh or silicone products as it causes many problems in us too.
  10. What kind of pain killers will be prescribed and how will they affect you?
  11. Does the surgeon send pieces of capsule tissue to pathology to check for bacterial and fungal infections and also the rest of the capsule to check for silicone, various immune reactivity cells, cancer or BIA-ALCL if applicable.  Does he send the implants to pathology to document their state and if they are leaking ruptured.  See a great link on pathology here:  http://www.nature.com/modpathol/journal/v13/n9/full/3880192a.html.  Will he test saline fluid for colonization by microorganisms such as fungus if applicable by sending to labs that test for fungus such as Mycometrics or Real-Time Lab?  How much will any of this testing cost you?
  12. What does he do to clean out the pocket if it is contaminated with silicone and or microorganisms?
  13. If you are dealing with a grossly ruptured silicone implant which silicone travelled to the lymph nodes, does he check lymph nodes for silicone through ultrasound and localization techniques and remove lymph nodes that cannot be saved?
  14. Does he take pictures or video of the explant procedure for you? We recommend getting the following video or pictures signed off by him; one of you with your implants still in before surgery, one of you after explant without your implants while on the surgery table, picture of the implants with capsule tissue still on to prove En Bloc removal and pictures of the implants and capsule tissue separately to document each of those clearly.
  15. Can you have a copy of your complete file including operative reports, pictures and tests at your first follow up meeting?
  16. Will he pack up and return your uncleaned implants and capsule tissue to you? Or send them else where if you request? We recommend that your implants not be cleaned by your surgeon, that they be returned to you as is in containers marked left and right and that you yourself do not handle them but instead wrap both containers in one plastic bag and place them in your fridge/freezer for future legal. Do not handle your implants as lawyers will say you tampered with them.
  17. Will you have drains and what should you expect with drains and how will you care for them? Who will remove your drains?
  18. What are the signs of an infection after explant?  What are the signs of a seroma or hematoma after explant? What are the procedures if symptoms of these occur?
  19. If you are explanting due to rupture, capsular contracture, pain or infection and your insurance covers you for explant will he work through your insurance or provide you the letters required for you to apply to insurance for refund yourself?
  20. Is there a deposit required and what happens with that deposit if you have to cancel or postpone at anytime?
  21. What are pre-surgery directions for avoiding supplements and medications and what are after surgery directions for compression, wound care, sleeping, massage and who will you call if you have problems or questions after surgery?
  22. Will he prescribe antibiotics for bacterial infections in the chest pocket and or antifungals if the implants are colonized with fungus and or if you experience an overgrowth of fungus in the gut and body due to antibiotics which is common in us.
  23. How long will it take for your breasts to heal and feel normal? When will the follow up appointments be and how many?  What can I expect in terms of size of explant incision scars?
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26 thoughts on “QUESTIONS TO ASK SURGEONS AT EXPLANT CONSULTS

  1. Tammy

    I ask to join the Facebook page to get information for Explant but it hasn’t been approved yet, was wondering how long approval takes?

    Reply
  2. Cheryl

    Thank you for the education. I had my saline implants placed under the muscles in 2012. I have been having worsening fatigued, joint pains, irritable bowels, so many other symptoms. My breasts are not feeling like they one did and have become very uncomfortable due to tenderness. I’ve not been feeling like myself. I’m 63 and need these implants out. I’m in the BrenhamTx area. I need the right surgeon not only for the En bloc but because of the size I will need a lift. Can you recommend someone near my area please if possible.

    Reply
  3. Hines

    Hi I had implant s for 15 years and had all the symptom every other week I’m in the hospital so much pain I suffer .keep getting ciss now. My heart is weak. The are turning me away because of my heart.( Doctors) what can i do I need help

    Reply
  4. Lori-Ann Williams

    I have only one expander due to infections during chemo and having to have two (2) emergency surgeries. Does this apply to me too; or just women with implants? Thank you.

    Reply
    1. admin Post author

      Hi Jean,
      Some health care plans and health insurance policies do cover explant for what they deem to be medically approved reasons which generally are for rupture, capsular contracture, pain and infection/necrosis caused by breast implants. Please see the Resource page of this website for more information on moving through the insurance process.

      Reply
  5. Brenda Culver-Kaiser

    Hi! I had explant surgery in Dec. 2016 with Dr. Susan Kolb in Atlanta Ga. Both of my silicone implants were ruptured, and the left breast had a large blood clot filled with infection. She removed 7 lymph nodes during this initial surgery. Last March she said I needed an additional surgery (following a sonogram) to remove 3 additional lymph nodes that were infiltrated by silicone. So I did that. Recently I went back for a follow up, and another sonogram. Once again, 3 lymph nodes, larger than the last, along with a cyst on my left breast appeared in the sonogram. But this time, she had her assistant call me to say, “We are just going to keep an eye on it.” With no other instructions for me. I would like to get a second opinion, but have no idea who to see. I have heard it can take over a year to see Dr. Lu-Jean Feng.

    Reply
    1. admin Post author

      Hi Brenda,
      So you have had a total of ten lymph nodes removed so far which seems scary and unnecessary. If I was you I would check to see if there is capsule tissue or silicone particulate left over in your chest rather than keep removing lymph nodes. Is it not more likely that your original explant was not entirely complete and entirely thorough and capsule tisue and or silicone particulate likely remains in your chest and is causing problems and lymph nodes to keep swelling? Also I would check for BIA-ALCL too if I was you as you your symptoms indicate the need to check for BIA-ALCL. For the most part Dr Feng, Dr Chun and Dr. Barnett and the other explant experts very rarely remove even one lymph node when they explant but rather they are impeccable and very thorough about cleaning the chest out of all capsule tissue and all silicone particles and restoring the chest to normal and subsequently these experts do not need to remove lymph nodes and do not need to additional surgeries on their patients who heal well.

      Reply
  6. Debbie

    These are great questions. Are we able to copy these for our own use?

    Do you know if Medicare covers Explant procedures?

    Reply
  7. Diane

    I had a explant 4 months ago due to capsule contracture. Soon after I felt some lumps but I was told that all the capsule wasn’t retired in order to avoid an hemorrhage; he said that my body will eliminate it naturally. Well soon after my breast were ok (symmetrical and soft for the first time after years) but a few weeks ago I noticed my right one is a little bigger and it’s hardening and feels like I still have the implant inside.

    Reply
    1. admin Post author

      Hi Diane,
      Please see your surgeon about this. It sounds like you have a seroma going on and that needs to be checked out and treated. In order for you to heal well and not experience complications such as this, all capsule tissue must be removed from your chest. Also if you had textured implants, we suggest you test for BIA-ALCL with CD-30 test to rule out BIA-ALCL. Please see this page for more information on BIA-ALCL: https://healingbreastimplantillness.com/bia-alcl-breast-implant-associated-lymphoma/.

      Reply
  8. Diane Haick

    Dr Mesa in Weston Florida did my implants in 2011. I’m totally confused on my choice of explant doctor. I’m 64 years old living in Niagara Falls New York presently. Just facing facts that breast implants not healthy for any woman. Can you help me decide?

    Reply
  9. Solaria

    Thank you for this information, I am currently looking for a surgeon and will use these questions. I have requested to join your FB group but not received confirmation yet. I would like to use that community with my search. Thank you! – Solaria

    Reply
  10. Bailey

    I have 20 year silicone implants, right is leaking and have enlarged lymph nodes. Left has busted and has had radiation in 2004. Wanted to explant but surgeon says the size on radiated side will be significiently smaller from lump etc and it was always smaller. She wants to replace for that reason and because everything will collapse due to radiation. Both can be smaller implants. She has concerns of getting every tiny bit of the ruptured implant out as too much movement could also mess with the healing of the radiated side. Any knowledge on this wold be great

    Reply
    1. admin Post author

      Hi Bailey,
      Come to the facebook group and speak with other ladies who experienced the same situation as you.

      Reply
  11. Jane

    I had Explant total capsulectomy but the surgeon said she couldn’t get it all. Where does this leave me? I’m afraid for my health. I feel that I am still sick. What should I do? Do I need another surgery and will insurance cover a second? Please help me.

    Also, my insurance covered the procedure but I still paid a lot out of pocket. Does the information below mean I can recoup my money ?

    If you are explanting due to rupture, capsular contracture, pain or infection and your insurance covers you for explant will he work through your insurance or provide you the letters required for you to apply to insurance for refund yourself?

    Reply
    1. admin Post author

      Hi Jane,
      If you contracted for a Total Capsulectomy (which means all capsule tissue is to be removed) then all capsule tissue should be removed or you should be refunded money. Some left over capsule may dissipate on it’s own say ten/twenty percent and you may get well. There are even women who left in their entire capsules and they recovered their health too but for the most part removing capsules correlates with full recovery. You can also try Serrapeptase which is an enzyme that will help break up biofilms and capsule tissue.

      Reply
  12. Kathy Willette

    Thank you for this information! I’m going to have mine removed since I have been ill for 14 years since I had mine put in. Had it not been for my daughter mentioning this to me, I would not have thought of this! I have been diagnosed with RA, fibro, Sjogenn’s Syndrome, and a plethora of other issues. I have had my tonsils removed and a hysterectomy this year, and am on my way to ER to check my gallbladder. When I recover, I’m headed to an explant surgeon and saving your information. Again, thank you!

    Reply
    1. Cammy

      Hi Kathy!
      My name is Cammy….I have Mentor Saline Implants that are 15 years old…5 years ago I was diagnosed with several autoimmune diseases as well. I am looking for a enbloc explant surgeon too.I have also had my gallbladder removed. For some implants are a bad thing and make us SICK…slowly so that we don’t realize how sick we are and what could be causing it. THANKFUL for this website.

      Reply
  13. Faye Emordeno

    I wish a lot of these questions were on here in march of 2016! I had my stuff sent to dr. Blais as it was stated to do. But it didn’t say that he doesn’t check for what type of organisms and all the specifics! Now I have no way of telling but to have another surgery ?

    Reply