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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 may suffice for smooth saline implants if you are not symptomatic but if you are symptomatic you may also want En Bloc / Total Capsulectomy for smooth 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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