BEFORE & AFTER PHOTOS
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Breast silicone implants: removal and options following implant Removal:
I have silicone implants from before 1992. What should I do?
These older implants were filled with a silicone material, which had the same consistency as pancake syrup. Once the outer covering or skin of the implant is broken or ruptured, the silicone material could leak out of the implant bag into the breast. When the implant is first inserted, your body reacts to any implant (knee, hip, breast, etc.) by putting a layer of scar tissue around the implant, we call a capsule.
If the implant breaks or ruptures, and this capsular layer of scar surrounding the implant remain intact, the silicone material stays within this capsule. This is called an intra capsular leak, (a leak within the capsule).
If the capsule of scar tissue has also ruptured, (this can happen spontaneously, or, with the forces of an air bag following a car mishap, a mammography examination, or a bad fall on the chest, etc.) then the silicone material can then leak beyond the capsule, into the breast itself, and even into the axilla (arm pit area). This is called an extra capsular leak, (a leak outside the capsule).
These older implants were never designed to be left in your body for life. If you have had a silicone implant prior to 1992, it is very likely that your implants are broken, and you have an intra or extra capsular leak. A consultation with Dr. Giuffre is recommended.
The pre 1992 type of silicone implants were taken off the market in 1992. There was a moratorium on using any silicone breast implants from 1992-2002 in North America.
After 2002, a new silicone implant was designed, and is currently being used today, called, Cohesive gel implants (gummy bear implants). These are far superior silicone implant than the older variety. They have an anticipated life expectancy of 10 years.
I had my silicone implants put in after 2002. What should I do?
Silicone Implants:
A new implant was introduced in 2002, and is often referred to as a “Gummy Bear Implant”. In medical terms, we call this implant a Cohesive Gel Implant. If you were to cut the implant in half, the two halves would stay together, similar to splitting a gummy bear in half. The implant has less rippling, and feels softer than a saline implant (if you were to hug someone). This implant has a finite life expectancy, (like a tire on your vehicle). Changing the implant, every 10 years, is recommended. There is a cost to replacing the implant every 10 years.
If the patient wants to maintain the same original implant size, the exchange of implants can often be done under local anaesthesia.
If the patient requests a larger size than the original implant, then a General Anaesthetic would be required to enlarge the space for the larger implant. *See FAQ Breast Augmentation
If the breast has aged and has become droopy (Ptosis), in addition to changing the implant, the patient may wish to have the breast lifted at the same time. This would require a General Anaesthetic. *See FAQ Breast Lift
What happens if I leave the gel implant in past ten years?
When the implants are first put in, they are very sturdy and can withstand considerable force and pressure. As time passes, the skin of the implant may weaken. If a large amount of force, over the chest, was suddenly transmitted on the older implant (>10 years), like an airbag going off in a car accident, or a bad fall on your chest, some of the cohesive silicone gel material, within the implant, could extrude through a rent or tear in the skin of the implant. (This is similar to hitting an open tube of toothpaste, where the toothpaste squirts out). If the capsule remains intact, then the result would be an intra capsular leak. If the capsule was also broken with the hard force to the chest, then the result would be an extra capsular leak.
How can I tell if this has happened?
Often, there is no immediate clinical symptoms or signs that anything is wrong. As the time passes, there may be change in the shape or feel of the breast. If the leak is extracapsular, your body will react to any extruded silicone by forming scar tissue around the silicone, which will produce a lump, (we call this a silicone granuloma). This can make breast surveillance for breast cancer difficult, because the silicone lump can mimic a breast tissue lump.
Is there any test that can be done to show if an Intra Capsular, or, Extra Capsular, leak has occurred?
An MRI is the best investigative tool we have to determine if the implant is intact. The only other way is to surgically explore the breast, and remove the implant, (and any extruded silicone if a rupture has occurred).
Will the silicone travel elsewhere in the body?
The silicone does not travel. It stays in the breast area. If the implant has ruptured, and is left untreated, more of the silicone will extrude out of the implant with any ongoing force. If the rupture is intra capsular, it may convert into an extra capsular leak with time and ongoing force. If the leak is extra capsular, the silicone will extrude into the breast tissue, and may extrude into the axial (arm pit), or in rare cases, through the skin. It does not go into your blood stream, or travel to distant locations in your body.
Can silicone affect my health?
Extensive studies world wide have been done on silicone and it’s potential impact on human health. Refer to the Mayo Clinic and John Hopkins Studies for more Information.
The findings and conclusions to all of these investigations were that silicone is immunologically inert and does not affect human health.
What a broken and leaking implant can do is allow the syrup like silicone to infiltrate into the breast and surrounding tissues creating lumps (silicone granulomas). This makes breast examination and breast surveillance for breast cancer difficult. The silicone itself does not cause breast cancer, but makes detection more difficult because of the formation of these lumps (granuloma).
operation:
If my implants are broken (ruptured), what should I do?
If you have had the older variety of silicone implants (pre 1992), there is a strong likelihood that your implants are broken, or will break. Dr. Giuffre recommends a consultation and an assessment.
If you have had the newer (post 2002) implants, and the implants are approaching 10 years old, then it is recommended that the implants should be exchanged. Dr. Giuffre recommends a consultation and an assessment.
What are the surgical options for treatment of the older (pre 1992) and newer (2002 and later) silicone implants?
For older implants (pre 1992):
The implant removal is most often done through the incision that was made to put the original implants in. This incision may be enlarged slightly, but there is little additional scarring to remove the implants.
If there is an intra capsular leak, the implant and the surrounding breast capsule is removed. The tissue is sent to pathology for examination. There is often a drain placed in the surgical site for up to a week.
If there is an extra capsule leak, and silicone has infiltrated into the breast itself, then as much of this involved tissue is also removed and sent to pathology. This may create a contour deformity of the breast if a large amount of tissue is removed. There will be a drain placed in the surgical site.
After the implants are removed, the patient may wish to not have further implant surgery done. After healing, the breasts will take on their natural shape and size. The effects of gravity, aging, weight gain or loss, pregnancy and breast feeding will all have an impact on how the breast will look after the implants are removed.
After 6 weeks, the breast shape and size has stabilized. At this time, the patient may wish to have further surgery to enlarge, or lift, or, enlarge and lift the breasts. *See FAQ Breast Lift and FAQ Breast Augmentation. Dr Giuffre will see all his patients in follow up at this 6 week period for a reassessment and consultation.
If the patient does not wish to have further surgery done, then regular breast examination and breast surveillance is recommended. There is no time line to have further surgery done. If the patient changes her mind years after implant removal, further surgery is possible.
If the patient wishes to have restorative surgery, (enlarge or lift, or, enlarge and lift: *See FAQ Breast Lift and FAQ Breast Augmentation) done at the same time as the implant removal, this option would be discussed with Dr. Giuffre at the time of consultation and assessment, before the planned implant removal surgery.
For Implants placed after 2002:
The new version of silicone implants should be exchanged every 10 years.
If it is a straight exchange of the same size implant, this can be done under local anaesthesia (freezing). This could also be done under General Anaesthesia if the patient wishes.
If there is a history that suggests the implant may be broken, an MRI would be done to confirm the status of the implant. Any suspicion would be investigated immediately and not wait the 10 years. If there is any suspicion that the implant is broken, the surgery would be done under General Anaesthesia and the implant along with the capsule would be removed and replaced.
If the patient wishes to have the implant removed and left out, the surgery could be done under local anaesthesia. If there is any suspicion the implant is broken, the surgery would be done under General Anaesthesia and the implant along with the capsule would be removed.
If the patient wishes to have larger implants, an implant exchange could be done under local anaesthesia if the implant pocket, where the implant sits, is large enough to accommodate a larger implant.
If the patient wishes to have much larger implants that require a much larger space to accommodate the larger implant, then a General Anaesthetic would be required.
How can I have my silicone implants assessed?
An assessment can done by Dr. Giuffre by calling his office for an appointment.
Breast saline implants: removal and options following implant Removal:
I have saline implants that were put in year ago. What should I do?
Saline implants:
The implant comes out of the sterile packaging deflated. The air is removed; it is then inserted in the space created surgically behind the breast and then filled through sterile tubing with sterile intravenous saline fluid from an intravenous bottle. The saline goes directly into the saline implant and never touches the outside world. Therefore the saline inside the saline implant remains sterile.
This implant tends to ripple more than silicone implants so it is overfilled to smooth the ripple. It therefore feels firmer.
It has the rare potential to leak. If that happened, the sterile saline would be absorbed by the local tissues like a glass of water with no harm to your health. Over 24 hours, the majority of the saline would leak out of the implant and the implant would deflate leaving one breast considerably smaller than the breast with the intact saline implant.
If this were to happen, the broken saline implant would require replacing. Contact the surgeon immediately for an assessment.
There is no schedule of replacement for saline implants. They can last for many decades. Regular breast surveillance is recommended.
The reasons for removing or changing the saline implants, would be primarily because the patient wishes for a change int he size of the breast.
If the patient wishes for the implants to be removed, this can be done under local anaesthesia. Once the implant is removed, the capsule that surrounded the implant will slowly disappear spontaneously. The capsule around the implant is your body’s response to a foreign body. Once the implant is removed, the scar (capsule) resolves.
After the removal of the saline implant, if the patient wishes to have the breast shape improved, or a further reduction in the breast size, a breast lift and/or breast reduction could be done. *See FAQ Breast Lift, and, FAQ Breast Reduction. This would require a General Anaesthetic.
If the patient wishes a somewhat smaller breast size, saline fluid can be removed from the original saline implant, using a fill valve, to decrease the implant size, and therefore, reduce the breast size. This is done under local anaesthetic.
If the patient wishes a dramatic decrease in breast size, but still wants more volume than her original breast size, then a new smaller saline implant would be required. This may require reducing the size of the breast pocket size. This would require a General Anaesthetic.
Patients often want to have their saline implants checked. Is that okay?
Patients who have had saline breast implants in for a long time, and would like the breast and implants assessed, may call 780-427-7737 for an appointment with Dr. Giuffre.