Episode 66: ENCORE: What are the Risks of Breast Implant Surgery?

Foreign Dr. Rob Whitfield, the board certified plastic surgeon specializing in explant surgery. Breast implant illness is a topic that is not often talked enough about, especially in medical community, but is something that affects many women. In this podcast I will be discussing the latest research, treatment options and personal stories of women who have undergone explant surgery in an effort to heal breast implant illness. In this podcast we'll explore the symptoms of breast implant illness and delve into the latest surgical techniques for explantation and the recovery process. You are currently experiencing breast implant illness or are considering explant surgery. This podcast is a valuable resource for anyone looking to take control of their health and wellness. So let's dive in. Before we get started today, I wanted.

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Rob in Austin, Texas and today we're going to assess the risk of breast implant surgery. So here we're talking about placement of an implant and why potentially people are seeking augmentation in the first place. Well, I'll give you perspective on two different age groups. Really. We'll say the first age group will be, we'll call it 1830 ish. And so that group is typically a group who may have underdeveloped during puberty. They may have taken a great deal of criticism, in fact even being bullied about the size of their breast, which has created a real psychological issue for them on body image. And so that group, they haven't had kids, it's really early in their life and it's a difficult decision. But many will arrive at breast augmentation as a way to enhance their physical appearance, increase their self esteem and body image because of that. And so they'll choose to undergo breast augmentation. And when you're looking at breast augmentation in the United States has a couple pathways in terms of choice of implant. The implant can be either filled with silicone and the surface can either be smooth or textured. The shape can be round or anatomic if you will. But in general, a standard augmentation, we'll just speak about one most commonly used would be round and smooth, would be the standard bearer. So excluding other things, we'll talk about what does that entail for surgery. Well, every surgery has basically the same risks involved. Short term are bleeding, infection, scarring. You could have asymmetry, you could have alterations in sensitivity of the nipple or either complex. In this situation, you could have malposition. And those are obviously the majority of the short term issues. Long term, you can have things that happen like capture contracture. You can have the device fail and if it's saline, it can deflate. If it's silicone, it could rupture. The rupture could be contained within the scar capsule or external and leak into the tissues. Far, far less common now with cohesive gel implants. And certainly as you age, people will lose and gain weight. They may have pregnancies. And so these alterations will change not so much the implant, but how the breast appearance is. It may start to sag off of the implant. Especially if the implant in a young person, which is typically placed behind the muscle, the muscle holds the implant in place and the breast ages off of that. So it can give you what we call a basically like a deformity where it's almost. You see two issues. You'll have the breast implant sitting higher and the breast tissue coming off of the face of the implant. And so when you have that happen, it leads to, you know, additional surgery. In that case where the tissue's aging off, maybe it's recommended that the patient undergo a lift surgery. It may be that they undergo a lift and an exchange surgery. So there's lots of variables in that. For the, the younger group, as they age with their implants and either have or don't have a pregnancy gain or don't gain weight, they will continue to age and the skin will in fact lose its elasticity over time, because it always does.

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So in the second group that didn't have augmentation early in life but had children, breastfed, had basically expansion of the tissues with milk production and then obviously contraction after they've discontinued breastfeeding, if they were able to do that over a period of time. And many times it'll take a period of time to lose weight accumulated during their pregnancy. And so once that's all sorted out, people may have an appearance where it's, it's deflated, the skin hasn't held tone, it's. It's relaxed more, there may be stretch marks, there may be all sorts of reasons for a change in breast aesthetics. And that's typically your second peak where the breast has lost volume. So it's kind of deflated appearance. It may be in a low set position now because it's expanded and with contraction lost some of the elasticity. And this can be the skin, it can be the nipple areolar complex or all sorts of aspects of this. And then that's when rejuvenation of the breast after pregnancies is recommended. And it can be typically implant placement for volume restoration coupled to lift or mastopexy to help with the skin that's become looser and is hanging the wrong position too below the fold typically. So that's mastopexy augmentation and so it carries short term risk. With mastopexy augmentation is there is a higher degree of asymmetry when you do them at the same time. And anytime you do more skin work, there's more complications related to skin infections. Obviously there's more scarring when you're doing something like that because it's a visual scar that is going to be down the front of the breast and around the areolar complex, unlike in a primary augmentation where it's probably under the fold around the nipple or in the axilla. So I think these are the, the issues. And if you're going to undergo augmentation at a young age or augmentation later in life, you want to choose a, a board certified or board eligible plastic surgeon for this type of procedure. I would not go to patients who are allowed to put implants in because they can buy them like an ear, nose and throat doctor, or a dentist or a cosmetic surgeon who has training in another discipline. It should be something that is not allowed, but it is. So I'll go back to, you know, selection of patients for augmentation. I'll, I'll give you my personal experience because I feel like as somebody who did oncologic reconstruction for a long period of time, we were faced with lots of challenges with people with preexisting medical conditions and we had to be careful in the selection process. And there are a number of factors that go into it. So for instance, if someone came into me who was younger but had a family history that they're aware of Sjogren's lupus, rheumatoid arthritis, lichen sclerosis, some autoimmune disorder, I would not recommend that they get a breast implant for augmentation. I would, you know, discuss fat transfer if that was an option for them. But I would not recommend that for a primary augmentation or a primary form of implant based reconstruction given their preexisting autoimmune situation. Just I felt was too complicated for them, especially my oncology patients, who would then progress to other therapies, chemotherapy, hormone suppression therapy, radiation, there, all these therapies would further complicate their situations. Typically other things that you'd have to really be careful about are people had skin conditions if, if people had a psoriatic condition, eczema, really bad issues with acne or breakout, because you have to put this through the skin. And the skin of the face, chest and arms has a lot of bacteria, especially very high in C bacterium acnes. And so these things all play a role in your interpretation from a provider of what you can offer safely, the kind of ages we're talking about don't put you in health category. Risk for heart disease, lung disease, kidney disease. Those things should be at play in this group. And those would have to be independently evaluated if they were, you know, ways to then minimize risk like we did in oncology, where to do all the above, as I mentioned, and then during the operation, be very specific about our technique. We had a no touch technique for the most part only I would touch the device after changing gloves. The skin was covered, carefully protected, and then in similarly in cosmetic augmentation, we'd be very careful with protection of the skin. Use what's called a funnel to pass the device, once again, using a no touch technique. And these are all things just to minimize risk. When working with an implant, it's born out of a hip implant, knee implant, breast implant, you're really trying to minimize your opportunity for contamination in the operative field or at the time from someone helping you in the operation. And then that sets the stage to have the best possible outcomes early on after surgery. So once again, having you fully explain this to clients. And now when you discuss, you know, breast augmentation with clients, you definitely have to discuss all the different aspects of these breast implant associated lymphomas as well as breast implant illness. And once again, you're trying to get a very, very clear understanding of patient expectations, their health and then what, what you can do in terms of technique to help them the most. There are multiple factors and obviously we want to make sure decision making is as careful as possible. And I always felt that was very complicated. When we're younger, it's a hard task to kind of think about all the long term implication implications of having an implant. Once again, whether it's a hip, knee, breast, neurologic, spinal stimul, defibrillators, it doesn't matter. I've helped every type of surgical discipline with an implant problem, obviously taking care of breast implant problems as well. So they each have their own problems because they're foreign bodies and you have to make sure that you do your best to inform the patient and set them up for success, provide them with adequate support and that will lend itself to the best overall outcomes. Thanks for joining me today. Today, I hope you found the information and stories shared on this podcast helpful and informative. Remember, taking control of your health and wellness is key to recovery from breast implant illness. If you're looking for additional resources and support, be sure to visit our online store, Dr. Rob's Solutions at drrobsolutions.myshopify.com you'll find a wide range of wellness products and supplements to support your journey to recovery. From specially formulated detox supplements to personalized skincare products, we have everything you need to aid your recovery. Visit Dr. Rob's Solutions today at DrRobsSolutions.com thank you for listening and we'll be back with another episode soon. Remember, you're not alone in this journey. And together we can overcome breast implant illness. Take care.