A short surgeon-led YouTube talk by Robert Whitfield MD explaining why saline breast implant removal can be more complex than it appears. Key points: large-volume saline implants (commonly >400–500 cc; author has seen up to 900 cc) are hard to remove intact via inframammary or periareolar approaches because saline does not compress like silicone gel. The surgeon advocates controlled, sterile in-office deflation prior to surgery (safe, analogous to rupture which typically drains and is absorbed within ~1 week) so the pocket and tissues contract over ~2–4 weeks and give a visual "preview" to guide counseling about lifts, fat transfer, or exchange. The video also notes electronic record-keeping and patient education (still photos and short intra/post-op videos) using the Simplast Health app.
Questions this video answers
Commonly over 400 cc and over 500 cc; has seen up to 900 cc.
About 2–4 weeks after controlled deflation.
Within about one week (typical case).
Simplast Health.
Chapters
So today I want to talk about saline devices and a way to manage what can be pretty complicated, given what I find in our experience is we see a lot of saline devices that are, we'll say over 400cc's, over 500cc's. I've had sailing devices up to 900cc's. I want everybody to understand it's a little complicated in terms of operating through especially the incision underneath the breast in the fold when you're trying to remove those and take all the caps from material out intact, which is our goal. The problem is you can't compress the saline implant. So it's a very unlike a silicone gel implant. The filler, which is gel and a silicone device compresses because the saline device won't compress. It's very hard to work around and get over the top of and see on the other side of it within the pocket, especially if you're going from below. And then if it's very large and overfilled, you can't do it through a periareolar approach. You can do it through a vertical approach, of course. So I had a really, really good discussion with a patient and her partner about this. And I want to highlight philosophically what I was trying to explain so people can understand it. So, for instance, over the course of my career, I've been working and our office will get a call that someone was in town visiting and they had their saline device rupture. And they want to be seen to make sure there's an exam done and anything else that you know, we can help provide assistance with because it's pretty alarming to have that happen. So, of course, over the years, I've seen patients who've had a saline rupture. And basically within a week, depending on how and where that rupture is, it usually it drains the saline, which is sterile when it's put in, in the operating room, will absorb into the body, won't have any consequences. I let the patients know it's best if you can have arrangements made with your surgeon about that if they want to do an exchange. So that was kind of traditional. And you would want to do it relatively quickly because the pocket starts collapsing down as soon as you remove the pressure of the implant, whether it's saline or silicone, the pocket starts to close down because it's being held open by the pressure being exhibited by the device. So if I have somebody with overfilled saline implants, like I will say that 900cc device, I referred To I won't operate on them without deflating their device. And people will ask, well, how can you deflate it and is it safe? Of course it's safe because just in the example I mentioned before, if you had a rupture and it deflated, nothing's going to happen untoward to the patient in a typical case. And so sterily in the office, as an office based procedure, we cleanse the area, use a sterile technique and withdraw the saline. Many times patients don't have their card or can't remember their exact fill volume. So then we're trying to measure that as well. But over a two to four week period after that controlled deflation in the office, the tissues start to contract back down and you'll get a preview of the tissues. It's obviously not exact because it's kind of a short term, but it really helps from a standpoint visually of where you can see, you know, okay, well this is the situation now visually. And then if someone wants to have other procedures done, you can counsel them about what options regarding different types of skin lifts or fat transfer or combination of those things. But it's for reference. Most people can't remember what their breasts look like prior to implantation because it was either so long ago, they don't have any before and after as they can't get those because of issues with maybe where they had it done, maybe that person who was their implanting surgeon retired and. Or maybe they only had paper records. In our system, basically everything's electronic and there's an app and there's always access to your records as long as you've maintained your username and password. On our app we use Simplast Health. I make everybody a little video of their surgery. After I have the implants out, I get asked to do videos intraoperatively of this surgery, but that's really hard to do. I used to wear like a helmet cam and it really was hard on my neck and it's really hard to get good pictures. So whenever I can, you know, get something, I get it. But definitely at the conclusion of each procedure we go back, we make a short video about removal of the capsules and what we found and examine the implants. We always have still photos, of course, so those are all maintained in the chart. But the point of the discussion is deflation can be a very useful technique to help give a visual preview. The actual breast, it hasn't obviously recovered completely because that's not enough elapsed time, but it can, can be very, very helpful. So I hope this is a helpful tool. Make sure to click that you like the episode and subscribe to the pod. If you have any suggestions, you can make them or DM them to us on Instagram or in the comments on YouTube. All right.
