Adjunctive Procedures and Informed Consent with Breast Implant Explantation

Abstract

Background: The use of injectable or implantable materials or devices in the breast for augmentation or reconstruction has a history of innovation and controversy. Staying current in the field of breast implant management today means understanding not just the published literature but also its absence. Cutting edge breast implant treatment also means awareness of patient and media-driven interests and requests. Methods: Adjuvant treatments to optimize physical and psychological wellbeing with breast implant explantation, without replacement, will be addressed through literature review and analysis. Results: The body of literature demonstrates evidence of variable, and sometimes contradictory, methods to address adjunctive management of systemic concerns, the capsule, soft tissue of the native breast/chest, and treatment timing related to explantation. Few approaches are supported by very strong evidence. Many treatment methodologies are defensible. Any current attempts at optimizing management in patients undergoing explantation will be somewhat impaired by the ongoing nebulousness of related issues, such as breast implant illness. It seems clear, therefore, that plastic surgeons must fulfill their duty as caregivers to provide explantation surgery, either to attempt to improve physical health, mental well-being, or simply to respect patients' wishes. A wellinformed surgeon will likely employ a variety of approaches, adapted to the unique patient presentations at hand. Conclusion: It is expected that consultations, incisions, tissue rearrangements, surgical timing, and treatment indications will continue to vary as scientific investigation strives to understand and to optimize treatment of patients experiencing difficulty with breast implants.

Developing an International Framework for Informed Consent in Plastic Surgery: A Focus on Cosmetic Breast Augmentation

“…There are also longer-term issues of capsular contractures, development of anaplastic large cell lymphoma or breast implant illness, ongoing surveillance of breast parenchyma and implants, predicted in situ lifespan of the implants, the effect of pregnancy, lactation and weight loss/gain, the need for future surgical exchange or explantation, and any adjunctive procedural alternatives. 29 All of these aspects need to be absorbed by the patient. As such, at least two preoperative consultations are recommended because such a thorough coverage can usurp a patient's concentration during a single consultation, particularly when they have preconceived ideas about the procedure from social media posts and internet sites.…”

“…There are also longer-term issues of capsular contractures, development of anaplastic large cell lymphoma or breast implant illness, ongoing surveillance of breast parenchyma and implants, predicted in situ lifespan of the implants, the effect of pregnancy, lactation and weight loss/gain, the need for future surgical exchange or explantation, and any adjunctive procedural alternatives. 29…”

Laser-Assisted Liposuction for Autologous Fat Grafting Following Elective Breast Explant Surgery

“…The demand for breast implants removal increased globally among symptomatic and asymptomatic patients [14]. It seems clear, therefore, that plastic surgeons must provide breast implant removal surgery, either to attempt to improve mental well-being, and physical health, or simply to respect patients' wishes [15].…”

One-step Glandular Reconstruction after Breast Implant Removal: Technical Refinements and Grafting of the Inferior Dermoglandular Flap

“…Afterward, the inferior dermoglandular flap (IDGF) is harvested and undermined until the inframammary fold. [16][17][18][19] After checking its viability, the IDGF is fat grafted and used as an "auto-prothesis" to increase volume and projection. (See Video [online], which shows fat grafting to the inferior dermoglandular flap before its inset as an auto-prosthesis.…”