SILICONE GEL IMPLANT EXPLANTATION - REASONS, RESULTS, AND ADMONITIONS

Managing the patient who requests removal of her silicone gel implants, either intact or ruptured, can be difficult because the treatment depends on the desires and perceptions of the individual patient, especially in the present absence of data concerning the possible long-term adverse consequences of a silicone gel implant, intact or ruptured. Over 12 months, 46 women underwent removal of 74 silicone gel implants placed for augmentation in 26 and reconstruction in 20. Reason for removal was fear of possible consequences of the silicone gel in 17 patients, aesthetic concerns related to encapsulation in 14, systemic symptoms in 8, rupture determined by mammography in 7, and fear of interference with mammography or clinical examination for breast cancer in 4. Ten of 26 augmented patients rejected replacement because of their concern about saline devices, but only 2 of 20 reconstructed patients declined. Capsulectomy was performed in 34 patients (74 percent). Mammography correctly predicted gel implant rupture in 7 of 8 patients. Eleven of 46 consecutive explantations were broken during removal. Only 1 of 7 patients with severe systemic symptoms was asymptomatic postoperatively, but with no changer; in laboratory values. Two patients had 3 implants (6.5 percent) deflate at 10, 13, and 90 days as a result of manufacturing defects. Subcutaneous mastectomy patients (5) had the least aesthetic improvement because of prominent rippling of the anterior skin of their breasts. Two patients developed infection after capsulectomy. We conclude that patients seeking explantation of silicone gel implants because of fear of the possible adverse effects of the silicone will be pleased despite aesthetic limitations. In general, the aesthetic concerns of patients with previous augmentation exceed those of patients having had. reconstruction. Patients must be very carefully informed about the limitations of explantation with or without replacement. In the absence of sufficient data, the plastic surgeon and the patient must relate to each other with an understanding of the ambiguities involved. These patients illustrate the necessity for practicing the art of medicine, especially in the absence of the science.