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 de pends on the desires and perceptions of the individual patient, especi ally in the present absence of data concerning the possible long-term adverse consequences of a silicone gel implant, intact or ruptured. Ov er 12 months, 46 women underwent removal of 74 silicone gel implants p laced for augmentation in 26 and reconstruction in 20. Reason for remo val was fear of possible consequences of the silicone gel in 17 patien ts, aesthetic concerns related to encapsulation in 14, systemic sympto ms in 8, rupture determined by mammography in 7, and fear of interfere nce with mammography or clinical examination for breast cancer in 4. T en of 26 augmented patients rejected replacement because of their conc ern about saline devices, but only 2 of 20 reconstructed patients decl ined. Capsulectomy was performed in 34 patients (74 percent). Mammogra phy 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 postoperati vely, but with no changer; in laboratory values. Two patients had 3 im plants (6.5 percent) deflate at 10, 13, and 90 days as a result of man ufacturing defects. Subcutaneous mastectomy patients (5) had the least aesthetic improvement because of prominent rippling of the anterior s kin of their breasts. Two patients developed infection after capsulect omy. We conclude that patients seeking explantation of silicone gel im plants because of fear of the possible adverse effects of the silicone will be pleased despite aesthetic limitations. In general, the aesthe tic concerns of patients with previous augmentation exceed those of pa tients having had. reconstruction. Patients must be very carefully inf ormed about the limitations of explantation with or without replacemen t. In the absence of sufficient data, the plastic surgeon and the pati ent 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.