Explanting After Reconstruction
More and more women are explanting after reconstruction. Women explant their reconstruction after mastectomy due to a number of complications. These complications include pain or discomfort caused by capsular contracture, various infections, discovering symptoms of breast implant illness and the possibility that many symptoms they attributed to their cancer treatment, (i.e. chemotherapy, radiation, preventative hysterectomies causing surgical menopause in premenopausal women, as well as side effects from breast cancer related drugs) could actually be caused by their breast implants instead. Some of these women have immediate reactions to their implants while others take longer to accumulate symptoms and some are suffering more severely than others.
Regardless, when women discover many of the negative effects of breast implants such as capsules and implants harboring mold or bacteria that could be making them ill or the silicone implant could be decomposing and leaking or ruptured inside of their chest cavity contaminating them with silicone chemicals and heavy metals they move to explant their reconstruction.
While the possibility of going through yet another surgery or second mastectomy and contemplating the idea of further reconstruction without implants versus going flat, is definitely agonizing, and fear-producing for women who have already been through the trauma of breast cancer treatment and loosing their natural breasts completely, it is a place many come to when discovering and researching breast implant illness and the negative effects of having breast implants inside of their body.
Breast cancer and subsequent breast implant illness survivors repeatedly express they were not informed of the possible negative health affects of either saline or silicone breast implants, the multiple surgeries involved going forward with reconstruction, nor were they provided other essential information to enable proper informed consent before they decided to reconstruct with breast implants. Most express that had they been provided the long list of possible risks and other complications, they would never have chosen reconstruction for themselves. These women commonly feel they were too quickly steered toward breast implants, or another type of flap reconstruction (that also sometimes includes implants), and never provided the option to “go flat.” Many women who had expressed the desire to go flat often say they were dissuaded or discouraged from doing so. Another common theme is the pressure and rapid pace by which these reconstruction decisions are required to be made, in the middle of a life-altering diagnosis, without the time to carefully consider all options.
Our knowledge and experience of going flat is evolving and we would like to point out there is a difference between going flat (explanting your breast implants) and aesthetic flat closure which is a procedure which removes excess skin and breast tissue to create a smooth chest. Not everyone is a candidate for aesthetic flat closure and it’s not an easy procedure to do well. In one surgeon’s words, “Flat closure is very confusing and most people don’t understand what’s involved. Flat closure requires tight skin as well as even contour at the mastectomy site and surrounding tissues. I have to remove that excess skin after the implant removal or patients will have loose skin fault that will prevent a flat appearance. But more importantly, the surrounding tissues especially subcutaneous fat cannot be very thick. After the mastectomy the breast area only has skin on top of the muscle with no subcutaneous fat. So if the patient is heavier and has thicker subcutaneous fat of the surrounding areas, the contrast between thicker surrounding areas and the mastectomy site where there’s no subcutaneous fat, is the reason for the concavity at the mastectomy site. As a result flat closures can only be achieved in thinner patients with very thin subcutaneous fat in the surrounding areas.”
The most significant points we would like to stress to women facing explanting their reconstruction breast implants due to breast implant illness is that proper explant which procedure is an En Bloc Capsulectomy or Total Capsulectomy (remove implant and all capsule tissue plus any other foreign body such as mesh or dermal matrix if used) is paramount to your healing from symptoms of breast implant illness and to preventing more cancer. At this time oncologic surgeons and reconstruction surgeons may not remove capsules or think it’s necessary. For your best healing, choose a surgeon dedicated to removing all the capsule tissue. Also, going flat without aesthetic flat closure may be the norm for most as many won’t be a good candidate for aesthetic flat closure.
Women ask if fat transfer to the breast works and the answer is it’s not suitable to replace breast reconstruction. In order to build a small breast mound you would need a series of five or so fat transfers that don’t fail but the truth is most fat transferred to the breast fails and especially when done at the time of explanting. When fat transfer fails other risks can occur such as the fat turns cystic and necrotic causing further problems in the breast. Women also report deformities at the harvest sites as well.
The resources in our group focus on surgeons who are experienced in proper explant and we are now adding a notation if they also do good aesthetic flat closure, not that aesthetic flat closure is necessary.
Below are some additional resources we gathered to support women explanting their breast implants placed following reconstruction for breast cancer related surgeries.
Facebook support groups for those considering or explanting to FLAT-i.e., no further reconstruction of breast mounds but still able to use breast forms or prosthesis if desired:
For women considering further surgical reconstruction of breast mounds post-explant:
Website(s) listing flat friendly surgeons:
Please join our Facebook group of over 150,000 women for support through your healing journey.
We look forward to your comments, feedback and personal stories about your symptoms due to breast implants. Please see the comment form below. Thank you.