This post is based on a phone consultation from earlier this week. I’ve changed a few unimportant details to protect patient privacy.
That bag is gonna be a killer to get into the overhead bin after surgery!
This lady has smooth, saline implants that are about 10 years old. She is part of the Pacific Northwest Breast Implant Illness (BII) Facebook group and she thinks her implants are making her ill. Her augmentation was done by the (IMHO) very best plastic surgeon in her state who lives and practices in the patient’s hometown. She has seen her plastic surgeon for explant and her plastic surgeon has agreed to do her explant and remove as much capsule as can be safely done. So why, I ask, does this patient want to come see me??? Am I an explant expert? Well, sort of in that I have done about a bajillion explants (mostly reasons other than BII) over the 28+ years I’ve been in practice.
But……………….explant and capsulectomy is not specialized surgery. This is a procedure that just about any plastic surgeon who does a lot of breast surgery is capable of doing. Now, I would not expect, say, a craniofacial surgeon to have any great expertise (or interest) in this but most “general” plastic surgeons are very capable of doing this. Promoting myself for explant and capsulectomy is sort of like Gordon Ramsey promoting himself as the ultimate chef for grilled cheese sandwiches.
So how about the fabulous explant experts who can guarantee an “en bloc” and offer “detox” products? Well…………………………….I’m not gonna throw anyone whom I have never met under the bus. But I will say this: There is zero, nada, zilch, nichts, niet, nula, noll, odo evidence that an en bloc resection is absolutely necessary or that detox does anything other than slim down your bank account. It’s super nice (and sort of fun) to do an en bloc in cases of silicone gel rupture but there is no evidence in peer reviewed surgical literature that there is any difference in clinical outcome. The same goes for cases of BIA-ALCL. Would I recommend a careless surgeon who is not thorough or does not endeavor to keep things as clean as possible? Of course not but I must say the vast majority of plastic surgeons are pretty damn thorough and meticulous. It’s in our DNA.
We plastic surgeons are always ragging on surgical tourism and espousing the danger of going to a distant land for el cheapo plastic surgery but we should also be ragging on traveling within the United States for routine procedures. Travelling adds a lot of complexity to the whole surgical process from initial evaluation to final follow up.
There are plastic surgeons being promoted as some sort of super experts by the breast implant illness activists. I have zero evidence that money is changing hands but isn’t it a little weird that this sisterhood, who should want what is best for other women, to recommend traveling hundreds and sometimes thousands of miles for a routine surgical procedure? Oh, and waiting sometimes up to a year to have their toxic bags of death removed? And as for detox? Zero evidence of necessity or efficacy. You can get your detox package from your local woo woo health provider who is happy to lighten your wallet.
So think global, buy local and support your probably very capable local plastic surgeon! Just make sure your plastic surgeon is the real meal deal and certified by the American Board of Plastic Surgery.
Thanks for reading and I would be thrilled if you followed me on Instagram @sowdermd and @breastimplantsanity.
Dr. Lisa Lynn Sowder
@lisalynnsowder
