Who’s a Candidate
Patients who are seen preoperatively and are excellent candidate for explantation with drainage tubes are evaluated for skin laxity, that is the amount of sagginess to their skin and whether or not they have enough tissue in order to do a full breast lift or if they need a full breast lift, depending upon the nipple position to the fold.
Preoperatively, this should be determined with the patient as to whether a full breast or formal mastopexy will be performed at the same time as the explantation with drainage tube.
Implant Removal With Lift Surgery
In our practice in Beverly Hills, normally the patients are placed in the standing position and if there is skin laxity that is severe with the implant preoperative then yes, a full breast lift will be performed after the removal of the implants and the drainage tube placement through a low inframammary incision.
Capsule tissue can be removed at the same as the implant removal, especially if there is silicone gel rupture and calcification. It is not always necessary to remove the capsule in patients with saline implant removal unless there is severe disfigurement. Ruptured silicone implant material should be completely cleaned out of the pocket. Open capsulectomy can be performed to soften the pocket, if necessary. All specimens will be sent to Pathology for diagnostic purposes. Once the implant is removed the capsule has been softened, the deep wounds will be closed along the periareolar and the inframammary fold. At this time the patient can be placed in the sitting position. Skin laxity can be addressed and if there is a significant amount, the nipple well below the fold, greater than 3 cm, grade 3, then a full breast lift is often performed, performing an inferior pedicle Wise-pattern technique. This is considered an anchor scar with skin removed around the nipple areolar complex vertically and long the inframammary fold.
Recovery After Surgery
Drainage tubes are 7 mm Jackson-Pratt drains that are secured along the inframammary fold and a bulb suction is placed for a minimum of seven days in my practice. Patients are maintained on oral antibiotics as long as the drainage tubes are in place. The drains should be maintained for at least five to seven days until there is less than 25 cc of fluid per day.
Explantation of the drainage tubes, plus or minus, breast lifts are always performed under general anesthesia with a Board Certified Anesthesiologist. LMA and general endotracheal tubes are placed, depending upon the patient’s history of reflux and also depending upon the patient’s history of asthma. Patients are monitored in the recovery room for a minimum of one hour after general anesthesia and Medicare standards.