Top Questions to Ask Your Explant Surgeon

It is important to know your surgeon has experience in removing implants in the way that you would like. Dr. Rai performs 6 explant operations every week and because of that experience feels very comfortable with the procedure and doing it in a safe and effective way for his patients.

To remove the capsule from the muscle and chest wall takes time. To remove both capsules completely will take approximately 2-2.5 hours. An explant with a lift will take around 4.5 hours.

Because the operation will cause some discomfort to patients, Dr. Rai does perform the procedure under a general anesthetic with the patient completely asleep and supervised by a Board-Certified Anesthesiologist. He also performs a nerve block during the surgery and offers a 72 hour nerve block if desired.

BIA-ALCL is a type of lymphoma associated with breast implants. Typically, these cases will present with a large fluid collection around the implant (seroma). If this occurs, it is recommended to get the seroma drained first and tested for CD30 to rule out ALCL. That should happen prior to the capsulectomy. If you have a textured implant and your surgeon finds a lot of fluid around the implant or a mass on the capsule it should be tested for CD30 to rule out ALCL. Dr. Rai is very familiar with BIA-ALCL and has given lectures to his local hospitals about it and how to test and treat it. Dr. Rai does offer CD30 testing of any fluid around the implant or the capsules. Learn more about BIA-ALCL

You will be put asleep with a combination of Propofol and gas anesthetic. With the MTHFR gene it is recommended to avoid Nitrous Oxide. Dr. Surjit Rai does not use Nitrous Oxide for any cases.

Dr. Surjit Rai gives a dose of IV antibiotics at the time of surgery and for most patients they will not require any antibiotics after. The only exceptions are active smokers, immunocompromised patients, diabetics, or breast cancer survivor patients. Dr. Rai will typically give two days of antibiotics for these patients.

Dr. Surjit Rai does test every capsule removed for breast cancer. Dr. Rai believes since the capsule is in contact with breast tissue it is reasonable to send it to be tested to make sure there is no signs of tumor cells within the capsule.

For patients concerned about anaplastic large cell lymphoma (ALCL) the capsules can be tested for CD30 as well. Some patients want the implant tested for other microorganisms such as mold or fungus. Dr. Rai can test the fluid within the saline implants for these microorganisms. He will have a discussion with every patient to determine if those tests should be ordered.

Dr. Surjit Rai will send the capsules to be tested by pathology. The implants will be returned to the patient if they desire. Otherwise, they are disposed per his usual protocol.

Dr. Surjit Rai always uses drains for these procedures. Once the capsule is removed there is a bit of oozing that occurs from the muscle edges and the rib cage.

Dr. Rai prefers all that fluid to come out of the breast pocket. The drains will typically stay in place between 3-5 days. Less for implants above the muscle and longer for patients who have had several breast procedures or are breast reconstruction patients. The drains are removed by Dr. Rai himself in clinic once they are no longer draining much fluid.

Removal of implants placed for cosmetic reasons is very rarely approved by insurance. Dr. Rai does not submit insurance claims for this procedure. If the patient desires to file it by themselves Dr. Rai will provide all the clinical notes, operative report, and codes used for the procedure.

Typically for removal of the implants the scar will be under the breast crease. If you have an existing scar in this location Dr. Rai will use this incision and cut out the old scar.

Dr. Rai will give you a list of supplements to avoid including but not limited to Aspirin, Motrin, Aleve, Omega3, fish oil and any other medications that could increase your bleeding risk

Dr. Surjit Rai will see you between day 3-5 to take the drains out, the following week to remove any stitches (they are all dissolvable) and then 2 weeks after that. Then you will follow up as needed. The big limitation is no heavy lifting for several weeks.

The breasts will go through a lot of changes over the first 4-6 weeks. Creases and wrinkles tend to smooth out during this time. Most patients are back to full activity without any restrictions between 4-6 weeks.

Dr. Rai understands the importance of removal of the capsule. He knows that is the only reason patients travel from all of the United States to come and see him. He promises each patient he will spend the time and energy to try to accomplish the goal of a complete capsulectomy at minimum and en bloc removal of the implant when possible.

Dr. Rai does not use surgical assistants or residents. You will have a board-certified plastic surgeon operating on you at all times.

Dr. Rai does perform a nerve block during every procedure. While this helps dull the pain it likely will not completely eliminate the pain for patients as the capsulectomy portion of the procedure can be tender if the scar is stuck to the ribs and muscle. Dr. Rai does offer a 72 hour nerve block as well called Exparel.

Dr. Rai will evaluate the muscle at the time of surgery. If it is low enough then he will re-secure it to the breast fold where it belongs. If it has shortened too much overtime he will tack the muscle down to the chest wall.

Dr. Rai will provide his patients with photos of the implants and capsules if they desire.