FCN's Treasurer, Katie P. Fink, after removing her breast implants.
Explant with Aesthetic Flat Closure
• Before we begin, it's important to note that each mastectomy patient's medical history
is unique, with different variables that may affect the final outcome.
• The information provided below is meant to be used as a guide, but is not
comprehensive and may not apply to your situation. We are breast cancer patients, not doctors - therefore Information provided by Flat Closure NOW shouldn't be taken as a substitute for medical advice from a licensed breast surgeon or oncologist.
• Please read through this guide and speak to your healthcare provider if you are considering explant
Skip to whatever section you need! 👇
2. Why Explant?
4. Will health insurance cover an Explant?
5. Can autoimmune disease be healed by Explanting?
6. Will Explanting reduce my risk of BIA-ALCL?
7. How will having an Explant affect my body?
8. Any Explant terms I should know?
9. Where can I find support from those who've walked this path?
10. Finding an Explant Surgeon
Implants & Capsules - From FCN President, Sondra Price
What is an "Explant"?
The word "Explant" is used in breast cancer & breast augmentation communities to refer to a patient's choice to have their breast implant(s) removed after beginning, or going through the mastectomy, reconstruction, or augmentation, process.
The decision to remove breast implants isn’t always easy... but it’s not as uncommon as you might think.
A study from 2017 shows that more than 19,000 breast cancer patients had their breast implants removed, according to the American Society of Plastic Surgeons. Overall, that number represents a 3 percent increase over 2016, and a 19 percent rise since the year 2000.
Breast implant patients may choose to explant due to one or more of the following:
Secondary Cancer concerns: Concern about BIA-ALCL, a cancer linked to breast implants by the FDA and WHO
Breast Implant Illness:
Physical discomfort: tightness, pain, temperature differential, numbness
Dissatisfaction: General dissatisfaction with the implants’ appearance
Capsular Contracture: hardening of the scar tissue surrounding the implant
Rupture: Breast implant rupture or silicone leakage
Infection: Chronic infection or inflammation around the implants
Identity: persistent feeling that the implants misalign with body image
... and we cannot forget that some patients are just "OVER IT"!
Yes, some patient simply do not want them anymore. Perhaps because after living with the reconstruction, their inner self doesn't resonate with the outer appearance of implants. Breast reconstruction can also take time and some patients get burned out on the appointments and procedures required.
PS: whatever the reason is... it is valid ♥
Many have walked this path before you; including us. You are not alone.
Are there any risks with an Explant?
Explant surgery has the same risks as most operations, including infection, tissue death, and blood clots. The one risk that is unique to explant (at least for those whose implants are under the pectoralis muscle) is pneumothorax.
Pneumothorax happens when air leaks into the space between the lung and the chest wall causing the lung to collapse. This complication is serious, but usually treatable.
If you are considering having explant surgery, keep in mind:
Even the best surgeon cannot always remove 100% of the breast implant as well as surrounding scar tissue
Having breast implants removed does not guarantee your chest will be perfectly flat. Be very clear that you want an aesthetic flat closure.
Revision surgery may be necessary if you are not happy with the cosmetic result.
Explanting may cause changes in the way your chest sensation. You may regain sensation but you may also experience other nerve sensations like pain, "zaps" or "itching" - over time these side effects could disappear or stick around. Each patient's medical situation (and body) is unique.
For more information on explant risks, visit the American Society of Plastic Surgeon’s (ASPS) page.
Will health insurance cover an Explant?
In the United States the Women’s Health and Cancer Rights Act of 1998 requires almost all insurers to cover breast cancer related surgeries, including explant and flat plastics closure, meaning contouring excess skin after removing the implant and capsule.
That said, not all plastic surgeons understand the law, and not all plastic surgery practices know how to handle the logistics, such as insurance claims, pre-approvals, and reimbursements.
You’ll need to be diligent about making sure all paperwork is filed properly. (And, if you are insured by Medicaid/Medicare know that coverage varies state-by-state so be sure to do your homework.)
If your surgeon says that your insurance won’t cover your explant, consider getting a second opinion.
Can autoimmune disease be healed by Explanting?
Anecdotal evidence has long hinted at a possible connection between breast implants and the onset of autoimmune (AI) disease and/or a collection of ailments called “breast implant associated illness." Until very recently there was scant evidence linking breast implants to AI disease. But in early 2019, that changed.
A study came out of M.D. Anderson in January of 2019 looking at long-term data for almost 100,000 patients with breast implants. The data, which was provided by breast implant manufacturers themselves as required by the FDA, showed that silicone implants are associated with higher rates of autoimmune disorders including Sjogren syndrome, scleroderma, rheumatoid arthritis. It also showed an increased incidence of stillbirth and melanoma (a cancer of the skin). Further discussion about the evidence on breast implant associated illness (BIAI) can be found at Midwest Breast & Aesthetic Surgery's blog.
Will Explanting reduce my risk of BIA-ALCL?
Breast Implant-Associated Anaplastic Large Cell Lymphoma (or BIA-ALCL for short) is a type of non-Hodgkin’s lymphoma linked to breast implants. Textured implants, specifically, put women at a 60- to 70-fold increased risk of developing this type of immune system cancer relative to the general population. Further research is needed to understand the relationship between the condition and breast implants and how explant affects a patient’s risk of the disease.
In 2019 the Food and Drug Administration held a public meeting of the General and Plastic Surgery Devices Panel of its Medical Devices Advisory Committee to discuss the safety of breast implants in light of new information about BIA-ALCL and “breast implant illness.” Check back as we will be updating our information to reflect new developments on this topic.
How will Explanting affect my body?
When it comes to the surgical treatment of breast cancer, breast implants are often placed under the pectoral muscle. To make space for an implant, tissue expanders are inserted under the muscle and slowly filled with saline. As the device expands (think of a balloon slowly filled with liquid) it lifts the muscle up and away from the ribcage to create what’s called a pocket for the implant. After several months of slowly filling the tissue expander, a second surgery is scheduled to take out the expander and put in an implant. Afterwards, some women report their pectoral muscles are not as strong as they were before surgery. Although removing the implant can help restore some of the muscle’s previous strength, the pectoral muscles may never regain their original strength. That said, physical therapy can help your body integrate the change. Ask your plastic surgeon, breast surgeon, or primary care doctor for a referral to a physical therapist to help you regain the pectoralis muscles’ full strength and function. (Referral requirements vary by insurance plan in the United States.) Another excellent resource is the Lymphedema Association of North America, an organization that certifies physical therapists who are trained in general rehabilitation post-mastectomy.
Like any medical device, tissue expanders and implants can prompt changes in surrounding structures. In particular, implants may leave an indentation in the rib cage that gives a concave appearance after explant. This is usually a cosmetic issue and doesn’t affect function.
While your surgeon will not be able to identify and account for all factors contributing to appearance of the end result, there is one aspect they do have almost full control over: whether or not to remove the excess skin that previously covered the implant. This is where you can advocate for yourself to ensure you receive the best possible flat result.
Looking “Deflated” After Explant
Because the skin is (usually) stretched to fit implants, it’s important that your surgeon has the skill and patience to contour and trim excess skin once implants are removed. If a surgeon either lacks the skill or doesn’t allot enough time to achieve a flat closure, he or she may leave excess skin (also called redundant skin) on the chest wall. To the untrained eye, the result may look “deflated” (right). Such a result can be deeply upsetting to the patient, particularly if she specifically asked to be flat prior to explant. Although excess skin can be removed in follow-up surgeries, most people want the best result possible from the fewest trips to the operating room. Other times, redundant skin is due to a miscommunication or a misalignment of expectations between patients and surgeons. Worse-case scenario is when a surgeon unilaterally decides the woman will “change her mind” and, therefore, leaves skin to accommodate future implants.
To be clear, breast cancer patients are allowed to change their minds. This does NOT justify a surgeon overriding a patient’s clear directive. A flat closure typically does not preclude future reconstruction but it may make the process longer.
So, as with going flat at the time of mastectomy, explant patients need to take steps to protect their decision and ensure they get an acceptable cosmetic result:
Explant Terms to Know:
Breast-Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): a cancer of the immune system associated with textured breast implants
Capsular Contracture: when scar tissue that normally forms around a breast implant becomes overly tight, leading to cosmetic problems, discomfort, and often to explant
Capsulectomy: surgical removal of all scar tissue associated with the breast implants
Capsule: scar tissue that forms around a breast implant over time
Explant: the surgical removal of breast implants and any scar tissue that formed around them (capsules)
Pectoral Muscle: the large paired muscles under the breasts that cover the front of the rib cage and are involved with shoulder mobility
Pocket: the space created by a tissue expander to receive a breast implant
Tissue Necrosis: when fat, skin, or other tissues die after surgery - may lead to cosmetic defects and/or require surgery
Where can I find support from others
who've been down this road?
You are not alone. Here are a few resources to get you started on your healing journey:
Healing Breast Implant Illness - Website
Breast Implant Illness & Healing by Nicole - Facebook group
Flatties Unite - Facebook group
Dr. Amanda Savage Brown - Explant Therapist
Send a message to FCN - two of our board members have explanted
Finding an Explant Surgeon
Consulting with a surgeon about explanting breast implants can seem daunting, but know that you are not alone. Many, many mastectomy patients have traveled this road before you (including us!). We suggest joining support groups or this list of vetted Explant surgeons. We hope that, along with the guidance below, helps in communicating your wishes with ease and clarity.
Write down your "why"
Whether it is because your health is suffering, secondary cancer concerns, or other reasons, it's important to articulate your honest, authentic feelings when meeting with the explant surgeon - even if they are raw. Write it down, take as much space as you need. The “whys” help medical providers understand the patient’s perspective.
PS: Be sure to make a copy of your letter to put in the medical record!
Show your surgeon photos
Come prepared with photos of your ideal aesthetic flat closure scar type to show your surgeon. You can find all sorts of gorgeous mastectomy pictures right here in our flat photo gallery! Your particular result may differ depending on your body type, where the cancer is located, prior health conditions, etc. - but this way your surgeon is aware of what you are hoping to achieve.
We advise patients to always “interview” their explant surgeon about their breast implant removal before surgery. This is extremely important because as patients, we have the right to a surgeon who will listen to our individual needs without judgement, respect our personal choices, and do their very best to achieve a beautiful aesthetic flat closure after explant.
Ask your surgeon what you can reasonably expect in terms of going flat after explant. Lots of factors contribute to whether or not your chest will be flat afterwards, including whether or not your body formed scar tissue around the implant or whether or not the implant is removed intact. Your surgeon can answer some of your questions but it’s impossible to know all of the answers until the explant surgery is underway.
Above are some interview questions we suggest asking your surgeon; to help you understand how they will achieve an aesthetic flat closure in your specific case, and if that surgeon is the right fit for you. There is space to take notes for each question. Observe their response; do they respect your decision? If not - it may be time to interview another surgeon.
You can download the list here - print it and take it with you to your appointment!
Listen to your intuition
This may be the MOST important tip of all: listen to your intuition and the thoughts, feelings, and sensations in your body when you think of your conversation with the surgeon. Did you feel at ease? Did you feel safe? Did you feel heard?
Or did you feel uncomfortable? Unsafe? Unsure? If it's the last part of that, we strongly suggest trusting your gut and finding someone else who will respect your wishes ♥