We're kicking off 2024 with a couple of short form articles which aim to answer common questions and google search terms. If you find your way here, hopefully this will give you some nice, simple answers to the questions you may have in mind.

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So, first question of the year:

What actually happens during explant surgery?

Bear in mind, this is what happens if I do it...I honestly have no idea what other surgeons are doing, but I am pretty damn sure it is different to what I'm doing. So you can't take this and go to some other surgeon and expect that this will apply. Just a gentle warning.

Anyway, let me give you a step-by-step guide of what happens on the day of surgery, and during your recovery, from start to finish.

1. I see you before surgery to do the necessary markings. This is all about planning to ensure that we have some fixed reference points which will help us to correctly position the breast after implant removal. Basically I get out my coloured markers and draw lines all over you.
2. You come into surgery, the anaesthetist works their magic, you go to sleep and then we get going.
3. The first thing we do is check our markings again, and then we inject local anaesthetic to ensure that the incisions are numb when you wake up.
4. If you are having fat transfer at the time of your explant, we do the liposuction first and then one of my team prepares the fat for injection whilst we do the next bits.
5. The incisions we use depend on what procedure you're having done. If you are having your implants removed without a mastopexy, we make the incision under the breast (where most ladies have their implant scars). If you are having a mastopexy, we use part of the eventual mastopexy scar to get into the breast.
6. The implant and the implant capsule are then removed. Sometimes we do this as a "total intact" (what he internet incorrectly calls en-bloc, but whatever) capsulectomy, other times we open the capsule to remove the implant, then finish removing all the scar capsule with the implant out of the way. If there is a rupture, we always aim to do this as a total intact/en-bloc approach. Some patients are adamant that they want the implant and capsule removed "en-bloc" and we are happy to accommodate this request once we have a proper discussion about it. We take photos of the implants and the capsules for all of our patients so you know what has been done.
7. We then carefully inspect the space in the breast and wash everything thoroughly. We check for bleeding or anything else that may cause an issue, like silicone, or any other residual foreign material (you'd be surprised how often we find bits of permanent stitch inside the breast after other surgeons have done things).
8. For ladies whose implants were under the muscle, we repair the muscle onto the chest wall (this is really, really, really, really important).
9. We then concern ourselves with the shaping of the breast. This is true whether we are doing a mastopexy or not. We use internal stitches to control the shape and position of the breast and we make sure that we sit our patients up during surgery to check that everything is exactly the way we want it.
10. The next part may involve either a breast lift, injecting the fat graft, or both. If we aren't doing either of those things, we can start closing up.
11. I don't use drains. Ever. You don't need them. There are a few tricks that allow us to do the explant this way, and drains seem to be a cause for concern for many women, so yay, there's one problem solved.
12. The first part of closing up involves the "internal bra" that I have spoken about before. This sets the crease position under the breast. This is also really (really) important.
13. All the incisions are closed with dissolving stitches and then we apply a layer of glue. I don't use any adhesive dressings and there are no dressings that need to be changed, or kept dry. All of our patients can shower the day after surgery. Water never harmed a wound in my experience; not showering has definitely harmed wounds.
14. Before you wake up, we put on the necessary surgical garments.
15. And then I go and do all the tedious paperwork.
16. You wake up in recovery, the lovely nurses there make sure you are comfortable, and most of my patients then head home on the same day as surgery, normally about 2 hours after surgery is completed. You have a post-op bag with all of your extra compression garments, instructions and a few other bits & pieces.
17. We see nearly all of our patients the day after surgery. This day 1 check-in allows us to discuss what we did, what we found, we can check on your pain relief, and we can make sure you understand all of your instructions.
18. We then see you (a lot) over the next 6 weeks to make sure everything is healing up as we want.
19. At 6 weeks we take your first post-op photographs, but it is important to understand that the result at this stage is still immature and it will be a few more months before everything has settled into the final position.
20. We see you again at 3-4 months, 6 months, and then 9-12 months. Depending on how your scars evolve, we may continue to see you beyond this time.
21. We generally have an open door policy for all our patients - if you need to see us, you just let us know and we make it happen.

And that's it.

I hope that helps clear up questions that people have about what happens during explant surgery.

Please let us know if there are any other questions you want answered.

We'll continue with these "2 minute reads" over the next few months so keep an eye out.

Have a lovely day.

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