I guess, in hindsight, it was almost inevitable that commercial opportunism amongst surgeons would lead to an increase in explant-related harm.

Something that seems to come up a bit when I chat to patients (who have often seen other surgeons) is the fact that, whilst many other surgeons now offer explant procedures, it is clearly a commercial decision rather than a choice based on any sort of conviction. Whilst there are surgeons who will now happily charge top dollar for an explant, women will sometimes leave consultations feeling judged and uncertain.

The choice to explant is accommodated, but there may be comments around that choice which leaves patients questioning themselves. Seemingly benign comments like “are you sure you want to remove your implants?”, or “it’s up to you, we can do that if you really want but…” are interesting fora number of reasons.

Without sounding like someone who is out there hunting down micro-aggressions (and I am hesitant to use the term ‘gaslighting’ but it really does seem to fit here), the problem with approaching the topic of explant like this is it betrays a fundamental dogma at the heart of aesthetic plastic surgery.

The pervasive dogma I am referring to goes a little like this: a) breasts can be “improved” with breast implants and b) once a patient has an implant, having a breast implant will always be superior to not having an implant.

Now, I disagree with that dogma on both counts, but we must also beware the appeal of taking an opposing, yet still dogmatic approach. Breast implants are not in themselves bad. In some cases, they are incredibly useful and can allow a surgeon to offer a patient a result that could not otherwise be achieved. There are absolutely cases where a patient will do better with a breast implant than without, based on their aesthetic preferences. That is just a fact.

However, I genuinely believe that we can offer many patients better outcomes with implant-free approaches, whether those patients have breast implants currently or not. But I also believe that the answers don’t lie in absolute positions.

This isn’t about taking some faux-sympathising approach that seeks to demonise breast implants as the silicone embodiment of evil. I actually push back on that quite hard.

I do believe that for some women breast implants are a source of health concern and that for some women there are biologically plausible explanations for a deterioration in their health linked to their breast implants. I also believe that some women are being exploited by a surgical industry, both when they have their implants put in, and again when they are taken out.

I choose to perform explant procedures because I think the results are good. Indeed, I think the aesthetic results I can offer patients after explant are often better than when those ladies had their implants. It is without a doubt that the functional outcomes are significantly improved. And my approach seems to allow women who seek explant (for whatever reason) an outcome that is very acceptable to them (and that matters more than what I think of their outcomes).

I don’t believe in chasing a cosmetic trend. I don’t take a patient’s money whilst sneering behind closed doors at their rationale or their choices. And I don’t abandon my pursuit of aesthetically ideal outcomes by performing a procedure I (for whatever reason) don’t want to do. If I don’t want to do an operation, I don’t do it. That is why I don’t do primary cosmetic breast augmentation with implants. But it seems there are an increasing number of surgeons performing explants who quite obviously don’t agree with the patient’s decision to explant and don’t want to do the surgery, but very much want the $$.

We are also seeing some surgeons take an ethically questionable, enabling approach to explant surgery which basically validates patients' victimhood - this isn't good for patients, and it certainly isn’t good for surgeons. It is dangerous and disingenuous, and it is leading to harm.

Whilst we are currently dealing with a burden of breast implant-related harm, it is inevitable that with the rise of opportunist explant surgeons, we will see a rapid, and totally unnecessary increase in explant-related harm.

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I see it more every day. Some surgeons seem all too prepared to accept the unacceptable following explant and their patients are left wondering where to turn.

I wish there was a desire to have a robust discussion on this topic amongst my colleagues. Whilst conferences run endless panels on the best kind of breast implants and the best surgical techniques for using breast implants (whilst running parallel panels on breast implant associated ALCL without any sense of irony), I don't think there has ever been a panel to consider approaches to explant, or how to achieve the best aesthetics after explant surgery. Why? Explant-related harm exists at least in part because surgeons are not being pushed by their peers to do better.

I know I come back frequently to concepts that I have written about before. For plastic surgeons, seeking aesthetic perfection (or as close to it as we can) should be a guiding principle of what we offer. Why then is that not the goal with explant surgery?

And the only conclusion that logic allows is that the decision by many surgeons to offer explant is commercially expedient. And that is all it is.

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If you are looking for further information, you can read about how I perform explant surgery in detail on our website here.

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