So, I don't know how much of an issue this truly is, but I think it is worth discussing regardless. More importantly, and as I have said elsewhere, I think it should be an issue that is largely controllable. Anyway, on with it.
Explant regret. It is a term bandied about a little bit, and I am curious to think a little more about it. More importantly, I want to consider the difference (and there is indeed a big difference) between explant regret, and a decision to re-augment, or have implants put back in at a later stage after previous explant surgery.
The reason for writing about this is two-fold. Firstly, on the American Society of Plastic Surgeons forums, there are often curious little discussion threads that, if nothing else, provide an insight into how our colleagues over there are thinking. The other day, a surgeon posed a (not unreasonable) question. He asked: are surgeons seeing many women who want to go back to having implants after having had an explant?
That was responded to by one the American leading lights when it comes to research on capsulectomy and breast implant illness, Dr Pat McGuire. Now, Dr McGuire's studies are about the only meaningful scientific data we have on things like resolution of BII symptoms after explant, which I often will quote in consultations. So she has a fair standing professionally. Her response though, I found curious. She said, in reply:
"There is a Facebook group with 11,000 members with “explant regret”. These are women who thought they had BII, had an explant with an aggressive capsulectomy, some of whom are left with devastating results and had no or incomplete symptom improvement...They are kicked out of the BII groups if they tell their story of no improvement or if they report complications from a recommended surgeon...I get messages from these women...(who) want recommendations for surgeons in their area who can help with their post explant deformities or reimplantation. I don’t know what percentage of BII patients replace their implants. I have had a few. I don’t know that we will ever be able to get a good number because most surgeons who promote themselves as “explant experts”, don’t replace implants...Patients need scientific data with ALL options discussed when making decisions about implant management." Indeed they do!
Now, in that reply, a couple of things really jump out at me.
Dr McGuire uses the phrase "aggressive capsulectomy" in introducing the idea of explant regret. I think that is unfortunate. The issue here is not that these women had capsulectomies. The issue is that the operating surgeon almost invariably did a capsulectomy (quite possibly they did it badly) then failed to do anything to ensure a good cosmetic outcome. The capsulectomy itself is not the culprit. A lot of Dr McGuire's research points to the idea that capsulectomy is not required for symptom resolution after BII. That may be so (and I tell my patients that), but I believe that (as my own research has suggested) capsulectomy IS necessary for a good cosmetic outcome, but that also requires that the explant surgeon does the right bloody operation! I have previously written about the fact that capsulectomy and BII are two issues that need to be addressed separately, rather than conflated as they so often are. Might be worth a read if you're interested.
She says she is contacted by patients looking for surgeons "who can help with their post-explant deformities or re-implantation". This is a curious one, because this wording would suggest that Dr McGuire views correction of post-explant deformity and re-implantation as one and the same thing. The reason I decided to publish my technique and results from explant was also to address the issue of preventing post-explant deformity (rather than having to fix it). To turn the question around a little, rather than asking about how many women are seeking correction of post-explant deformities, perhaps we should be asking how many women are having their explant surgery done correctly?
"...rather than asking about how many women are seeking correction of post-explant deformities, perhaps we should be asking how many women are having their explant surgery done correctly?"
The final comment Dr McGuire made, which I found interesting was the statement that so-called explant experts "don't replace implants". This one is interesting because, whilst it may be the case in America, it sure isn't in Australia. Honestly - if you google "explant expert Australia" you see a big ol' list of plastic surgeons, all of whom have very busy breast augmentation practices....well, except for me that is. What you'll also see these days is surgeons who do cosmetic breast augmentation with implants also splashing some rubbish over their social media pages along the lines of "We believe in BII". You've basically got these guys playing both sides. They shove the implants in. They "believe" you when you say the implants are causing health problems. They take the implants out. I have no idea what these sorts of surgeons actually believe, but it seems to be they really just believe in $$$, no matter how they get their mits on it.
Now, I choose not to do primary cosmetic augmentation, but I don't think implants are evil, or toxic, or dangerous per se. I do use implants for reconstruction work, in revision cases, and I will happily speak with my explant patients about a subsequent re-augmentation/re-implantation if that is what they wish to do.
Oh, and secondly, I recently spoke with one of my explant patients from a few years ago who is considering having a small implant reinserted. Which makes this especially topical for me.
Anyway, that I guess gives context to this discussion around the issue of explant regret.
Let me bring it back to my practice though.
I have rarely had discussions with my own explant patients who decide to "re-augment". The term "re-augmentation" is seemingly coming into use in the particular context of a patient whose implants were removed and they then decide (for whatever reason) to have a revision breast augmentation at a later stage. Now, you'll notice there that I don't use the term explant regret.
Over the last 5 years or so, I have had conversations with only 2 (one of whom is pictured at the top of this article after her re-augmentation) of my patients about re-augmenting. Obviously that isn't a lot (it's a fraction of a percent to be clear). But it has certainly taught me a few things.
So let me put it this way.
A patient requesting "re-augmentation" is NOT the same thing as a patient having "explant regret".
Re-augmentation is (in my experience) a decision that my patients have made because they still want a larger bust than is possible naturally. Which is a completely reasonable choice. Re-augmentation is, in some ways, best considered a variant on a staged implant revision procedure, with everything that normally entails (for me).
Explant regret, by contrast, is a consequence of a surgeon doing an explant badly.
Let's not conflate those two issues.
Let me leave you with a final thought. Whilst we are considering the issue of explant regret, let's examine that from a different perspective. What is the incidence of breast augmentation regret? How many women have breast implants and almost immediately decide that they have made a mistake? How many of those women try to broach this topic with the surgeon who operated on them, only to be dismissed or shut-down?
I can tell you right now, that is a common story that I hear during consultation. But I am sure that most surgeons with a large breast augmentation practice would tell you that it almost never happens.
So what does that tell us? Well, it all comes back to perspective I guess.
From my point of view, I see cosmetic breast augmentation as being frequently aggressive, destructive, and I consider it an operation with a high rate of poor outcomes. On the other hand, explant surgery, done carefully, is an operation with a high satisfaction, and the ability to rebuild the breast to create positive cosmetic outcomes. But these opinions are all a reflection of my practice.
Make of that what you will.