Explant

It seems to me that either the implants were never removed (unlikely, particularly if your wife’s breasts are smaller now than before the surgery), or your wife has seromas (pockets of serious fluid occupying the space where the implants used to be). “Stacked” (double) implants were performed on occasion 25-30 years ago especially in reconstruction patients who needed more volume to match their remaining natural breast than standard implants could achieve. I would ask that the MRI be evaluated by another radiologist well-versed in breast imaging to determine if what is seen is truly an implant or just a fluid collection (seroma).

In the United States during the 1980's and early 1990's some plastic surgeons were stacking two textured implants to produce increased projection of the breast. This technique was short lived.

Other possibilities that can be considered are a Seroma filled cavity from the old breast capsule, or residual silicone from a ruptured silicone implant. Both these possibilities can usually be identified by careful review of the MRI with the radiologist and plastic surgeon.

The answer to your question is yes rarely. The proper question is, given that a pre-op MRI was performed, ALL implants/implant material would have been known to the surgeon, so why wasn't it removed?

I suggest that you gather hard copies of pre and post-op MRI's and get a second opinion. Something doesn't add up at all.

sek

Thank you for sharing your excellent question. Assuming the physician was aware of the preoperative MRI, and the discussion was had that all implants were to be removed, this would be very odd. Implants were stacked in the past to achieve improved volume for some patients, but this is an older technique.

Probably seromas (fluid collections) in the same spaces from which the implants were removed. I usually remove most if not all of the scar tissue (what we call a “capsule”) around the implants when I remove them for this very reason. Costs more, requires placement of drains and takes longer, but helps prevent this. I find it unlikely that a properly trained and experienced plastic surgeon who sets out to “remove implants” wouldn’t feel/see another remaining implant in the same place, but I wasn’t there.

This most probably is an encapsulated seroma. Encountered this in my practice.

Will need removal of the capsule with the seroma enblock. Drains are needed after surgery.

Very strange. It sounds like you need another opinion and a better evaluation with the MRI. I would like to see the pathology report for the removal of the implant if one exists

You can start with the operative report from her original procedure as it will tell you if one or two implants were used. Then have the MRI reread (second opinion) as they could be seeing the capsule and interpret that as another implant. Finally, the surgeon was there and if he/she did any kind of additional look into the pocket (as opposed to simply seeing one implant, pulling it out and sewing it up) and should have easily detected another implant if it was present. Stacking of implants were done for a short period of time as there were too many complications from that. But I find it hard to believe the MRI if your surgeon just took the time to look into the pocket after removing the implant.

I have seen cases where one implant has been "stacked" on top of the other. This has usually been in patients that want XL sizes though now I use different techniques to achieve that. I would have both MRI's read by a radiologist to ascertain what is going on for it would be very unusual to not see another implant at the time of removal of the implants!?

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery

Newport Beach, San Francisco,Miami, EU, Anguilla

Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)

Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors

President,American Society of Bariatric Plastic Surgeons

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