In this video, Dr. Gavin Sandercoe of Norwest Plastic and Cosmetic Surgery in Sydney performs an explant surgery on a patient and you get a sight of how the surgery is performed.  Not all surgeries are the same for all patients, depending on their individual needs. Although Dr Sandercoe performs many En Bloc style explant surgeries, this patient was suffering from muscular problems due to her implants being too large and decided against having the implant and capsule removed En Bloc. The patient did not want a scar longer than the original implant incision, which is required to remove the implant and capsule En Bloc. 

The video begins with pictures of how the patient looked like before the surgery. It then continues to show how a plane around the implant capsule is developed. Then you see the explants in progress being performed on the patient by Dr. Sandercoe. Thereafter, the deep surface of the breast gland and pec major after explants of the submuscular implant is shown.

Once the pec major reconstruction to rib insertion is complete, you witness the drains getting inserted to remove the seroma fluid. You also see how the implant delivery gets done for complete capsulectomy. As the video continues, the removed implants and capsules are exhibited while the surgery progresses and is about to be completed. Dr. Sandercoe then, closes the incisions in very precise manner. Thereafter the pictures of the patient after the explants surgery is complete are shown. As the video nears its ending you see how the patient’s appearance has transformed with the help of the explant surgery while you see the before and after the explants surgery pictures of the patient.

Depending on how much of the capsule we take, it might either be open capsule move the implant everything and seal up those thing or we can do a partial Capsulectomy and get rid of it as much as we can or complete Capsulectomy where we take all the capsule out as part of the removing the implants. And if I were to keep the implants and the capsule all in one piece, that’s called en bloc Capsulectomy.

Most of my patients that come to me wanting their implants out requesting an en bloc Capsulectomy, there’s some thoughts in popular media at the moment that some implants making people sick. At the moment there’s no concrete evidence for that. However, I do find patients that want this procedure and generally pretty happy that they’ve made sure that their implants are not contributing to any of their ongoing issues.

En bloc Capsulectomy specially requires an increase in the incision length. What’s possible is to get in a 12 cm wide implant through a 5 to 6 cm incision, it’s absolutely impossible to get an implant with its capsule out particularly in one piece through anything other than closer to the width the implant are. So the 12 cm long implant which is pretty common, normally it’s about 10 cm long incision that has to be to remove that. The other thing that I normally advise patients once their implants are out is that, of course there is no evidence at the moment, I can’t promise to make them better. But I can promise to remove the implant and get rid of as much the capsule as possible, so that we can eliminate that as a possible cause of any issues.

The things that I want to, I want to take a chisel to your ribs to get rid of the last piece of implant capsule that’s stuck to them. I want to thin out your pec measure muscles to the point where it is not functioning. There’s pretty much to limits as to how much capsule I can get out during operation. Anyone who’s had an implant under the muscle, I’d normally repair the muscle put the lower bone of the pec measure back to where it started and that’s probably the most uncomfortable part of the operation but it’s just restoring normal anatomy.

Essentially anyone who’s had breast implant normally start with smaller breasts, then put an implant in, the implant stretches the skin, thins out the breast tissue, thins out the fat, and then you move the implant plus the capsule in and now you’ve got thinned overlying tissue. You can’t predict what the results are going to be like. There are some things we can see, lucky if we can see a cleavage point between the breast gland and the pecs measure muscle, there are things that we can do about that.

The other thing that is very important is in terms of reconstructing that breast using your own tissue. That crafting is not done by part at the time of complete Capsulectomy, since you are missing the complete floor of the breast gland and there is just no point putting fat transfer into that breast at that stage.

Later we let everything settle down, scars down, and the breast is sitting back on the pec measure muscle and after that we’ve got a floor that we can sort of start building on top of.