Women Going Flat Need Support to Advocate for Their Choice.
Those who are facing explant post-mastectomy are particularly in need of solid, concise and comprehensive information that they can use during their consult to ensure their decision is respected. That’s because these women are really looking at two procedures: explant AND flat closure, neither of which have a robust standard of care in place that aligns with patient’s expectations.
Explanting and Mismatched Expectations
Explant can be technically complex and there is significant variability in what surgeons hear when their patient requests explant surgery. This makes it much harder for patients to advocate for themselves, and exacerbates the risk of mismatched expectations which can present significant additional hardship for the patient.
Specifically, some surgeons consider implant removal with capsulotomy (making a cut through the scar tissue to release the implant) to be sufficient. But explant activists, along with many explant-specializing surgeons, maintain that the entire scar capsule must be removed along with the implant because it has been in direct contact with the implant and may therefore harbor harmful contaminants. This is a more invasive and costly procedure called “total capsulectomy.” Removing the capsule and implant in one piece (en bloc) minimizes the risk that a potentially ruptured implant and any associated contaminants will spill out into the chest cavity during the surgery.
There is also variability in the type of testing surgeons will order on the excised materials. Most non-specializing surgeons don’t routinely send for the battery of tests that explant specializing tend to recommend. As a result, patients may need to be very specific when discussing their expectations for pathology, documentation, and – if the patient desires – post-testing implant return.
A Tool to Support Both Patients and Providers
Our new brochure “Going Flat After Implant Reconstruction: Your Body, Your Decision” was created to address this problem. It was produced by a collaboration of multiple stakeholders including explant activists, explant and flat closure specializing surgeons, and others. Much of the information on explant was sourced from Nicole Daruda’s HealingBreastImplantIllness.org, and the information on flat closure was sourced from other NPOAS publications. This brochure includes:
- reasons women decide to explant
- clear & concise information about total capsulectomy, pectoral muscle repair, pathology, documentation and implant return
- how to interview your surgeon
- images of flat (acceptable) vs. unacceptable flat closures for reference
- a checklist of questions to ask your surgeon
- concrete steps to take to ensure your decision is respected
- links for further information
Having all of this information centralized in one easy to read brochure will help women seeking explant of their implant reconstruction to advocate for themselves and to get the surgical outcome that they expect. Patients can print the brochure out at home and take it with them to use in their surgical consult.