Sensing a foreign object in the body after breast surgery

Interview with Dr. Petra Berger, board-certified plastic surgeon (Frankfurt am Main and Zurich), on implant removal.

Dr. Berger, after seeing a real boom in breast augmentation using silicone implants in recent years, it now seems the opposite trend is ocurring. More and more women are having their implants removed. Am I wrong? What is your experience in your practice? Dr. Berger: It varies greatly. On the one hand, silicone implants are still a very good choice for women with smaller amounts of fatty tissue, who wish to fulfil their dream of having larger breasts. I have patients who weeks after surgery still stand in front of the mirror every day, congratulating themselves on their decision. On the other hand, there is also an increasing number of desperate women considering implant removal who are turning to me for advice. And what do you advise these women? Dr. Berger: That obviously depends on each individual case. Some women want to go too big and are then surprised by the obviously unnatural result. In this situation, one solution might be to change to a natural shaped implant. Then, there are also women where the breast augmentation appears successful and yet despite this they are completely unhappy. What are the reasons for this? Dr. Berger: The phenomenon behind this is the feeling of a foreign object in the body. Silicone – and let’s not kid ourselves here – is not a natural material. In some women, it causes a sensation of having a foreign object in the body, which doesn’t go away if you try to convince them otherwise or with time. You cannot predict which patient will suffer this effect. Some have no problem with it, others are troubled by it. When lying in bed on their silicone breasts, when going for a swim or doing some other kind of sport, their thoughts are always fixed on their implants. In this instance, only their removal will help. We’re actually participating in one study in order to learn more about this phenomenon. Why might it be appropriate to remove the implants? Dr. Berger: In some cases, implanted silicone gel causes pain, which has been described to me by some patients as similar to being pricked by a thousand small needles. It may be that there is pain in only one breast, while the other is perfectly fine. Another problem is capsular fibrosis (scarring and hardening of the tissue – Editor’s note), which can occur at any time after silicone breast augmentation. There seems to be reason enough to argue for implant removal. Certainly a lot of women will try and avoid this step for fear of making things worse, but is this fear justified? Dr. Berger: The result really depends on the initial state of the breasts, but of course it also depends on how they were operated on previously. Nevertheless, I can reassure the patient. Generally we can help make a big improvement with some minor breast remodelling –  sometimes even without it. Especially when used in conjuction with insertion of the person’s own fat you can sculpt beautiful breasts. Does this mean that affected women can choose either a) continuing to live with artificial breasts and the feeling of a foreign object in the body or b) Going back to having small breasts that they were unhappy with before? Dr. Berger: No, you can choose between a), b) or c). That sounds promising. What does option C) entail? Dr. Berger: Breast augmentation using natural materials – for example, Macrolane made with hyaluronic acid. This is a kind of natural sugar, which is broken down if it is not topped up at regular intervals. For women without their own fat stores, it is a method worth considering. For women with their own cushions of fat there is yet another rather innovative option for breast enlargement: lipocondensation. Please could you explain that in more detail, Doctor? Dr. Berger: Lipocondensation uses the patient’s adult stem cells as starting material, which then undergo a complex process of  enrichment and purification. With that we get very pure additional fatty tissue, which promises yields of 70-90% above average when compared to conventional practices. Certainly because it comes from the patient’s own body cells, the final product is not only suited to breast augmentation, but can be used anywhere on the body. This is so-called BioShaping we’re talking about here. That sounds really innovative. Patients will certainly not then be able to complain about this sensation of a foreign object in the body. This will give new hope to all concerned.Thank you, Doctor, for your clarification on the subject of implant removal.
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