Dr. Joel Aronowitz - Toxic Breast Implant Removal - When Bleeding after Surgery fills the space around the Implant

 

Dr. Joel Aronowitz

Dr. Joel Aronowitz: "Hi, I'm Dr. Joel Aronowitz. Today, I want to show you a case of the chocolate breast. This is a woman who is in her 70s. About 25 years ago, she had breast cancer, had a mastectomy, and a reconstruction with an implant. But, she had complications and for many, many years, she had an enlarged breast that was very painful, that restricted the motion to her arm, and she was referred by her doctor to come over and see me and figure out what the problem was. So, let's dive down on the problem with this breast reconstruction, what I call the chocolate breast. So, the patient has one of these. This is a silicone gel implant. This is a smooth implant, but hers is textured, and the texture implants, in general, we want to remove nowadays because they've been associated with some other problems. So, that implant is sitting here on her chest, under the skin, and also the pectoralis muscle, muscle that comes across like this, is at least partially covering the implant, and because it's very swollen, it's tenting up the pectoralis muscle and restricting the motion in the patient's arm, and even causing her some numbness. The implant itself is not enlarged. What's happening is, around the implant, there was bleeding after surgery, and that blood was not absorbed by the body. Not only was it not absorbed, but it created irritation that caused even more swelling. So, that breast implant, instead of being one size, is basically double the size that it was intended to be, and it hasn't gotten better over years and years, and the only thing to do at this point is to open up that skin incision, remove the implant, remove all of the intrafluid and old blood, the free silicone that's there because the implant itself ruptured, clean everything out, and start fresh with a reconstruction by putting in a brand new implant that's the appropriate size to match her other breast. So, I want to introduce you directly to Elena. She's very kind to share her story with us, and she's doing that because she thinks that everybody should have the opportunity to see what it's like to have breast cancer, what are some of the problems that can occur afterward, and what can be done about it. So, here's Elena, one of the loveliest patients I've known. Can you tell us how it feels different? Oh, so much. I can't believe you put up with it for 25 years. Well, it's that long, right?”

Elena: “Oh my gosh, yeah. It started in 1998. I had the breast cancer diagnosed on May 1st, May 3rd, my birthday, and then they checked it all out, and it was cancer, and after they put the saline implant.”

Dr. Joel Aronowitz: “They put a tissue expander. They did a mastectomy, and they took the nipple in. Nowadays, we don't really need to take the nipple in unless the nipple is involved in the breast cancer. And you also had radiation afterward.”

Elena: “I had chemo and radiation because they found that I had metastasis of the lymph nodes. So they took all the lymph nodes. That's why I don't have any lymph nodes. But then they also, after the leak of the saline implant, they replaced it with that thing.”

Dr. Joel Aronowitz: “The silicone implant. That's a texture implant. The idea of a textured implant is so it doesn't get hard, but the reason yours got so hard was because there was bleeding that was probably unrecognized or that occurred after the surgery, and that's what caused all that extra volume in there. And that should have been taken out, washed out years and years ago.”

Ella: “What would it cause the leaking, doctor?

Dr. Joel Aronowitz: “Well, usually what happens is when the implant, so here's the breast implant. This is a smooth implant, but the breast implant, you can squeeze it really hard without breaking it. But if you, if it folds like that and it stays folded, then just like a piece of paper that you keep folding, you've got a crease and that's a weak spot, and then you push it, and it and it tears. Or there's a little scratch from the surgeon's needle on the back of the needle when the surgeon is closing it, and that little scratch doesn't heal, and it becomes a weak spot that then can leak. And that's one of those two things probably is what happened. And then this silicone leaks out, but in your case, also blood leaked into the implant. Yeah, and you're a tough woman, and you put up with a lot, so you put up with it for a long time instead of having it taken care of.

Ella: “It was painful, but I thought, hmmm, you know, I do want to find out if it was…”

Dr. Joel Aronowitz: “Are you glad you finally, did it?”

Ella: “Yeah, it was a tough decision at first.”

Dr. Joel Aronowitz: "What made you decide to finally come in?"

Ella: “Dr. Green, number one, he says, "No, you get it. Take care of it." So, I said, ‘Well, what if?’ I kept asking my husband, "What if I don't, you know, I just let it sit there?" Because I didn't know about my other situation, my other problems, if I was going to make it or how long do I have it, you know. So, I said, "No, I better; if I die, I die, I go be comfortable." So, I said, "Okay, let's go. But Dr. Green really talked very highly of you.”

Dr. Joel Aronowitz: "Oh, that's nice."

Ella: “So, I would not have had it done if he said, No, he's the best.”

Dr. Aronowitz: " So, because your doctor recommended it. Now, I think if a woman has a lot of pain from an implant, whether it's after reconstruction or not, or just an implant, it can be a sign of other problems besides just a tight scar tissue. And in your situation, there was the mixture of the silicone in the blood and a textured implant was not a good combination. And so, if you know you have a textured implant, it should be replaced at some point. And if you know you have a ruptured implant, it's not an emergency for most people. Most people, it's not as bad as you. They called yours a chocolate breast because what came out looked so chocolatey. But most of the time, it's not that. And most of the time, even a ruptured implant, it's not that bad. And there's not an emergency to it, but it should be replaced.”

Ella: "What are the signs and symptoms that I should really watch for?"

Dr. Joel Aronowitz: “For you, don't worry about anything you're finding. But if you have more pain, if you have more swelling and the breast gets bigger than it was, the implant isn't supposed to grow. And if your arm is restricted or something just doesn't feel right, you have rashes on the breast or something, you know, you have worse fever, chills, that sort of thing. But if something doesn't feel right, it's better to just check it out. Under the muscle symptoms, the most common things are the breast feeling like it's particularly full back here. And one will come in and say, "I need to hold my breast like this or it hurts." It's because that muscle is pushing down here where your hand is. It's pushing down, it's forcing the implant down now like this. So, the woman comes in holding that breast like this to support the heavy implant because it feels so much better. And that happens over sometimes soon, but sometimes over the course of years, the implant gets pushed to the side and the breast all of a sudden is under her arm. And that's what brings a lot of women in who have under the muscle implants.

Ella: “I really postponed any kind of complaint because my mom, you know, I was taking care of her and I could not have surgery. And my pain tolerance is a lot. Well, and like a…”

Dr. Joel Aronowitz: “Lot of women, you're very, you're very tolerant. I'm not tolerant of pain. I'm a huge baby, but you're really good. And, but it, you know, it doesn't serve you well. There's no point in suffering. It's something that's easily corrected like this. I don't think you had a really bad recovery. You even, you know, I mean, you took out your own drain even.

Ella: “It was, it was not bad. It...was my daughter did a great job, brought me all kinds of stuff.”

Dr. Joel Aronowitz: "That's great. Anything else you..want to tell everybody?”

Ella: "I just really appreciate everything you've done."

Dr. Joel Aronowitz:"Oh, that's sweet. You..."

Ella: “I am, I'm sure that you're going to get more referrals from word of mouth because-”

Dr. Joel Aronowitz: “I just want to make sure that women who get breast cancer or worried about breast cancer know what their options are and know they don't have to have their breasts removed and many times don't need radiation and that the breast can be reconstructed without disfigurements. So, it shouldn't be something you live in fear of.”

Ella: "Yeah. I think that's part of the dilemma is that we always are afraid for somebody to touch our bodies. And then there's so much imperfection that's going on right now that you just kind of wonder, ‘Do I want to take a risk? You know, should I?’ And then when it's time, I guess it's time.”

Dr. Joel Aronowitz: “You're just a blessing. You're a very wise woman. Thank you very much for sharing your story with everybody.

Ella: “Thank you.”

Dr. Joel Aronowitz: “So what you can see in the post-operative photos, the reconstructed breast, the nipple areola has been tattooed later and you can see that tattooed nipple areola here. You can see the pectoralis muscle is coming over the implant and now the implant you can't really see, but if you feel the breast, it's much softer and the patient has better range of motion of her arm without pain and without restriction. Thanks for watching the video. Hope you enjoyed it. I hope you learned something and we have a lot of other videos about surgery as well as some reaction videos and other interesting videos to watch on our YouTube channel, Aronowitzland.”

 

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