Breast Removal, Explant Surgery, and Total Capsulectomy

Breast Implant Removal with Total Capsulectomy

In addition to removing the implant, Dr. Barr can also perform a total capsulectomy (removal of the capsule). The capsule is the scar tissue that develops around the implant.

Reasons to Remove Breast Implants

Women choose to reverse their breast augmentation procedures for several reasons:

• Personal reasons: An individual may feel that augmentation was not the right choice for them or that the implants don’t have the right shape or size
• Implant complications such as implant deflation or rupture
• Complications such as infection, silicone leakage, or tension bands asymmetry
• Capsular contraction, which is the tightening of the scar tissue around the implant
• Breast implant illness (BII)
• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

BII and BIA-ALCL are potentially debilitating conditions. In most cases, healthcare providers recommend a total capsulectomy to mitigate the risks and side-effects associated with BII and BIA-ALCL.

Breast Implant Illness

Breast implant illness is a cluster of symptoms that some women experience after undergoing breast reconstruction or augmentation surgery with breast implants. Any implant can result in BII, including implants containing saline and silicone.

BII affects individuals in different ways, but some symptoms generally include but not limited to

• Hormonal problems
• Joint pain
• Vision issues
• Sleep problems and chronic fatigue
• Concentration and memory difficulties
• Anxiety and depression
• Breathing difficulties
• Skin conditions such as rashes
• Hair loss
• Headaches
• Dry mouth and eyes
• Gastrointestinal health issues

There appears to be a link between BII symptoms and those of autoimmune and connective tissue disorders such as scleroderma, lupus, and rheumatoid arthritis. To date, the medical community has not scientifically established this association, and the U.S. Food and Drug Administration (FDA) does not recognize BII as an official medical diagnosis.

However, the administration is increasingly paying attention to BII and looking for ways to help women make informed decisions.

BIA-ALCL

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a type of non-Hodgkin Lymphoma that develops inside the scar tissue and fluid surrounding the implant. BIA-ALCL is a rare form of cancer, but it is not the same as breast cancer.

In 80% of cases, BIA-ALCL presents as a late seroma 8 to 10 years after breast augmentation. A seroma is the collection of fluid around the breast implant. Other symptoms of BIA-ALCL may include palpable mass, lymphadenopathy, skin rash, or fever.

However, the lack of a seroma does not rule out the condition. BIA-ALCL can also present as a late-developing capsular contraction with evidence of swelling, rupture, or fluid collection around the implant.

In most cases of BIA-ALCL, textured implants or textured expanders are involved. The higher risk associated with textured implants may result in tissue irritation, which, in turn, leads to malignancy.

According to the ASPS and FDA, the incidence rate of BIA-ALCL is very low, and the condition has a high cure rate. Conventional treatment of BIA-ALCL involves an implant removal with a total capsulectomy.

Contact Dr. Fredric Barr

Undergoing breast implant removal surgery has risks and benefits. If you are experiencing BII symptoms or want to prevent BIA-ALCL, it is critical to gather information and make a calculated decision.

Contact Dr. Fredric Barr at Palm Beach Plastic & Cosmetic Surgery to schedule a call with a patient counselor and gain insights into the condition of your breast implants. The patient counselor will also listen to your concerns and schedule a call or an appointment with Dr. Barr, who will provide you with safe, informed solutions to resolve any issues you may be experiencing related to your implants.

If you want to choose the best course of action for your health, a consultation with a patient counselor at Palm Beach Plastic & Cosmetic Surgery is the first step.

Disclaimer

Please understand Dr. Barr will do his very best to achieve a pleasing result – HOWEVER, due to the unknown effects of tissue damage caused by the implant and its removal, cosmetic results are unpredictable and cannot be guaranteed. 

Private Insurance Considerations for Breast Implant Removal Procedures

If you plan to cover your breast explant procedure using private insurance, prepare with these helpful resources — many of which have been collected and contributed by women in our community that have faced or are facing a similar situation. It is empowering to learn from others who have secured the coverage necessary to follow through with their choice to remove their breast implants in pursuit of a healthier future. Review the information at the links below that apply to you:

• Guide to Seeking Private Insurance for Breast Implant Removal – A step-by-step guide highlighting the information you must file to secure insurance coverage for your breast implant removal procedure.
  • You will need to determine whether your insurance considers the procedure “medically necessary” before pursuing a strategy for pre-authorization.
  • You should coordinate with your medical care provider to have them file the claim following your procedure.
• Sample Letters of Medical Necessity – If you seek insurance coverage for explantation, you must have your doctor send your insurance company a letter indicating your need for an explant procedure.
  • The sample letters available at the link above are general examples, and your letter of medical necessity must be specific to your needs.
• Steps To Follow to Appeal a Denial – You have the right to appeal your insurance company’s decision if they choose to deny coverage for your breast implant removal procedure.
  • While your healthcare provider may handle some appeals, you can also personally handle an appeal.
  • Be aware of the appeal deadline for your policy.
  • First, learn the reason(s) cited for the denial. Then, gather the information you submitted with your claim, review the Evidence of Coverage document (also known as the Benefit Policy Document), and call your insurance company’s member services phone number for additional clarification, if needed.
  • Your insurance company may have a standardized appeal form, or you may need to prepare an appeal letter. You may add additional evidence supporting your claim. This process would be an internal appeal, and you may seek an external appeal through a third party if insurance denies your claim again.
  • The Department of Insurance in your state may also be able to help you through the appeal process. Review the information at the link above for additional details and steps if you seek to appeal a denied insurance claim.
• See a Sample Appeal Letter – Review the format of an example appeal letter, which may be downloaded as a Word document file (.docx) and used as a rough template.
  • This sample is from the doctor of a real woman whose claim was denied for a breast implant removal procedure as she suffered from a severe capsular contracture and a ruptured implant.
  • Of course, your letter would need to carefully replace names, policy number, insurance company name, addresses, and other information with the details involving your claim, procedure, and condition. Maintain the general format while explaining why your insurance company should cover the procedure under your policy.
  • Your health provider may be able to assist you and prepare the letter on your behalf based on this template.
• Consider the Affordable Care Act (Obamacare) for Breast Explant Coverage – While breast implants were considered a previously-existing condition before the Affordable Care Act (ACA, or “Obamacare”) and had, therefore, often been denied coverage for problems involving the breast implants or the breast tissue itself, under the ACA, insurers must pay for “medically necessary” services that are required to keep you healthy or improve your health.
  • Be sure to carefully review individual policies to avoid choosing one that would not cover your procedure because they only consider it a “cosmetic” need.
  • Note when “Open Enrollment” is in effect each year, which is the window of time during which you may choose a plan through the health insurance marketplace.

If you have additional questions regarding private insurance or related communications involving coverage, claims, or appeals for your breast implant removal procedure, our supportive staff is happy to help you.