Tuesday, June 5, 2007

It's Happened Again

Updated 3/2017--  all links (except to my own posts) removed as many no longer active.

A patient calls–My right implant has ruptured. I woke up this morning and now my right breast is smaller than the other. I gently correct her–Your implant has deflated. Saline implants deflate, they don’t rupture.
Patient–Is it going to harm me?/I have a trip planned for this coming week. Me--Your body will simply absorb the IV saline that was used to fill the implant. It isn’t a medical emergency though it can be embarrassing. We can take our time and fit it into your life/work schedule (If patient is pregnant, it can safely wait until the delivery of her baby.) Put a shoulder pad or some other padding in your bra to even it out for now. When would you like to be seen?
Patient–Well what do we have to do? I didn’t realize they would do this. Me–Yes, I reviewed this with you before surgery. All implants fail at some point. Just like anything else man-made.
Patient–So what do we do now. Me--I will need to see you and then call the implant company to arrange the free implant replacement(s). Do you know if you have the "extended warranty"?
Patient–No, I don’t think so. I think my surgery was yyyy. Me–Okay, the extended warranty program didn’t exist prior to October 1, 2000, so you won’t get any other financial help. Just the free implants.
Patient–So what will this cost me? Me–The surgery center will charge you $800, anesthesia’s charge is $500, and my fee is $***(depends on time passed since surgery and whether I was the initial surgeon). This time we will make sure you get the extended warranty (I began paying for it for each patient out of my fee back in 2002 when I realized too many of them were failing to spend the extra $100.)
Patient–I will have to talk to my husband and see if we can afford that. Me–Okay, just let me know when you want to go forward. I will need a minimum of 2-3 days between the office visit and the surgery date (shipping time for the implants and the paper work to facilitate payment, if warranty is in effect). Would you like to schedule an appointment or call back after talking to your husband?

I truly appreciate the patient who remembers the preoperative discussion and who read the information brochure (pdf file). I try very hard to make sure the woman knows that the saline implant is not permanent. Approximately 1% deflate within 1 year, 3% within 3 years, and 10% within 5 years. Because of the warranty set at 10 years, I caution all of them that the mean deflation is 10-12 years (or half at that point). I tell them that it is rare to have a deflation at 1 year, but it can happen. And yes, the implant may last for 20 years, but don’t count on it. I tell them to begin saving money, if they get to 8-9 years without a deflation because they will likely end up out of the extended warranty period.
And all this is said on top of reminding them that this is surgery, the risks of surgery are infection, bleeding, anesthesia/drug reactions, scar, loss of/or decrease nipple sensation. The risks due to the implant include capsular contracture, asymmetry, visible wrinkling of the implant, deflation, repeat surgery to correct any of the before mentioned problems. You will need to be more careful with your mammograms. Four views will need to be done rather than just two. Make sure you go to a facility that is comfortable with implants and do mammograms often on women who have implants.


Margaret Polaneczky, MD (aka TBTAM) said...

Judt found you blog and am posting in on my blogroll. Lots of great info here!

rlbates said...

Thank you.