OUR FEATURE ARTICLE OF THE MONTH
by
| Dr. Edward Melmed has been a practicing surgeon now for
over 27 years. In addition to being board certified by the American Board of Plastic Surgery, he is also board
certified in England, Scotland, and South Africa. Other achievements include his position as Medical Director for the Dallas county gang tattoo removal and volunteer program. He also works as a volunteer for plastic surgery programs in LeSotho, Mexico. He has graciously agreed to share this article with us this month. Thankyou Dr. Melmed! |
| In 1988, Connie Chung, on national television, reported about women who were
having problems with breast implants. I, like most plastic surgeons, had performed this operation hundreds (if
not thousands) of times. Among the claims of adverse reactions were that women had short-term memory loss, joint
pains, hair loss, fatigue, etc. Facetiously I said to myself, "I have those symptoms: do you think it's from
handling silicone?" Ha ha. Then a lovely lady, Paula, came to see me, and I removed her implants and she looked terrific and felt better. She asked me if I was interested in seeing other women who had similar complaints. Being very open minded, I started seeing these patients and this really opened my eyes. Now, nine years later, I have removed implants from over 700 women. During the course of this time, my technique has evolved and I have refined my procedure to where, if a woman has any tissue left whatsoever, (I'll discuss mastectomy later) I can usually remove the implants with minimal deformity. In fact, I would state, for a number of reasons, that 95% of these women look much better after explant than they did pre-explant. From what I have observed, most implants are too large, women have aged and may have put on weight, the breasts have dropped, become hard, displaced, etc. These findings have also been documented in the Journal of Plastic & Reconstructive Surgery in April 1998. During explantation, when possible, the implants are removed within the capsule through the original incision, exceptions being when the transaxillary approach has been used or when the patient has opted for a breast lift (mastopexy). Throughout the years of my involvement in explanting women with breast implants, I have come across some interesting findings. For example, it is documented (but well hidden) that 30% of women lose sensation to their nipples when an inframammary incision is used. My findings are that between 20-30% recover feeling after explant! Some of my significant findings post explant have been these: Symptoms of fatigue usually respond well and improve after explant, and energy is typically much better, yet joint pains respond poorly. Memory loss is slower to recover (but does not continue to deteriorate). From my personal experience in dealing with women I have explanted, I would estimate that 95% of them say it is the best thing they have ever done (This calls to mind the old joke about the two happiest days in a boat owner's life: the day he buys it and the day he sells it ). Explantation surgery is typically day surgery and is done under general anesthesia with an M.D. anesthesiologist at a major hospital where I practice . Regardless of whether the implants were placed above or below the muscle, the silicone can be removed, although under-the-muscle placement is much harder. Patients go home the same day with a chest wrap and a drain tube, which is not sewn in. The drain is gently removed the next day. Patients are then asked to wear a sports bra. On the third day, they can shower. Pain is not usually a factor as most pain was experienced with implantation, the reason being when tissue is stretched, it hurts (putting the implants in). When implants are removed, pain is often minimal, if not non-existent. Most women report that their back pain and shoulder pain immediately disappear, as the adherence of the capsule to the ribs or pectoral muscle is typically responsible for this pain. As for sutures, since self-dissolving sutures are the sutures of choice, most oftentimes, the sutures dissolve and there is nothing to remove. A personal note to finish with: As a plastic surgeon who has been around throughout the entire course of the breast implant era and witnessed, firsthand, the down side of this ever-increasingly popular elective surgery, from the perspective of hindsight of which I now view breast implants, I think that future generations will look back on this time in history and say "what did doctors do to women? And what did women do to themselves in the name of self esteem?" BOTH are equally guilty. I can also attest to the fact that, after 10 years, almost all women with implants have alteration in shape, size, contour or feel. Lastly, I find myself asking why is this operation pushed so hard by the doctors (could it be the money?) and the media? As a plastic surgeon who performs any number of various cosmetic procedures, I can state unequivocally that there is NO other operation with a list of complications like that for augmentation, which continues to be done despite the GUARANTEE of such complications, and that needs to be redone every 10 years! |
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Dr. Melmed performs his operations at the Medical City Hospital of Dallas. His Story may also be found at: |