Top Questions to Ask Your Explant Surgeon

1. Are you a board certified Plastic Surgeon:  It is important to know not only if your surgeon is board certified but what are they board certified in. Plastic surgeons are certified by the American Board of Plastic Surgery and have to complete at least 6 years of plastic surgery training and then pass both an oral and written exam to complete their certification. Dr. Surjit Rai is board certified by the American Board of Plastic Surgery. You can check your surgeon’s board certification status here: https://www.abplasticsurgery.org/ModDefault?section=SurgeonSearch
2. Do you have hospital privileges: This means if there is a problem either during or after surgery the doctor can admit you into the hospital for any care you need. This is important because it shows that your surgeon has met all the hospital requirements that would demonstrate they are a safe and ethical surgeon. Dr. Rai has hospital privileges at three north Texas hospitals including Medical City Dallas (which his office and operating room are attached to). This means if there is any issue during or after the operation you are already in the hospital and can be cared for quickly.
3. Where do you perform these operations: It is important that your procedure be performed in a safe environment with trusted personnel around. Dr. Surjit Rai performs his procedures in his AAAASF fully accredited surgical center in his office. This accreditation means his operating room meets the same strict requirements as any hospital operating room but is much more private and convenient for patients.
4. How many capsulectomy/en bloc procedures have you done: It is important to know your surgeon has experience in removing implants in the way that you would like. Dr. Rai performs 3-5 explant operations every week and because of that experience feels very comfortable with the procedure and doing it in a safe and effective way for his patients.
5. How long will the surgery take, and will I be completely asleep: To remove the capsule from the muscle and chest wall takes time. To remove both capsules completely will take approximately 2-2.5 hours. An explant with a lift will take around 4.5 hours. Because the operation will cause some discomfort to patients, Dr. Rai does perform the procedure under a general anesthetic with the patient completely asleep and supervised by a Board-Certified Anesthesiologist. He also performs a nerve block during the surgery and offers a 72 hour nerve block if desired.
6. Are you familiar with Breast Implant Associate Anaplastic Large Cell Lymphoma: BIA-ALCL is a type of lymphoma associated with breast implants. Typically, these cases will present with a large fluid collection around the implant (seroma). If this occurs, it is recommended to get the seroma drained first and tested for CD30 to rule out ALCL. That should happen prior to the capsulectomy. If you have a textured implant and your surgeon finds a lot of fluid around the implant or a mass on the capsule it should be tested for CD30 to rule out ALCL. Dr. Rai is very familiar with BIA-ALCL and has given lectures to his local hospitals about it and how to test and treat it. Dr. Rai does offer CD30 testing of any fluid around the implant or the capsules. Learn more about BIA-ALCL
7. What type of anesthesia is used and does it change if I have an MTHFR gene mutation: You will be put asleep with a combination of Propofol and gas anesthetic. With the MTHFR gene it is recommended to avoid Nitrous Oxide. Dr. Surjit Rai does not use Nitrous Oxide for any cases.
8. Do you require antibiotics after surgery: Dr. Surjit Rai gives a dose of IV antibiotics at the time of surgery and for most patients they will not require any antibiotics after. The only exceptions are active smokers, immunocompromised patients, diabetics, or breast cancer survivor patients. Dr. Rai will typically give two days of antibiotics for these patients.
9. What kind of testing is done to the implants/capsules:  Dr. Surjit Rai does test every capsule removed for breast cancer. Dr. Rai believes since the capsule is in contact with breast tissue it is reasonable to send it to be tested to make sure there is no signs of tumor cells within the capsule. For patients concerned about anaplastic large cell lymphoma (ALCL) the capsules can be tested for CD30 as well. Some patients want the implant tested for other microorganisms such as mold or fungus. Dr. Rai can test the fluid within the saline implants for these microorganisms. He will have a discussion with every patient to determine if those tests should be ordered.
10. What is done with the implants and the capsules: Dr. Surjit Rai will send the capsules to be tested by pathology. The implants will be returned to the patient if they desire. Otherwise, they are disposed per his usual protocol.
11. Will surgical drains be used: Dr. Surjit Rai always uses drains for these procedures. Once the capsule is removed there is a bit of oozing that occurs from the muscle edges and the rib cage. Dr. Rai prefers all that fluid to come out of the breast pocket. The drains will typically stay in place between 3-5 days. Less for implants above the muscle and longer for patients who have had several breast procedures or are breast reconstruction patients. The drains are removed by Dr. Rai himself in clinic once they are no longer draining much fluid.
12. Will you file under insurance for removal of my implants: Removal of implants placed for cosmetic reasons is very rarely approved by insurance. Dr. Rai does not submit insurance claims for this procedure. If the patient desires to file it by themselves Dr. Rai will provide all the clinical notes, operative report, and codes used for the procedure.
13. Where will the scar be and how long will it be: Typically for removal of the implants the scar will be under the breast crease. If you have an existing scar in this location Dr. Rai will use this incision and cut out the old scar.
14. What supplements and medications do I need to avoid during surgery: Dr. Rai will give you a list of supplements to avoid including but not limited to Aspirin, Motrin, Aleve, Omega3, fish oil and any other medications that could increase your bleeding risk
15. What is recovery like and how often will I see my doctor: Dr. Surjit Rai will see you between day 3-5 to take the drains out, the following week to remove any stitches (they are all dissolvable) and then 2 weeks after that. Then you will follow up as needed. The big limitation is no heavy lifting for several weeks. The breasts will go through a lot of changes over the first 4-6 weeks. Creases and wrinkles tend to smooth out during this time. Most patients are back to full activity without any restrictions between 4-6 weeks.
16. Are you committed to a complete capsulectomy: Dr. Rai understands the importance of removal of the capsule. He knows that is the only reason patients travel from all of the United States to come and see him. He promises each patient he will spend the time and energy to try to accomplish the goal of a complete capsulectomy at minimum and en bloc removal of the implant when possible.
17. Who will be performing the surgical procedure: Dr. Rai does not use surgical assistants or residents. You will have a board-certified plastic surgeon operating on you at all times.
18. Do you perform a nerve block during the procedure: Dr. Rai does perform a nerve block during every procedure. While this helps dull the pain it likely will not completely eliminate the pain for patients as the capsulectomy portion of the procedure can be tender if the scar is stuck to the ribs and muscle. Dr. Rai does offer a 72 hour nerve block as well called Exparel.
19. Is muscle repair performed at the time of surgery: Dr. Rai will evaluate the muscle at the time of surgery. If it is low enough then he will re-secure it to the breast fold where it belongs. If it has shortened too much overtime he will tack the muscle down to the chest wall.
20. Do you take photos of the implants and capsules: Dr. Rai will provide his patients with photos of the implants and capsules if they desire.