As stated earlier, Dr. Nicolaidis is the first Plastic Surgeon world-wide to report prospectively on the complications of capsulectomy with simultaneous breast lift, presented at the American Society of Plastic Surgeons Meeting in October 2022. Here, Dr. Nicolaidis was pleased to win the “outstanding paper presentation” award. The following are the complications in his first 500 explant cases; it is important to keep in mind that these complication rates are in experienced hands and are likely higher in the hands of someone who does not do these surgeries regularly:
Pneumothorax: Risk of pneumothorax is probably the main reason that many Plastic Surgeons hesitate to perform complete capsulectomies. Pneumothorax involves penetration of the covering around the lung (NOT the lung itself), typically as the capsule is being peeled off the rib cage. This occurred in 8 out of 500 patients (1.6%), all of whom had submuscular implants. The pneumothorax was recognized immediately and a small tube was placed in the hole. The tube was removed the following day with no further consequences.
Bleeding: Bleeding is the most common complication of capsulectomies, requiring return to the operating room to stop bleeding in 4 patients and simple drainage in clinic in 5 cases. So a total of 9 cases in 500 explantations for a rate of 1.8%.
For these reasons, Dr. Nicolaidis now places drains for all patients and asks them to keep their elbows on the sides for 2 weeks following surgery.
Skin laceration: This occurred in the two out of 500 patients, both of whom had implants above the muscle. One patient had severe contracture with the capsule stuck on the skin. The other patient was extremely muscular. An incidence of 0.4%. It is important to note that these two complications occurred in the first 50 explantation cases. Dr. Nicolaidis reached 700 explants in January 2023 with no further skin lacerations. Obviously, experience helps to diminish these complications.
Nipple necrosis: Nipple necrosis involves death of the nipple tissue when the blood supply to the nipple is severely compromised and requires removal of the dead nipple tissue. Fear of nipple necrosis is the reason that Dr. Nicolaidis waited a full year before doing his first complete breast lift at the time of explantation. In 500 cases, he had one case of partial nipple necrosis, in a patient whose nipples had to be raised 7 centimeters and who had a delay in draining a hematoma after she returned home. Two other cases posed a concern for nipple loss but this was avoided with 1-2 days of hyperbaric oxygen treatment. So, 1 partial nipple loss out of 1000 nipples for a rate of 0.2%.
Seroma: Seroma is a collection of non-bloody fluid that typically develops in the explant pocket. This occurs in small amounts in many patients, such that the liquid gets absorbed by the body over a period of weeks. Dr. Nicolaidis has had 3 cases of more significant collections which required drainage under ultrasound. So, a rate of 0.6%.
For seromas, drains may be effective. But Dr. Nicolaidis does not feel they are necessary given the low incidence of seromas. Nevertheless, if a patient really desires drains, Dr. Nicolaidis will be happy to comply.
Infection: Minor infections may occur following small wounds in the closure sites. One patient required oral antibiotics for concerning infection around the nipple following a large lift and did fine. So, a rate of 0.2%.
Reaction to Anesthesia: While some patients may develop a sore throat following anesthesia, no patients had a major reaction to anesthesia, requiring transfer to the hospital or anything of that nature. So, a rate of 0%.
Total complication rate: 4.8%. For comparative purposes, the estimated revision rate for breast augmentations is 10%.
Revision Surgeries Following Explantations
Revision surgeries are typically done 4 to 6 months following explantation, in an effort to improve the final appearance of the breasts. But before we get to that stage, consideration is always given to massage and cupping of the skin to improve indentation, etc. Even Dr. Nicolaidis is sometimes amazed at how much breast appearance can improve with such treatments. Should that fail, minor scar revisions and releases can be done under local anesthesia. But clearly the most powerful revision tool is fat transfer to the breast.
The worst results Dr. Nicolaidis has seen are in patients who did not undergo breast lift at the time of explantation. He has a number of patients who regret not touching the nipples at the time of explant. However, he has no patients who regretted having a lift at the time of explantation.