Surgical removal of the implants
Surgical removal of the implants
1.5 – 2.5 Hours
Immediate effect, final result after 2-3 months
Breast Implant Illness + Capsulectomy from € 6,900.-
Initial consultation for new patients: 50 €
Advance transfer, cash or card payment possible.
For most patients, breast augmentation is accompanied by an increased, positive body feeling – in rare cases, however, the implants can lead to inexplicable symptoms such as hair loss, headaches, sleep disorders, muscle pain, or others. The term “breast implant disease” has been established for many years for these unfortunately very unspecific symptoms. Since the symptoms are unspecific, they should also correlate with the time a few weeks or months after the breast operation, so that one can think of a diagnosis of “breast implant disease”.
Breast Implant Illness does not relate to symptoms that are directly related to breast surgery with implants. It is a collective term for diseases that were observed in close proximity. This does not mean that there is a causal relationship, but it cannot currently be ruled out across the board. Clarifying this connection is a large, sensitive topic and is currently being researched.
After an in-depth consultation and an analysis, we recommend the complete removal of the breast implants if breast implant illness is suspected, as we have observed that the symptoms disappeared in almost all patients.
Capsulectomy vs. en-bloc removal.
Patients who contact us with this disease have already dealt intensively with the topic and often wish for the “en bloc” removal of the implants, which is often mentioned in Internet forums. Here, not only the implants but also the capsule surrounding them should be removed without leaving any residue. We do our best during the operation to remove all easily accessible parts of the capsule – however, for implants that lie under the muscle, the capsule is usually also firmly attached to the rib muscles and the bony ribs, and removal of these segments can lead to a so-called Lead “pneumothorax” (= air accumulation in the lungs), which has fatal consequences. Therefore, the following applies: in every breast implant illness case, we perform a removal of the implants and a capsulectomy (= the removal of the capsule parts) – however, the compulsory removal of firmly grown tissue is avoided due to the risks. The list of patients with whom a small proportion of the capsule is firmly attached and who, despite the fact, has become symptom-free is long, and we are therefore convinced that the stubborn attempt to remove “en bloc” is not always correct. A total en bloc removal is not always possible and necessary, especially for patients who do not have capsular fibrosis, but only an extremely thin capsule.
During the procedure, we document exactly how the cave looked before and after removal and how much of the capsule we removed. The implants are the property of the patient and are handed over to her.
The intervention takes place in Vienna on a daily basis and under general anesthesia. Spending the night in a hospital is rarely necessary for medical reasons. Our patients like to stay overnight when the journey is long or you just want to treat yourself to a night’s rest from everyday life. When you are discharged, you will receive a support bra that you should wear for 6 weeks. My team and I are always available for you should you have any questions. You can always reach me on my mobile number at night after the operation.
Further check-ups in the ordination are important to optimally accompany the healing process. After 2-3 days there is a change of plaster, after about 2 weeks the sutures are removed. You should avoid sport until the seams are removed and do not wet the seams.
Result: A breast without an implant and a new, better body feeling without symptoms.
Patients who show symptoms suffer and wish to have their breasts restored to their original condition without an implant. We take the concerns of our patients very seriously, often with the recommendation and the result to remove the implants.
I became aware of Dr. Bartsch on a Facebook group and felt very well cared for from the start. He took my symptoms seriously, gave me detailed advice, and then we made an appointment to remove the implants, including the capsule. I wanted to have a video of the operation, he did that too. Since then my symptoms have completely disappeared and I finally feel good in my skin again! Thanks again to the whole team, I can only recommend theaesthetics.
Questions that are very important to my patients.
Are you a certified plastic surgeon? Do you have a health insurance license (can you settle with the health insurance?)
Ich bin Facharzt für Plastische, Ästhetische und Rekonstruktive Chirurgie und seit über 15 Jahren in diesem Gebiet selbstständig. Wir haben keine Verträge mit den Krankenkassen – können jedoch bei einer bestehenden Zusatzversicherung Anträge für eine Kostenübernahme erstellen. Niedergelassene plastische Chirurgen in Österreich haben so gut wie nie Kassenverträge. Sollte man eine Explantation über die Krankenkasse planen, ist eine Abteilung für plastische Chirurgie in einem öffentlichen Spital eine Möglichkeit
I want my implants to be removed "en bloc". How many explants did you do "en bloc"? (Note: there should have been at least 50). Can you show me photos of past "en bloc surgeries"? Because photos are the only way to see these skills. The surgeon should undertake to remove all capsule tissue so that no follow-up surgery is required.
Since I have been working in this area for over 15 years, I have so far carried out approx. 100 “en bloc” distances. This technique is not only used for breast implant illness, but is also a very common technique for a complication that can occur after breast augmentation – the so-called capsular fibrosis.
Since our patients increasingly request photo documentation of their “en-bloc” removal, I also have photos and videos of interventions that have already been carried out.
If there are swellings, seromas or capsular fibrosis and especially with textured implants: the doctor should undertake to have the CD30 test (test for BIA-ALCL) carried out. Ask your doctor if he will aspirate fluid if he discovers a seroma / hematoma during explantation and sends it and the capsules for the CD30 test! Insist.
This is how we do it: every seroma that is present is sent in and examined. BIA-ALCL is still a rare disease. If a BIA-ALCL is suspected due to persistent swelling of the breasts on one or both sides or an accumulation of fluid around the implant, we can organize a CD30 test for our patients at the University Clinic in Graz. The pathology in Graz specializes in the examination.
Ask the doctor what he will do with a rupture and if silicone has migrated to the lymph nodes. Will he use ultrasound to examine the lymph nodes beforehand and remove any affected lymph nodes?
If there is an existing rupture of the breast implant, it is completely removed and the bag is rinsed thoroughly several times and then cleaned. Ultrasound examination of the lymph nodes is only indicated if symptoms persist postoperatively. Removal of the lymph nodes is only necessary if BIA-ALCL is confirmed and is performed by specialized gynecologists.
Unfortunately, ultrasound is often not sufficient to diagnose a rupture. An ultrasound examination can show both a false positive result, i.e. a rupture although none is present, and a false negative result. In this case there would be a rupture but this was not visible on the ultrasound. Therefore, we always recommend an MRI examination of the breasts if rupture is suspected.
How will he clean the bag if it is contaminated with silicone or microorganisms?
The pocket contaminated by a rupture of the breast implant is rinsed and cleaned several times with a betaisodona solution (containing iodine). The antiseptic effect of this solution ensures that microorganisms and silicone particles are removed.
Request film or photo documentation (from you with implants, after explantation without implants, on the operating table, photos of the implants WITH capsule tissue before opening the capsules from both sides, photos of the implants with the associated capsule marked with the right and left) )
Since our patients are increasingly demanding photo documentation of their “en-bloc” distance, I also have photos and videos of interventions that have already been carried out. On request, we can document the steps of the operation using photos and videos.
Insist on the surrender of your implants and agree that the surgeon will definitely send the capsules for a pathological examination. The implants should be packed in two plastic bags, put them in the icebox if they are needed for later examinations or a court case.
If there is reasonable suspicion, we can send in the implants and have them examined pathologically. In any case, you will receive your implants well packed after the operation, as they are your property.
Insist on the delivery of your complete patient file (surgical report, images, test)
On request, we can send you a copy of the surgical report, the intraoperative image material and the results of any tests that have been carried out. You always have the right to be given your patient record, so there is no need to discuss this beforehand.
Drainage is usually not necessary for an (en-bloc) implant removal. If, however, unexpectedly, heavy bleeding manifests itself, we will resort to drainage – this usually remains in the chest for one day and will be removed personally by me at the first check-up.
What are the signs of infection after explantation? What are the signs of a seroma or hematoma? What will the doctor do about these signs?
Signs of postoperative infection are pain and reddening / warming of the chest or scar. Seromas or hematomas manifest themselves in a clear swelling of the entire breast, and the breast feels hard. Most hematomas occur only on one side. If you experience any kind of such symptoms, you can reach me at any time by telephone (also at night) on my private cell phone number (+43 699 11222000).
Can you take out follow-up insurance through his practice? Are follow-up treatments due to rupture, capsular fibrosis, infection, wound healing disorder etc. covered by this insurance?
We discussed follow-up insurance a few years ago and decided against it after negotiations with the insurance companies. The cost of such insurance would always have to be borne by the patient, is only possible in the long run if it is offered to all patients, since the insurance companies “like to see it” if it is not only offered in high-risk cases. If there is a necessary operation due to a complication, you have to reckon with € 1,900- € 2,900.-. We always treat any complications, such as small wound healing disorders, without incurring additional costs.
What happens to your deposit / payment if you cancel or postpone the operation?
You do not have to pay a deposit with us – you should have transferred the money for the procedure by the day of the procedure or bring it in cash on the day of the operation. If you do not want to perform the operation for personal or medical reasons, you will receive a full refund of the money already transferred. We currently have no cancellation fees (as of 1.4.2020)
Are there any recommendations for food supplements, medication? Which laundry (compression laundry) is needed, what do you need for wound care at home? Is he at your disposal for problems after the operation?
You will receive a prescription for pain relievers as well as antibiotics from us immediately after the operation. You can get the support bra from our nursing staff in the hospital. You do not need any utensils for wound care at home – we carry out all important checks and treatments directly in our office. If, in selected cases, bandages are also needed for at home, you can get them from us.
If you have any problems, I am available 24 hours a day by phone or via WhatsApp / signal at +43 699 11222000.
Will the attending doctor give you antibiotics for bacterial infections or an antifungal if the implants were moldy?
We give you a single dose of an antibiotic through the vein during the operation. In some cases you will get a prescription for an antibiotic that you should take for a few days after the operation.
If the implants are affected by mold, we will take a smear intraoperatively to identify the exact pathogen and then start a suitable therapy. In principle, cases with mold implants are very rare.
How many follow-up exams are planned?
We will have 3-5 scheduled checkups: one a day immediately after implant removal to change the patches, in some cases another in about 4-5 days after the procedure, one after about 2 weeks for suturing, then 6 weeks after the operation and the final check then takes place about 3 months after the procedure. If you have any questions or complaints, you can of course make an appointment with us at the ordination. Personally, I can also be reached at +4369911222000 via Messenger.
How big are the scars likely to be?
Access is usually via the underbust fold. In some cases we also performed a breast lift in the same procedure, which of course creates new scars. Basically, revision procedures after breast augmentation are usually accessed via the underbust fold. Regardless of whether the intervention was selected via the areola, under the armpit or primarily via the underbust fold.
Insist that you read the papers in peace before signing them. Are you required to maintain confidentiality (that is, should you commit yourself to keep everything related to the operation, including photos, results, price, etc., secret and not to publish it anywhere? If so, look for another doctor !
We found this point very exciting. As mentioned above, you have rights to all documents that we create before, during and after treatment. So we can only agree. If you do not have a “good gut feeling”, choose a different doctor.
Which anesthetic is used in the operation? What side effects are known? If they are MTHFR positive, will this affect your anesthesia? MTHFR positive people are advised to use Nitrous Oxide.
Our anesthesiologists will perform the anesthetic using a laryngeal mask – the medication used is usually a mixture of propofol (= anesthetic) + Ultiva (= pain reliever). The main side effects include a rapid drop in blood pressure (therefore it is injected very slowly) with Propofol and respiratory depression with Ultiva. However, we are a very well-coordinated team with our anesthetists, and their experience in the field is responsible for ensuring that most patients come out of the OR almost painlessly and can leave the hospital just a few hours after the procedure.
You can see how the anesthetic works with us in this video: https://youtu.be/ei6H6IjltCc
Are you given antibiotics during the operation? If yes, which? Will you be given nausea medication?
You will be given a single dose of ceftriaxone during surgery – this is a broad-spectrum antibiotic that has a broad antibacterial spectrum to cover the most important germs. If there are special allergies or diseases, we will adjust the antibiotic dose accordingly.
You will of course also receive a medication for nausea and pain intraoperatively via the peripheral venous catheter.
How will any bleeding be stopped during surgery?
Smaller bleeding (usually from very fine vessels) is obliterated during the operation using special tweezers. Major arterial bleeding is very rare – if you injure a large vessel, you can suture the opening with a thread and stop the bleeding.
Insist that no foreign objects are used (mesh, clips, silicone products - e.g. for tightening)
We will not use any permanent foreign objects in the “en-bloc” removal.
What pain relievers will you get?
You will be given pain relievers before the procedure begins. During the operation you receive “Ultiva” from our anesthetist – this is a strong, very short-acting opioid, which is effective against the pain during the procedure and for a few hours afterwards. You will then receive a prescription for pain relievers. You can take this pain reliever up to 3 times a day if necessary.
We always say: “The gut feeling has to be right”. Let your instincts guide you. But there are also a few hard facts that can make your decision easier:
Operative Entfernung der Implantate
Soforteffekt, endgültiges Ergebnis nach 2-3 Monaten
Erstgespräch für neue Patienten: 50 €
Vorab-Überweisung, Bar- oder Kartenzahlung möglich. Bei Zahlung mit Kreditkarte fallen 3% Spesen an.