Is your doctor checking your Capsule for Pathologic Abnormalities

Women who undergo explant surgery are faced with having to make overwhelming decisions before and after this procedure. One specific topic remains obscure – Screening for abnormalities in the capsule.

Women who undergo Explant surgery are concerned with their Breast Health. They need to know that their doctor ran all the necessary tests to rule out pathological findings in their capsules. However, many shared posts on social media validate that at the present time not all plastic surgeons include pathology evaluation of the removed capsules.


College of American Pathologists requirements

One of the reasons is that the last revised recommendations by the College of American Pathologists, which include breast implants, have no requirements for microscopic analysis of implant capsules.

Furthermore, the recommendations for processing specimens by pathologists are not defined and appear to vary according to particular institutional bylaws.

Recommendations in textbooks are still for random sampling, 

No standardized pathologic processing of the capsules exists

Further sampling or analysis may be triggered by pathologists when neoplastic or atypical cells are unexpectedly found upon microscopic examination. This would include immunohistochemically stains such as CD30 and ALK. But no standardized exams of the capsules associated with breast implants illness are in place.

Breast implant capsules abnormalities

In reality Breast Implant Associated- Anaplastic Large Cell Lymphoma occurs rarely while inflammation, fungus and bacteria in the capsules are common. According to Dr. Feingold 30-40% of the capsules return positive with some kind of pathogens, for which he recommends further treatment.  

Mold or Fungus

Randall Feingold, MD performs en bloc explant surgery regularly and has developed a safety protocol based on his clinical training and many years of experience that provides a panel of pathology evaluation of the capsules to rule out certain abnormalities. 

Taking Bacterial cultures

He photo-documents the capsule specimens so that his patients can feel comfortable that they were indeed removed. He also sends the capsules specimens to pathology, as well as for bacterial and fungal cultures. These tests are done during the explant surgery and typically the results are ready within 7-28 days. 

Randall Feingold, MD uses the following protocol to thoroughly evaluate and treat his patients

Randal Feingold’s list

  • Photo documentation of capsules and implants provided to patients for reassurance
  • Pathology evaluation of capsules to assess degree of inflammation and rule out malignancy (particularly for textured implants)
  • Microbiology testing of capsule lining to investigate for colonies of bacteria and fungus/mold
  • Long term antibiotic or antifungal therapy for positive cultures

Final Note

To summarize, different pathology labs may study capsule specimens differently. Discuss this with your plastic surgeon before surgery to ensure that useful studies such as pathology and microbiology are performed to increase the likelihood of finding the underlying cause of symptoms and allow selection of proper treatments.






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