Pittwater Life April 2019 Issue

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Health & Wellbeing The link between breast implants and ill health with Dr John Kippen Health & Wellbeing As noted in a previous article there is an association between breast implants and anaplastic large cell lymphoma. Increasingly there appears to be an association with breast implants and general ill health. This has been termed ‘Breast Implant Illness’. A variety of symptoms that overlap with other conditions preclude a single definitive test. As awareness has increased, the prevalence has also increased. Several celebrities have suffered with this condition, and there are a number of support groups. The exact mechanism of causation is not fully understood. Equally removing the implants and capsule may resolve some or all symptoms. This may be a rapid and complete resolution or a slow improvement over some time. Some people may have little change. Fortunately, most do improve – and usually quite substantially. The crucial surgical principle is to remove the implants and all of the capsule. This is termed “en bloc” removal and termed explant surgery. Removal is difficult in three main areas: First, if the implants were TREATMENT: Removing implants may resolve some or all symptoms. placed deep to the muscle or in a dual plane pocket, then the back surface, against the ribs, is often quite adherent and stuck down. Second, the apex of the pocket, when under the muscle, is close to the nerve and blood supply to the muscle. Third, the armpit, or axilla, is close to the nerve and blood vessels that supply the arm and hand. As mentioned, it is imperative to remove all of the capsule. Using refillable syringes and small injections, the tissue planes can be dissected by fluid before surgical dissection proceeds to remove the capsule. After surgery there is often a degree of droop of the remaining breast. Multiple factors influence this: initial breast size, implant size, duration of implants, pregnancy number, breast feeding, breast size change with pregnancy or breast feeding and base skin elasticity. The worst case is small initial breasts, expanded with large implants, over a long time with multiple pregnancies and breast feeding where the breasts increased during this time. Using electro-cautery, at the time of surgery, an attempt can be made to reduce the pocket size and tighten the tissue. A lift procedure may be required, usually meaning additional scarring. Surgery may also reveal pre-existing asymmetry. Most surgeons will consider using draining tubes and some form of compression or binder. This helps seal and close the old pocket space. Surgery is usually performed under general anaesthetic in a hospital. Removal or explant surgery is often considered more difficult than implant surgery. Women with Breast Implant Illness often have a diffuse, non-specific inflammatory zone at the interface between the breast tissue and capsule. This makes establishing a surgical plane and therefore removal, more difficult. At the time of consultation the condition and surgery will be fully explained. A likely procedure and the risks involved can also be explained. Our columnist Dr John Kippen is a qualified, fully certified consultant specialist in Cosmetic, Plastic and Reconstructive surgery. Australian trained, he also has additional Australian and International Fellowships. Dr Kippen works from custom-built premises in Mona Vale. He welcomes enquiries and questions. Please contact him via johnkippen. com.au or by email: doctor@ johnkippen.com.au 46 APRIL 2019 The Local Voice Since 1991
Palliative care boost The planned palliative care facilities at Mona Vale Hospital will be enhanced by a $10 million boost from the NSW Government to improve end-of-life care for patients. The first of its type on the northern beaches, a new 10-bed unit has been designed to take advantage of Mona Vale Hospital’s peaceful location overlooking the ocean and will enable people to be cared for closer to home in a comfortable environment during the final stages of illness. Health Minister Brad Hazzard and Member for Pittwater Rob Stokes announced the extra funding last month. “This additional investment will ensure the design and fit-out of the new inpatient unit will be of the highest standard and comfort,” Mr Stokes said. Mr Hazzard said the NSW Government’s strong economic management had enabled it to make record investments to support palliative care patients, including $45 million for an extra 100 palliative care nurses and other palliative care improvements announced in March. Supported by palliative care specialists, the dedicated inpatient unit will operate 24 hours, seven days a week with a patient-centred approach encouraging family and carer involvement. Health & Wellbeing The Local Voice Since 1991 APRIL 2019 47
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Pittwater Life April 2019 Issue

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