This case shows a patient carrier of breast implants which were inserted many years ago in a very peculiar way; unforeseeably and unknowingly to patient it was found the right implant was silicone gel filled and the left one was soybean oil filled; both of the prostheses were ruptured and leaking, however the right one was somehow entire with only one point of silicone leakage, while the left one was totally corroded by the soybean oil acidity and an inflammatory reaction happened within the capsule, besides she was unhappy with the result and sought breast revision; a total bilateral capsulectomy, old implants explantation and meticulous cleansing of silicone, calcifications and fibrosis were carried out.
The goal of this case is showing the correlation between the external look of the breasts and the intraoperative findings at the prosthetic location during a breast implants revision surgery procedure, as well as offering a vision of the state of the implants over time in this patient's clinical context; the technical option chosen by the patient to revise or repair her breasts and its outcome are not the subject of this case.
The capsule around the breast implants is a beneficial and necessary scar wrapping the prostheses as a perfect mold of their shape and size; it is formed by patient's tissues during the first four postoperative weeks and it provides fixation of the implants, sealing of cavities, long term mechanical stability, maintains the positioning and prevents droopiness and a long series of biological benefits.
A capsulectomy, literally entire removal of the periprosthetic capsule, should not be mistaken with capsulotomy which means cut or section of the capsule without its removal. The capsulectomy is a state of the art maneuver in breast revision surgeries, however a simple capsulotomy is not acceptable nowadays.
The capsulectomy is the mandatory maneuver in any breast implant renewal, either ruptured, leaking, corroded, degraded, worn or even if the prosthesis is intact.
The capsule formed around one given prosthesis is exclusive for its shape and dimensions and not valid for any other implant, it is unwise inserting a new implant into the capsule previously formed by another implant of different dimensions.
Furthermore there are two known biological phenomena occurring at the periprosthetic capsule over the years, which are the bacterial and fungal growth in it and the presence of micro particles of silicone within the immune cells present around the implant; needless to say these biological elements need to be eradicated from the patient's tissues before inserting a new implant.
Finally, when the implant is aged, degraded and corroded by the biological action of patient's immune system, eventually leaking silicone, the defensive features of the surrounding tissues do deposit calcium carbonate, literally like gypsum, onto the periprosthetic scar shell and around the prosthesis itself, eventually penetrating the depth of the prosthetic shell and its filler; these calcified particles need total removal for being incompatible with a smooth healing of a new implant and mainly for being a source of misdiagnosis and bias during future mammograms.
Periprosthetic capsulectomy becomes a golden standard and a routine stage in any breast revision surgery involving implant renewal for whatsoever reasons, treatment of capsular contracture, prosthetic repositioning, elective explantation, etc; such capsulectomy has to be comprehensive and total, not leaving any trace of the previously formed periprosthetic scar shell.
Failing to comply with the mandatory capsulectomy entails a certain risk of seroma, chronic lack of prosthetic adhesion, capsular contracture, infection, extrusion, rippling, folding, early implant rupture, interference with breast imaging tests like mammograms, hardness, unnatural results, etc.
It must be bore in mind the periprosthetic capsule is a neo formed tissue not belonging to the original breast tissues, it is a structure build by patient's body to host and stabilize the breast implant, playing no other functional or biological role; therefore each breast implant must give birth to a new capsule, by means of hosting the prosthesis in fresh, healthy, vascularized and safe original patient's tissues, something only feasible by means of capsulectomy.
Due to the competitiveness scenario of the markets most plastic surgery clinics and plastic surgeons feel forced to invest large sums of money into advertising and marketing campaigns; this non medical additional cost is always and necessarily charged on top of the final price paid by patients, leading thus to an overprice of surgeries and treatments. No one patient wishes to bear that financial burden embedded in the surgical costs, furthermore neither surgeons nor clinics are happy to increase their retail prices and penalize their customers with costs not bringing any kind of special medical benefit, safety enhancements or results improvement; the promotion budget aims only to disseminate the public knowledge of a services provider and raise the awareness about its presence to potential customers, but not to make the service or the product a better one.
Seems like this model is a no-way-out labyrinth from which no one can be freed, furthermore it is such a tempting, easy and hassle-free way that actually most patients and plastic surgery providers are locked into it, happily or with resignation, paying a high price due to being non collaborative; however there is an ideal alternative, based on keeping up a good hard work based on a strive for providing quality service and achieving patients' satisfaction, which necessarily requires the decided support of the clients and somehow their involvement in such virtuous business model grounded on top-notch results
When plastic surgery providers and patients do actively engage into a collaborative economy scenario a win-win basis is set for their relationship, since the clinics and surgeons obtain the best promotion ever possible with no budget for marketing investment and the patients get in return rid of any additional and unnecessary costs; such a price reduction does not represent any loss in the quality of the treatment they are receiving, furthermore this saving achieved will actually reward customers with a reinforced confidence and guarantee the service providers will strive to perform the best job possible and obtain results second to none.
It is not a paradox or contradiction; under a collaborative economy umbrella plastic surgery patients enjoy a greater plus of confidence that clinics and surgeons will do their very best and beyond to satisfy their customers, in spite the price is lower than in marketing-based non collaborative models; plastic surgery providers who found their business sustainability on the pillars of exclusively or mainly incremental budget investment in ongoing promotion campaigns do have little incentive in achieving first-class results and the best patient experiences, since their business model is not based on returning patients after word-of-mouth dissemination of their reputation but on the attraction of cold clients with sophisticated advertising methods of higher or lesser moral acceptability, attracting customers as parachutists randomly landing on unknown land, which is a perverse business model frequently leading to an unavoidable degradation of safety and results quality besides an uncontrollable increase in costs and prices; this marketing-based model creates no incentives to keep up the good work and pushes the prices higher on and on due to require increasing promotional investments.
On the other side, which is definitely our side, clinics and surgeons who rely solely or mostly their existence and survival in the competitive plastic surgery market enjoying the widespread of their excellence extended by their own patients results and satisfaction, like a mill driven by the winds of prestige, have the strongest ever incentive to be the best service providers around, sourced from the support of happy clients and their operated cases as proof of their excellent jobs; needless to say such supporters, the patients, have to enjoy a share of this benefit so that the incentive is reciprocal; under this scenario clinics and surgeons strive to provide the best service and accordingly patients release and transfer in a fair exchange the materials and tools required to build a marketing-budget-free and virtuous business model which creates the perfect incentives to build the best sponsorship-free reputation, based on the grounds of medical quality thus allowing prices control within affordability thanks to the minimal cost of its maintenance.
This is the deal; patients give in our favor the release and transfer of the intellectual property, the rights of image, the medical records and the personal data of their cases for scientific dissemination, medical teaching, public communication, commercial promotion, advertising marketing, commercial exploitation and disclosure in general, and they receive in exchange a compensating remuneration of a -20% discount from the standard price list for our treatments, as it is publicly visible by default in all the prices and quotations on our website.
As can be observed our visible prices are highly competitive if compared with other plastic surgery providers, actually the difference is approximately a -20% from the average price of each particular treatment in other clinics and surgeons from similar economical areas and countries of comparable development; this is not due to any quality or safety downgrading but to our collaborative business model; in other words, the budget which theoretically should be invested in marketing and promotion campaigns is discounted from the retail prices and, unlike other plastic surgery providers, is not wasted into pointless advertising to patients which entails no kind of added value for them; such campaigns are replaced with our superb results publicized thanks our patients support by letting us use their cases' Before & After and Intraoperative & Technical images and medical details; this explains that price gap between us and other clinics and surgeons.
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