Lydia's XL Diary

<From Dr. Baeke.  This young lady embarked on getting very large breast implants, going to another plastic surgeon.  Complications happened.  Eventually, she came to me for help and fortunately we were able to turn a bad experience into a good experience.  Many women want very large breast implants; and I respect that.  Before beginning that journey, read Lydia's diary to better understand the risks.>

When I first began my journey with XL implants, I didn’t know how big I wanted to go. I knew I wanted my breasts quite large; at least 2000cc by rough estimation. The problem was that XL implants are uncommon, so it was difficult to find a surgeon that does them, let alone well. I found one who seemed well-known for XL implants. I had thought I had done my due diligence. All the reviews I could find told positive stories. He told me that the safest and best way to reach large sizes is with conventional 800cc silicone shells. To achieve this, he had to overfill the 800cc shells. With those implants, I went from 0cc to 1000cc, 2025cc, 3025cc, and then 4050cc in under a year-and-a-half. Each size increase happened approximately every 3 months.

I’d never had surgery of any kind before getting breast implants. Lacking surgical experience, I thought my body tolerated the recovery from surgery well. I experienced swelling and considerable bruising. Sometimes leakage of serous fluid through the surgical incisions. With every increase in size, the swelling would worsen before resolving. My surgeon at the time assured me that all these things were completely normal. When I went to 3025cc and 4050cc, he placed surgical drains. He said they would help reduce swelling.

Lydia's XL Diary

After the surgery to 4050cc, the swelling was in my right breast was worse than ever before. It was at least 50% larger than the left breast. Serous fluid leaked from the incision. In addition to dissolvable stitches, my previous surgeon had used surgical glue on my incisions. Some of the surgical glue had seeped deeper into the incision. As expected, the surgical glue fell off after a week. When it did, so did the glue deeper in the incision. This left a small hole where most of the fluid leaked from. The small hole scabbed over. The swelling in my right breast continued to linger much longer than any prior time. My surgeon advised a “wait and see” course of action. Absent of fever, redness, or purulent drainage, it didn’t seem like I had an infection. I didn’t know that delayed wound healing is itself a sign of poor healing and higher infection risk.

Two and a half months after surgery, there was still a scab along the scar on the right breast. It would shed from time to time, weeping small amounts of serous fluid. The scab itself never got smaller. The right breast did not relax and settle into place the way the left one did. Nothing changed from the initial concern I had at about 1 month. My previous surgeon continued to recommend we wait, watch and see.

At 2¾ months, the scab began getting bigger. Serous fluid would more regularly drain in increasing amounts. Still no fever, nausea, or redness. The wait and see approach continued as the scab increased in size with each near-daily natural shed. It still seemed like a normal scab to me. My previous surgeon wasn’t worried: I thought this was a normal part of the healing process. I didn’t think I needed to inform my primary care practitioner or get a second opinion because I trusted my previous surgeon.

Around 3 months after surgery, I had a shower. When I got out, the scab fell and revealed a hole in the tissue. Whenever the scab shed in the past, there seemed to be a thin layer of pink, fresh looking skin beneath it. This time, there was a dark purple hole. The implant was now exposed and visible. Within a few hours, the hole rapidly degenerated. The hole was now over an inch in diameter. I wasn’t aware this was a potential outcome from a non-healing scab. My skin kept sloughing away, leaving more implant exposed in its place. During this time, I was in contact with my previous surgeon. Initially, he told me that exposed implants happen sometimes, and I needed to get it fixed ASAP by him or by a local surgeon. The plan was to immediately replace the implant and close the hole. I felt I’d rather have him fix it, as he was familiar with my case. I didn’t question his method or solution, believing him to be the expert. During that conversation, the implant became even more exposed. The hole multiplied in size in a few hours. Considering that, it was terrifying to picture how bad it would get if I left it for the day or two required to travel. I asked him if I could do something in the meantime to lessen further tissue damage. He said that I could pop the implant myself, which I did.

A few days later, after a having an exposed implant for days, I had surgery with my previous surgeon. He flushed the pocket, placed a fresh implant, and closed the hole. After the surgery, he said that the tissue was extremely tight and looked angry. Despite this, he said nothing about a potential infection. The breast looked awful compared to how it had been before. Within a few days, the tissue began sloughing off around the incision, and the implant became exposed again. He seemed shocked by this outcome. Since he said he didn’t know what was happening, I was even more scared. I thought that my body had become unable to heal at all. I had to wait several more days for an answer, and to resolve this new hole. Before the next surgery, less than a week later, my original surgeon said he finally had an answer. During the replacement, he had taken a bacterial culture from the pocket. It showed multiple types of bacteria present. Rather than replacing, the implant needed to come out. I also needed different antibiotics than those I was already on. Though I did not become septic, this infection could have become life threatening. I had undergone an unnecessary, unsuccessful surgery.

I wish I had taken the time to learn even more about surgery before getting breast implants. As a patient, just following the aftercare instructions is not always enough. It is important to understand how the body heals, and what to watch for during recovery. This is especially true if you intend to have XL implants. XL implants place even greater strain on the body’s ability to heal. I now understand that at 4050cc, there was a significant amount of pressure on the skin, and any holes or incisions in it. This is one reason that the scab that was there for months was unlikely to heal. 

Also, this situation shows the importance of having a surgeon you can trust. I should have at least gotten the opinion of a local plastic surgeon regarding the section that kept scabbing over. If I had, I may not have lost as much tissue, nor gone through an unnecessary surgery to lessen the implant size. You shouldn’t have to wonder whether you need to second-guess your surgeon. You should be able to rely on them to give you sound medical advice and work in your best interests.

My experience with infection and subsequent explant has been emotionally traumatic. A large portion of one of my areolae is now missing. However, I haven’t given up on breast implants. After doing even more research into surgeons, I found Dr. Baeke. Helping me get back to symmetry (or as close as possible), I’ve had reconstructive surgery and tissue expanders placed.

The past damage has not made reconstruction a smooth process. I rigorously followed aftercare procedures but had an allergic reaction to a surgical adhesive. Although everything was done right, something still went wrong. The surface infection cleared up quickly, but it had let bacteria break through my skin. The undamaged breast cleared it out, but the damaged one did not. It became infected, and the implant had to be removed again. After a long course of targeted antibiotics and allowing the site to heal for another six months without an implant, surgery was successful. 

I now have expanders in both breasts. The fill process is still ongoing and is progressing well. I’m adding fill to the expanders at a slow pace my body can handle. An enormous relief for me is that I don’t need further surgeries for each small size increase as I work back toward my goal. Everyone heals in different ways. For me, recovering from surgery with Dr. Baeke was much easier than my previous surgeon. I bruise easily. After previous surgeries, I had significant bruising and swelling all over my breasts. Somehow, I had almost no bruising or swelling after surgery with Dr. Baeke. If I could go back in time and start from the beginning with XL implants again, I would have used expanders from the start and wanted Dr. Baeke to do the surgery.

-Lydia

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