Patients facing surgery often encounter a mandate to remove all jewelry, a requirement that can be concerning for those with established piercings. The medical necessity for removing metal jewelry is rooted in well-documented safety risks within the operating room environment. However, the use of alternative materials, such as flexible, non-metallic plastic retainers, presents a complex issue regarding procedural safety and institutional policy. This article clarifies the specific dangers posed by traditional metal jewelry and explains why even non-conductive materials may still need to be removed.
Why Metal Piercings Pose Surgical Risks
The primary reason for removing metal jewelry is the widespread use of electrosurgical units (ESUs), which use electrical current to cut tissue and seal blood vessels. Metal is an excellent electrical conductor. If the current path is diverted, metal jewelry can act as an unintended pathway for electricity, generating intense heat at the piercing site. This can lead to mild to severe burns on the surrounding tissue where the metal touches the skin.
A second concern involves the thermal properties of metal, which can retain both heat and cold. During lengthy operations, changes in body temperature or the application of warming blankets can cause metal jewelry to heat up or cool down significantly. This localized temperature change can result in tissue damage, which is often unnoticed while a patient is unconscious under general anesthesia.
Metal jewelry can also physically obstruct a procedure or interfere with diagnostic imaging. Tongue piercings present a significant risk during intubation, as the jewelry can snag the breathing tube, traumatize the tissue, or become dislodged and potentially aspirated into the lung. Furthermore, metal objects can create artifacts that obscure important structures during X-rays, CT scans, and Magnetic Resonance Imaging (MRI) studies.
Understanding Bioplast and PTFE Materials
Recognizing the desire to maintain piercing tracts, inert alternatives to metal were developed, most commonly using materials like Bioplast and Polytetrafluoroethylene (PTFE). These are medical-grade, biocompatible polymers designed for internal use, not standard acrylic plastics. These materials address the primary safety concern because they are non-conductive, meaning they cannot transmit electricity or heat.
The non-conductivity of PTFE and Bioplast effectively mitigates the risk of electrocautery burns, the major hazard posed by metallic jewelry. This property allows them to be safely worn during procedures involving ESUs. Because they are non-magnetic, they also pose no risk when exposed to the powerful magnetic fields generated by an MRI machine.
These alternatives are often used as retainers, designed to keep a piercing open without presenting a hazard. PTFE is highly flexible, which reduces the chance of trauma to the piercing site if the surrounding tissue swells. These specialized polymers are distinct from the cheaper, non-sterile acrylics found in costume jewelry.
Facility Policies and Exceptions for Plastic Jewelry
While the material properties of Bioplast and PTFE solve the conductivity issue, procedural and institutional concerns often require their removal nonetheless. The most significant exception is for piercings located in or near the airway, such as the tongue, lip, or nose. Even non-metallic retainers in these areas pose a mechanical risk of dislodgement, which could lead to aspiration or interfere with the anesthesiologist’s ability to safely intubate the patient.
The anesthesiologist has the ultimate authority regarding any jewelry near the head and neck. Their primary concern is maintaining a clear and protected airway throughout the procedure. They may require the removal of all oral and nasal jewelry, regardless of material, to eliminate any chance of obstruction. This decision is based on a safety protocol that prioritizes the patient’s breathing over the preservation of a piercing.
All types of jewelry, including plastic, can become problematic if postoperative swelling occurs. A retainer that fits comfortably before surgery can become tightly embedded in swollen tissue afterward, potentially restricting circulation or requiring emergency removal that could damage the piercing tract. Medical professionals prefer to eliminate this complication risk entirely by having all pieces removed pre-procedure.
Many hospitals and surgical centers enforce a standardized, blanket “no jewelry” policy for all patients entering the operating room. This institutional rule is implemented to prevent confusion among staff about the material type of the jewelry and to standardize safety protocols across all cases. Therefore, even if a plastic retainer is technically safe, the facility’s policy may still mandate its removal. Patients should always contact the surgical facility ahead of time to confirm the specific policy and be prepared to remove all items.