Should the Capsule Be Removed During Breast Implant Removal?

I have only had my implants for 2 years. Silicone, places under muscle. I have had no trouble but would like them out. I am wondering if the capsule should be removed? I don't quite understand this process. En bloc? Thank you for your help.

Doctor Answers (19)

Capsulectomy at the time of implant removal

+2

If the capsule is removed it increases the risk of bleeding.  If a silicone gel implant has ruptured then removal of the capsule would be recommended otherwise I would leave it alone unless it was calcified.  If there is distortion of the breast after implant removal may also be a reason to remove the capsule.  

Atlanta Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast Capsule Removal (Capsulectomy) Guidelines

+2

The guidelines I recommend for my patients are pretty straight forward. If the capsule is very think and distorts the breast or is calcified it needs to be removed. The same for any ruptured silicone implants as it gives you the opportunity to remove traces of free silicone. On the other hand, if there is no rupture of a silicone implant, or a saline implant (ruptured or not) and the capsule has normal thinness I leave it alone. These guidelines have served me well over the past few decades.

Orange County Plastic Surgeon
5.0 out of 5 stars 31 reviews

When implants are removed, the capsule does not necessarily have to be removed.

+2

Most of the time with explantation, the capsule need not be removed with the implant.  If a silicone gel implant has failed and the capsule has taken up some of the silicone, I will remove it.  It is generally thick and calcified which is no a health risk to the patient but could create some aesthetic problems.  If the capsule is thin and normal in appearance, it will generally resorb once the implant is removed.

Web reference: http://www.zubowicz.com/subpag,13-atlanta-breast-augmentation.htm

Atlanta Plastic Surgeon
4.5 out of 5 stars 6 reviews

Breast implant removal usually does not require capsule removal

+2

As tempting as it is to perform capsule removal (capsulectomy) with implant removal, it is not routinely necessary. A surgical drain should be placed to provide negative pressure (a vacuum seal) and to remove any residual fluid. In the absence of a breast implant, most capsules will gradually shrink in volume, though they will never go away completely.

The difficulty with routine capsulectomy is that it adds time, expense, and significantly more pain without any tangible benefit.

When is a capsulectomy advisable (in conjunction with implant removal)?

1. When implants are being moved from a subglandular (above muscle) plane to a submuscular (below muscle) plane. If the subglandular capsule is left intact, it will interfere with implant expansion and make the implants feel hard.

2. When there is an extracapsular rupture of a silicone gel implant. This means that the silicone gel has penetrated through the implant capsule into the surrounding breast tissue. At least a partial capsulectomy should be considered to "clean out" the silicone gel.

Dallas Plastic Surgeon
5.0 out of 5 stars 7 reviews

En Bloc means in one piece

+2

Hello,

I usually have the capsule removed in part (at least) depending upon how firm and thick it is. They tend to be thicker with old silicone gel implants, but of course this varies. With really old implants, I remove most if not all of it.

In this case, "En Bloc" means to remove an implant and its scar capsule in one piece.

Orange Plastic Surgeon
5.0 out of 5 stars 22 reviews

Should the Capsule Be Removed During Breast Implant Removal?

+1
Generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, there is no indication to have them removed.  On the contrary, capsulectomy can expose you to additional risks, such as bleeding and some breast size loss.
Having said that, I often remove a small segment of capsule tissue when removing breast implants ( even when not encapsulated) with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.
What your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.
Patience is definitely indicated after removal of breast implants; it will take many months for the skin to “bounce back” and for you to see the final appearance of the breasts.  
I hope this, and the attached link, helps.

Web reference: http://www.poustiplasticsurgery.com/Procedures/breast-implant-removal.htm

San Diego Plastic Surgeon
5.0 out of 5 stars 626 reviews

Capsule Removal with Explant Procedure

+1

If there is thick capsule/capsular contracture, infection, or implant rupture; then the capsule should be removed.  

Otherwise, I will only cauterize the capsule to help promote adherence after the implant is removed.  I also recommend drain placement after implant removal to minimize fluid collections, which can be a future source of infection or scar tissue.

I wish you a safe recovery.

Web reference: http://www.drpaulgill.com

Houston Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast capsule implant capsulectomy breast capsule implant revision

+1

Hi Littleagain,

I would remove the breast capsule. I would just remove the anterior portion of the capsule. I would leave the back wall of the capsule in place. Removing the back wall of the breast implant capsule, increases chances of complications. It increases the risk of bleeding and getting into the lungs.  I also believe by removing part of the anterior breast capsule, your healing and recovery will be faster.  A surgical drain should be placed.  The part that is removed would look like a half of a grapefruit. As you can see by other plastic surgeons answers,  there is a wide variety of opinions regarding what should be done.  Good luck with your surgery.  

Web reference: http://www.breastcapsulectomy.com

Los Angeles Plastic Surgeon
5.0 out of 5 stars 23 reviews

Capsule removal

+1

Not all capsules have to be removed with implants.  If the gel has leaked then I usually try to remove it with the capsule intact.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

Reasons to remove breast capsules...

+1

When I am performing revisional breast implant surgery, there are usually two reasons to remove the breast capsule. The first is if the capsule appears to be thick, calcified or abnormal. The second is in order to close down the space following removal of an implant. Although the capsule does not necessarily need to be removed completely, doing so will help close down the space and prevent fluid from accummulating.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 15 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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