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.
Should the Capsule Be Removed During Breast Implant Removal?
Doctor Answers (18)
Capsulectomy at the time of implant removal
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.
Breast Capsule Removal (Capsulectomy) Guidelines
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.
When implants are removed, the capsule does not necessarily have to be removed.
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.
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Breast implant removal usually does not require capsule removal
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.
En Bloc means in one piece
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.
Capsule Removal with Explant Procedure
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
Breast capsule implant capsulectomy breast capsule implant revision
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
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.
Reasons to remove breast capsules...
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.
Capsulectomy during breast implant removal I
t is possible to completely remove the capsule during breast implant removal. If you are having difficulty or thickness with the capsule this technique may be recommended. However if the capsule is soft and is not affecting adjacent structures, the capsule may be left in place.
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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