I have had silicone implants under the muscle for 5yrs and have developed capsular contracture in one and now want to explant (may reimplant at a later date). Is it necesssary to do a complete capsulectomy? If I leave the scar tissue in, what are the risks if any?
Is Capsulectomy Necessary for Capsular Contracture when Getting an Explant?
Doctor Answers (9)
Breast explantation and removing breast capsules...
A "complete" capsulectomy is usually NOT necessary when performing explantation!
When a patient with a periprosthetic capsule is undergoing removal of her implants (explantation), the treatment of the capsule depends upon several factors:
- The thickness of the capsule tissue
- Whether the capsule has developed calcium deposits (only very long standing capsules)
- Interior condition of capsule (infection, loose silicone or, simply, the old implant)
- Location of the capsule (in front of or behind the muscle)
- Degree of adherence between capsule and the adjacent breast tissue, muscle and ribs
In my experience with capsule management during explantation, it's almost always preferable to perform just a partial capsulectomy. Portions of the capsule typically allowed to remain are those which are firmly adherent to the muscle and ribs. Permitting them to remain is generally considered to be entirely safe. Attempted removal of those capsule segments unquestionably creates more bleeding and post-op pain, and, at an extreme, can risk inadvertent lung deflation (pneumothorax).
The surgeon should always be given the option to handle the capsule, during surgery, in whatever manner he believes to be in the patient's best interest.
Capsulectomy with implant removal?
It is probably in your best interest to have the capsule removed to avoid problems such as firmness and irregularity. These problems may confuse self breast exam (for cancer detection). Furthermore, calcification in the capsule may confuse mammography use for breast cancer screening.
It is important during this process of removal of the capsule to avoid excision of normal breast or subcutaneous tissues
I hope this helps.
Capsulectomy following explantation.
The main reason for removing the capsule following explantation is to prevent the occurrence of a seroma, or fluid collection. The entire capsule does not need to be removed, usually just the anterior surface. That being said, a total capsulectomy is not terribly difficult to perform, particularly for subglandular (on top of the muscle) capsules.
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When a patient develops capsular contracture, it is a common assumption that it is the implant that is hard. In reality, it is the scar tissue/capsule around the implant that is causing the problem. To fix the problem, the capsule needs to be removed.
Reason for Capsulectomy at Explantation Surgery
Breast Capsule Removal (Capsulectomy) Guidelines and Explanation
The guidelines I recommend for my patients are pretty straight forward. If the capsule is very thick, calcified or otherwise 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.
The purpose of the Capsulectomy is to Remove Abnormal Internal Scar Tissue. Without doing so it will remain. A Complete capsulectomy for all practical purposes means removal of all internal scar tissue. Your body as a part of natural part of healing under ideal circumstances will make a new thin and supple capsule when the new implant is placed rather than a thick stiff one that was removed.
IS A CAPSULECTOMY NECESSARY?
If you only want to remove the implant and not replace it at the same setting, then capsulectomy is not necessary. If you want to replace the implant, then you will need either a complete or partial capsulectomy. Another approach would be to create a new pocket (neopocket) between the muscle and the scar tissue capsule. Your surgeon should discuss all your options during your consultation.
Capsule Removal for Capsular Contracture
No one has the final answer for what causes capsular contracture to harden breast implants. One of the ideas that plastic surgeons are researching is that capsules can be caused by a biofilm. A biofilm is a secretion from bacteria the live in the capsule where it is difficult for antibiotic to penetrate. If that theory is correct then leaving a capsule behind may set you up for a repeat capsule when a new implant is placed in that contaminated space. You and your surgeon may get away with an implant removal without capsulectomy but it is not as safe a choice. Best of luck .
Capsulectomy at the time of explantation
If you have a thick capsule, at least the anterior portion of your capsule should be removed. If the anterior capsule is not removed, you would feel irregularity and firmness of the capsule. Performing a total capsulectomy decreases a risk of seroma (fluid collection) formation; however, it may increase a risk for bleeding.
Capsulectomy and breast implant removal
The simple answer to your question is no, unless the capsule is demonstrably abnormal. Capsules are a layer of scar tissue and a new one will form where the old one is taken out (though not a spherical one if there is no implant). If the capsule (scar) is abnormal (thickness, abnormal growth, calcification) then it may be justified to take out some or all of the capsule. Removing the capsule when it's not abnormal adds time, expense, risk, and some unpredictability of settling to a simple implant removal. Also evaluation of the breast by mammogram after the implant is removed because of the capsule is no worse than when the implant was in.
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.