Should the Capsule Be Removed with the Implants?

Question

If someone wants to permanently remove their saline breast implants, does the capsule need to be removed as well? If the capsule stays in, what happens to it? Will it move to other parts of the body or does it dissolve eventually? I've heard conflicting information about it. I heard from some that it is risky to remove it and it will dissolve over time. On the other hand, I read other stories about women who get sicker from leaving it in. Which is correct, to remove the capsule or leave it in after removing the implant permanently?

Otto Joseph Placik, MD · Answer

Breast implants can certainly be removed(explantation) under local anesthesia.

	In regards to the capsule:

	
		 There is some controversy among surgeons if this should be removed and this is difficult to perform under local.
	
		Over the muscle capsules are easier to remove than under the muscle capsules
	
		 With saline implants in which there is minimal capsule, i have left in place.
	
		With saline implants that have a severe, thickened or infected capsule, I will attempt to remove all or significant portions of the capsule
	
		In instances incwhich there may be concern about pathology such as Atypcial Lymphoma, I will remove signficant portions of the capsule
	
		With intact silicone implants of relatively short term duration (,<5 years) I will leave these in place
	
		Wtih silicone implants of long term duration with thickened capsules I will attempt removal of the capsules
	
		In ruptured intracapsular silicone implants, I will attempt en bloc resection.
	
		In ruptured extracapsular silicone implants, I will attempt en bloc resection in combination with involved tissues.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jed H. Horowitz, MD, FACS · Answer

Good day! For your guidance, the removal of the capsule will enable the surgeon to remove as much silicone as reasonable without creating significant deformity. However, this operation may require a larger incision and longer surgery and recovery time. General anesthesia is usually necessary and subsequently all of the costs associated with this operation will be higher. Do not hesitate to ask your doctor if this is the right route for you and discuss realistic goals and expectations. Best of luck! #RealSelf100

Richard J. Bruneteau, MD · Answer

In the vast majority of
explantation cases, it’s not necessary to remove the capsule that surrounds the
breast implant.When these capsules are
left alone, they collapse upon themselves and the implant pocket is eventually
obliterated.In addition, capsule
removal may be associated with secondary complications such as bleeding.For this reason, removal of breast capsules
is not undertaken without specific indications.When patient’s have ruptured silicone implants, calcified
capsules, or thickened capsules with breast distortion, capsulectomy is usually
indicated.Under these circumstances,
failure to remove the capsule will result in a persistent deformity.In someone who’s not having problems with capsule
formation, simple removal of implants without capsulectomy is probably
reasonable. Under these circumstances,
it’s important to discuss this issue with your plastic surgeon.Your surgeon should be able to formulate an
appropriate treatment plan.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps!  Best wishes!

Farbod Esmailian, MD · Answer

In general the implant is removed and a drain is placed. Now if you have silicone implants are there is some possibility of rupture, I like to remove everything en bloc. Remove the capsule and the implant all at once.

	If the capsule is very thick, I also like to remove the capsule and place drains. Drains are a necessity whether the capsule is left or taken out.

	Good Luck.

Camille Cash, MD · Answer

When removing breast implants there is the option to remove the capsule or leave it behind.  If the capsule is causing issues, has become thickened, or if there is capsular contracture it is often recommended to remove it along with the implants.  If there are no issues it is an option to leave it behind.  If the capsule is thin, removing it can actually make the procedure more challenging. Visit with a board certified plastic surgeon near you to find out what is recommended in your situation.

Tom J. Pousti, MD · Answer

If the capsule is symptomatic (thickened, firm or calcified) it is in your best interest to have the capsule removed to avoid problems such as firmness and irregularity  of the breasts postoperatively. These problems may confuse self breast exam (for cancer detection). Furthermore, calcification in the capsule may confuse mammography use for breast cancer screening. Of course, it is important during this process of removal of the capsule to avoid excision of normal breast or subcutaneous tissues.

	If the capsule is soft and asymptomatic then excision is unnecessary.

	Best wishes.

Steven Wallach, MD · Answer

Most capsules that are soft around the implants do not need to be removed.  They will often just resorb over time.

Fredrick A. Valauri, MD · Answer

No, most breast implant capsules do not need to be excised following breast implant removal because they will be absorbed by your body.

	If your are doing having a breast implant exchange, particularly if a larger implant is being placed, and the same pocket is being used then sometimes a cutting of  the breast implant capsule  to release it might be done.