Should the Capsule Be Removed with the Implants?
- Asked by worried and nervous in PA
- 4 years ago
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?
Managment of the capsule with breast implant removal (explantation)
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.
Partial removal of capsule or total removal
It is a normal process to form a capsule around breast implants. Most surgeons will remove a portion or totally remove the capsule at the time of implant exchange. Total capsule removal can be a messy operation with prolonged drainage. I try to avoid this if possible reserving total capsulectomy for cases where other options do not exist. Implants can be placed in a different position with a fresh pocket created allowing the surgeon to avoid some capsule removal. Choose a surgeon that performs this frequently. I always say look for some gray hair, but not too much.
Capsulectomy with implant removal?
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.
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Do breast Implant Capsules need to be Excised?
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.
Capsule of implants
Most capsules that are soft around the implants do not need to be removed. They will often just resorb over time.
Everyone is right!
Capsules left in can be nothing or they can fill with fluid and create a bulge.
Ideally, some or all of the capsule should be removed and then the pocket sutured closed. I prefer to lift the breast tissue at the same time, by suture the anterior pocket a little highr than befor removal.
Capsulectomy during breast implant removal
It 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.
At least part of capsule should be removed
Saline implants do not tend to produce firm capsules, but the pocket wil heal in better of at least a part of it is removed. If you have ever had silicone gel implants, the scarring will likely be worse and a more complete removal may be helpful.
Treatment of the capsule in explantation
The considerations for removing implants are to streamline a woman's life (ie eliminate the maintenance concerns) and optimize the appearance of her breasts. Assuming that your nipples are at or above the inframammary fold (where the breast meets the chest wall) and your skin brassiere is elastic, there is a chance that your eventual result will be acceptable, even if somewhat deflated.
My approach is as follows: a) for low grade capsules (Baker I & 2); capsulotomy, drain placement, antibiotics, compression and limited activity for 4 weeks; b) for high grade capsules (Baker 3&4) open dome capsulectomy (subtotal release), drains, antibiotics, compresssion and limited activity for 4 weeks. My rationale is to ensure that the prior space collapses down consistently.
Capsule and removal of breast implants
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.
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.