Implant explant capsule removal/leave

Question

Is it common practice to leave capsules when removing implants? My research has been inconclusive. Some say it’s paramount to demand removal and some say it’s okay to leave in place.

Alan Gonzalez, MD, FACS · Answer

Hello @Optimistic166510, thank you for your question. Yes, removing the capsules is key.  I believe that every time an explant is performed, the capsule must be removed. Complete capsulectomy. Whether it is en bloc does not matter as long as the whole capsule is removed and the tissue is sent for pathology after taking the capsule out. This will prevent future inflammatory responses from the body because capsules do not get reabsorbed. Here is a video that sheds more light on the topic.  Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),   International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Daniel Barrett, MD · Answer

Dear Optimistic166510,
generally speaking, if you have capsular contracture or thick capsules, then they should be removed. Thin capsules can be left inside the breast. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Shaher W. Khan, MD · Answer

Thank you for asking. En bloc or 100% total capsulectomy is recommended. The capsule is which contains all of the gel bleed or silicone toxicity. Capsules should always be removed.

Azita Madjidi, MD, MS, FACS · Answer

Capsulectomy is not done for each case. It can create more harm than good in most cases. Your surgeon has to have a good reason to do it such as a mass, or old silicone implant rupture, calcified capsule etc. Otherwise it is not harmful to leave it in.

Daniel Butz, MD · Answer

If the capsule is thin and not contracted it's absolutely okay to leave it in place. A lot of the emphasis for "en bloc" capsulectomy come from breast implant illness pages. There isn't any conclusive scientific data to support this and it can have more risk involved and tissue removal - resulting in more volume loss and deformities. There was a recent consensus statement put out on the terminology and need for en bloc capsulectomy - it's really only indicated when there is a cancer involved - which is extremely rare. 
My logic is that the capsule is scar tissue and once the is removed it shrivels up and contracts quite a bit. Never goes away completely though. If we removed your body creates more scar tissue there. So you'll never not have any scar tissue related to the implant. Capsulectomy requires drains, is more painful and has higher risk of seromas after surgery. A simple implant removal can often be done under local anesthesia with a quick and easy recovery. Discuss the pros and cons with your surgeon and make sure you're doing what's necessary, not what blogs suggest.

Stefan Mark Szczerba, MD · Answer

My personal opinion is that this decision should be done case by case. If the the capsule is firm, contracted or calcified then yes take the capsule. If the implant was textured, take as much of the capsule that is safe and reasonable. If the implant was under the muscle, take as much capsule that is safe and reasonable. If the capsule is soft and normal, then leave the capsule and the body will absorb it. Be wary of the surgeon that recommends aggressive surgery when you don't need it- the science doesn't seem to support that approach. Best Wishes!!

Carl de los Reyes, MD · Answer

FDA recently came out with a concensus statement. Removal of entire capsule and rim of normal tissue is only necessary for patients with an established or suspected breast implant-associated cancer after appropriate medical workup. This may cause a large deformity and more time consuming and expensive procedure. There are various alternatives depending on type of implant and whether there is rupture of the implant if there is no cancer.

Camille Cash, MD · Answer

If the capsule is thickened, causing issues, or if there is a rupture to a silicone implant it is generally recommended to remove the capsule at the time of explant.  If the capsule is thin and not causing problems it is an option to remove it or leave it behind.  Your board certified plastic surgeon will help you decided what is best in your situation.

Connie Hiers, MD, FACS · Answer

Leaving a smooth, thin capsules is usually not a problem, except for the increased risk of developing a seroma of fluid collection. Sometimes it is more risk to try and remove the posterior capsule with thin capsules. Thick or calcified capsules should be removed for comfort and better mammography. Capsules of ruptured old gel implants will also need to be removed to try and remove all the gel.

Mats Hagstrom, MD (license on probation) · Answer

There’s no yes or no answer to your question.
There are subjective differences in opinion among different plastic surgeons, and it also depends massively on how much of a capsule has developed.
Very thin capsules can be left alone and will cause more damage in an attempt to remove them.
Thick capsular contractions should almost always be removed.
Best,
Mats Hagstrom MD

Implant explant capsule removal/leave

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