Is it possible to have the rest of the capsules removed after the fact?

Question

I’m a 43 year old woman who recently had 15 year old 350cc smooth saline implants removed after experiencing symptoms of BII for 10 years. I expressed my concerns with my surgeon prior to booking my surgery. I told her I wanted the implants and capsules removed. She said that would require surgery in OR under general anesthesia. After surgery I was told only 50% of the capsules were removed. Is it possible to have the rest of the capsules removed after the fact? I wanted it all out!

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

Shaher W. Khan, MD · Answer

Hello, yes thank you for your question! We are able to remove the remaining capsule, this is called a residual total capsulectomy. This surgery is where just the capsules that are left behind are removed from the chest, along with associated inflamed tissue, and any other foreign body material. This would also require surgery to be completed under twilight anesthesia, depending on your health history.

Ryan Rebowe, MD · Answer

The majority of the time, the portion of the capsule that is left in place is the part along the chest wall. Removal of this capsule is sometimes not possible due to its strict adherence to the intercostal muscle and the ribs. If the capsule is very adherent, it is possible to get air around the lungs or even a lung injury with the complete capsulectomy. If you are pursuing removal of further capsule, I would make sure that you are pursuing this with a board certified plastic surgeon that is performing their procedures in an accredited operating room with access to critical care facilities.

Daniel Barrett, MD · Answer

Dear jennyf1979,
it is hard to tell for sure without an examination. 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

Zoran Potparic, MD · Answer

Alhtough it may be initial intention to remove entire capsule around implant, removal of posterior part of capsule, placed over ribs and intercostal muscles, can be lenghty, dangerous and bloody procedure. If there are no absolute indications for that, like ALCL or other local malignancy, it is best to leave that portion of capsule where it is. Hope this helps.

Alan Gonzalez, MD, FACS · Answer

Hello @jennyf1979, thank you for your question. Yes, it is possible. However, I always perform this procedure under general anesthesia . Before making any decisions, it's important to discuss your expectations and what the specialist can do for you so you can have more information and this will help you determine what is the right option for you. 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)

Heather Vande Ven, DO · Answer

When breast implants are placed in the body, the body's natural response is to form a thin layer of scar tissue around them. This scar tissue is known as a capsule. In some cases, the capsule can thicken and contract, leading to a condition called capsular contracture.If you've undergone breast implant surgery and developed issues with the capsules, it is possible to have additional surgery to remove the capsules. This procedure is called capsule removal or capsulectomy. In some cases, only a partial removal of the capsules (partial capsulectomy) may be necessary, while in others, complete removal (total capsulectomy) might be recommended.It's important to note that decisions regarding capsule removal depend on various factors, including the individual's symptoms, the severity of capsular contracture, and the plastic surgeon's assessment. The procedure may be performed for medical reasons, such as to address pain, discomfort, or distortion caused by the capsules, or for cosmetic reasons.If you are considering capsule removal or have concerns about your breast implants, it is crucial to consult with a board-certified plastic surgeon. They can evaluate your specific situation, discuss your options, and recommend an appropriate course of action based on your needs and goals. Always make sure to have a thorough discussion with your plastic surgeon to understand the potential risks, benefits, and expected outcomes of any surgical procedure.

Bryan Curtis, MD · Answer

Yes, it is possible to have the rest of the breast implant capsules removed after breast implant surgery. This procedure is known as capsulectomy and involves the surgical removal of the scar tissue (capsule) that forms around breast implants. It can be done for various reasons, such as addressing complications or discomfort. However, the decision to undergo capsulectomy should be made in consultation with a skilled plastic surgeon, as it depends on individual circumstances and medical considerations.

Connie Hiers, MD, FACS · Answer

If your capsules were thin, they may have been too difficult to remove without damaging your chest wall.  
I am sure she did what she thought was safest for you. Plus, I have seen thin capsules on saline implants absorb over time and not be present. Please discuss this with your surgeon.

Leland Webb, MD · Answer

At this phase, returning to the operating room to attempt to remove any remaining capsule, may cause more complications than benefit. It is important to understand that, although often there is an effort to remove all of the capsule, some of the capsule is so densely adherent to the chest, wall that removal presents itself as more risk to the patient than benefit. Remember too, that a capsule is simply your body‘s natural scar tissue, and that this will often dissolve, remodel, or soften or even not be present upon return to the operating room. I do hope that you are feeling better after removal of your implants, however, I do not think that it would be a standard to return to the operating room to attempt to remove any remaining capsule that may or may not be present.We would love to talk to you more about this. -Webb Plastic Surgery