Why must a thickened capsule be removed for explant?

Question

Why is it so important to remove the capsule with grade 3cc? Can it just be scored? Is it for medical or cosmetic reasons? Isn't there a risk of loosing natural breast tissue?

Nelson Castillo, MD · Answer

Thank you for sharing your question.  In most cases a thickened capsule should be removed in order to not have a continued firmness to the breast tissue and to limit the chances of a fluid collection developing, termed a seroma.  Hope this helps.

Kenneth Hughes, MD · Answer

Despite extensive research, the cause of capsular contracture remains unknown. Two main theories address the underlying cause: subclinical infection and hypertrophic scarring. Surgical removal of the scar tissue capsule is known as capsulectomy. This is the most effective method of capsule correction. The implant is either moved to a sub-muscular position or switched with another textured implant. This procedure does not eliminate the probability of the reoccurrence of capsulation but is the most effective method for limiting the recurrence.

Olga Bachilo, MD, FACS · Answer

Thank you for your photos and question. During breast implant removal most of the capsule is usually removed in order to allow complete healing and prevent fluid collection after surgery (seroma). In the setting of capsular contracture, capsule should be removed to avoid potential continued capsule thickening and further scarring. Usually only the capsule is removed without taking any breast tissue, but there can be a small volume decrease. Hope this helps to answer your question.

Gary M. Horndeski, MD · Answer

Capsules are removed at the time of surgery in the cases of calcified capsule, infection or ruptured silicone implants.  Thickening is not necessarily an indication for capsule removal.  However, taking out the capsule can do 2 things: decrease volume to the breast  and injure the blood supply or nerve supply to the remaining breast tissue.  The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear orbis,
in case of capsular contracture, implants should be removed together with capsules in order to avoid possible complications such as seroma. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Farbod Esmailian, MD · Answer

Great question.  When the scar tissue or capsule is thin it is not necessary to remove it even in an event of removing implants for immunologic reasons. The capsule is actual scar tissue the body produces, it is not any part of the implant.  In cases where the capsule is thickened, then the capsule will need to be removed at the time of explant.  If the capsule is left behind, it can lead to issues with fluid accumulation, also known as a seroma.There is always a balance in surgery between pros and cons and is it worth the risk to do any particular procedure.  In the case of a thickened capsule, it is rather easy to remove the capsule and not risk major issues.Hope that helps.

David C. Yao, MD, FACS · Answer

Thank you for asking. Significant capsular contracture tends to distort the breast shape and can be painful. It also does not always allow for proper healing internally. Seroma fluid can build up without proper drainage. Talk with your local board certified plastic surgeon who should examine you and discuss a treatment plan. Best wishes!

Donovan Rosas, MD · Answer

Capsulectomy is only warranted/indicated in a few situations:
-Capsular contracture
-Ruptured silicone implants
-Suspicion of BIA-ALCL in the setting of a textured device (late fluid collection with ALK+ and CD30+ lymphocytes present)
A thin, soft (non-calcified) capsule in the setting of an intact silicone implant does not necessitate removal. Following explantation, it will simply shrink down. However, high grade firm/calcified capsules will remain so if not removed. In the absence of the implant this remain palpable and may be a source of discomfort.
As always,discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Verified Member
RealSelf Top 100
RealSelf Hall of Fame

Tracy Kayan, MD · Answer

There are no hard and fast rules as to when a capsule should be removed, but generally if it's grade 3 or 4, it may still be palpable if it's not removed especially if it is severely calcified. If your surgeon elects to leave the capsule in place, it may fill with fluid (seroma) if the surface is not scored. The only instance in which it may be advisable to remove the capsule regardless of grade is if you have a recalled textured implant. Typically, with a surgeon experienced in total capsulectomies, a very minimal amount of actual breast tissue is removed, and only the actual capsule, which is comprised of scar tissue (not breast tissue) is taken out.

Jeanette Padgett, MD, FACS · Answer

A thickened capsule from a grade III encapsulation is best removed.  If the thickened capsule is left after implant removal, the capsule left behind may leave a visual deformity or palpable mass.  The retained capsule may increase the likelihood of fluid buildup-seroma.  Very little breast tissue if any will be removed with removal of the capsule.  Hope this helps. Best wishes.

Why must a thickened capsule be removed for explant?

Answers (13)

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