Breast implant removal - capsule removal BII

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

Hello @BAquestions23, thank you for your question. It is important to completely remove the capsule, when capsule stays in the body it does not get reabsorbed and the body can show responses to the capsules in the future. Also it would be necessary to carry out a preventive biopsy on the remaining tissue of the capsule. I link to a video that will shed some more light. To obtain more information and recommendations, it is best to consult one or more board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” American Society of Plastic Surgery Member (ASPS) (IFATS), International Federation for Adipose Therapeutics and Science Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

Breast implant illness (BII) is a controversial condition, and there is currently no consensus on its causes or optimal treatment. While some patients report experiencing significant improvements in their symptoms after having their breast implants removed, the exact mechanism behind this improvement is not well understood.

Regarding the issue of capsule removal, there is currently no scientific consensus on whether total (en bloc) or partial capsule removal is necessary or beneficial for the treatment of BII. Some studies have suggested that removing the entire capsule may reduce the risk of recurrent BII symptoms, while others have found no significant difference in outcomes between total and partial capsule removal.

There are also some potential risks associated with capsule removal, including bleeding, damage to surrounding tissues, and the need for additional surgery. Some surgeons believe that leaving a thin capsule in place may be beneficial in reducing the risk of complications and promoting healing.

Ultimately, the decision to remove or leave the capsule will depend on a variety of factors, including the patient's symptoms, the condition of the implant, and the surgeon's assessment of the risks and benefits of the procedure. It is important to discuss all of these factors with your surgeon and make an informed decision based on your individual needs and circumstances.

As for textured implants specifically, there have been concerns about the association between certain types of textured implants and a rare form of cancer called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Some surgeons recommend total capsule removal in cases of BIA-ALCL, while others may recommend partial capsule removal or no removal at all depending on the individual case. Again, it is important to discuss the risks and benefits of each option with your surgeon.

Best of luck !

To my knowledge there is no scientific evidence supporting the need for en bloc capsulectomy. My experience would also mirror that.

Dear BAquestions23,
it is hard to tell for sure without an examination. Generally speaking, most surgeons will remove implants and complete capsule if the patient has capsular contracture. 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

It is impossible to give you correct answer about benefits of full capsulectomy vs. no capsulectomy, since it may take next 10-15 years to find more about it! At the time being, however, most plastic surgeons think that capsule should be removed in the case of significant thickening and calcium deposits. Thin, transclucent capsule does not have to be removed, based on out current standards. Removal of entire capsule, in particular part that is over ribs, may create significant complications like extensive bleeding, perforation of chest wall with pneumothorax, scarring and secondary breast deformity. In the case of textured implants anterior capsule should be removed and send to pathology analysis to rule out ALCL. When it comes to BII results are very different; some patients see benefits immediately after surgery but many end up with the same symptoms with or without capsule removal.? Hope this helps.

"En bloc" terminology is used for surgery in patients with cancer and is not used to just remove capsules. Most surgeons will try and remove as much capsule as possible without risking damage to your posterior wall and entering the lung or heart space. Sometimes, some of the posterior capsule must remain for safety to your posterior wall.