Can the surgeon tell how thick is your capsule is by examining your breast?

Question

Been having gel implant for 6 years and I really want to have an explant now. I’m having no symptoms of capsule contraction though. I wonder if by examining the breast, can the surgeon tell if the capsule is actually thin or thick and should I know in advance that en bloc can be performed on me at the time of explantation? Thank you!

Yannis Alexandrides, MD, FACS · Answer

It's very difficult to say how thick the capsule is by examining the breast especially if the breasts are not very thin. However, the surgeon could have an idea of what stage your capsular contraction is e.g. stage 1, 2, 3, or 4.

Kenneth Hughes, MD · Answer

The manner in which a capsule, the lining that forms around the each breast implant, differs from one breast to the other.  Capsular contracture occurs when that lining hardens and creates too much scar tissue.  The capsules begin to form soon after surgery.  Despite extensive research, the cause of capsular contracture remains unknown and only occurs 3% of the time or so.
Capsular contracture can occur in even the most careful board certified plastic surgeon's practice.  The most important thing in this consideration is to find a board certified plastic surgeon who does hundreds of breast augmentations and revisions and who is very sophisticated in the approach to treating capsular contracture SHOULD it occur.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Larry Weinstein, MD · Answer

An experienced board certified plastic surgeon should be able to determine weather there is a significant capsule or not. An MRI can tell the exact thickness and with 97% accuracy determine if the implants are ruptured. Smooth implants tend to have thinner barely discernible clear capsules. If ruptured or textured the capsule can be calcified and or thicker. We do not recommend removal of normal clear capsules. However any abnormal tissue around the implant or if ruptured it is usual to remove the capsule and implant in one piece. Good luck...

Daniel Barrett, MD · Answer

Dear michelleminhdo,physical examination can't reveal the thickness of capsule. 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

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  In most instances a thickened or calcified capsule can be identified through a physical exam to be able to offer you the best implant removal procedure.  Be sure to see a series of ASPS board certified plastic surgeons in consultation so that you can make the best decision for your desired results.

Camille Cash, MD · Answer

The surgeon will be able to determine to some degree if the capsule feels thickened.  If it is thickened typically it is recommended to remove the capsules when removing the implants.  If the capsule is thin and not causing issues it is up to patient preference if the capsules are removed or left behind.

Tom J. Pousti, MD · Answer

Yes, a well experienced plastic surgeon can tell (by physical examination) whether or not the capsule around the breast implant is thin (normal) or thickened.   This physical examination should also allow for your plastic surgeon to determine whether or not en bloc removal of breast implants is likely to be successful or not. Best wishes.

Christine Blaine, MD, FACS · Answer

Hi and thank you for your question.  While a physical exam cannot speak to the exact state (thickness) of your breast capsule, it can provide a pretty good idea as to its severity.  I would recommend seeking a consultation with an experienced Board Certified Plastic Surgeon for an evaluation and to review your concerns in person.

Natan Yaker, MD · Answer

Thank you so much michelleminhdo for you question! A physical examination can give an indicator of the condition of your capsule.  Your surgeon will need to access more thoroughly intra-operativley. Be sure that ypur operating physician is a Board Certified Plastic Surgeon. We wish you the best.

Scott R. Brundage, MD · Answer

While an examination cannot predict the exact thickness of a capsule it can give you some idea. When an examination shows that the breast is very firm and appears distorted, more than likely the capsule will be thickened to the degree something will need to be done to it (capsulotomy or capsulectomy). This is considered a grade 3 capsule. If you are having pain then it will be a grade 4. A normal, perfectly soft breast is a grade 1 and if it feels a bit firm, but looks ok, it is a grade 2. Usually only grade 3 and 4 will need surgical intervention. A thin capsule does not need to be removed.

Can the surgeon tell how thick is your capsule is by examining your breast?

Answers (12)

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