Please explain capsule and implant. I thought it was one item. That the Saline (gel, etc)in its capsule is called an implant.

I want to explant. In reading general responses (not from my questions) I have come to read implant AND capsule. I thought they were one and the same? So the liquid (saline, gel etc) in the capsule is not called an implant? Drs have been saying when you remove implant you need to remove capsule. Also what is a harmonic scalpel? If I explant is this something I need to ask PS to use for best results?

Doctor Answers 6

What is a capsule

The terminology around breast implants can be confusing. The breast implant is a bag. It is a bag with a silicone shell and contains either silicone gel or salt water.  When the augmentation is performed thebreast implant is placed into the body. The body's natural reaction is to create scar tissue. The scar tissue forms like a ball around the implant. It is generally paper thin  This ball of scar tissue is called a capsule . In my experience when implants are removed the capsule may or may not need to be removed as well. If the capsule is thin and the breasts have been soft, you can leave the capsule inside with placement of drains to help close the space. If the breasts have been hard  then the capsule should be removed as much as possible.  Generally with saline implants the capsule that forms is not as thick and does not have to be removed very often. Your best option is to seek out a board-certified plastic surgeon who is very experienced in breast augmentation surgery 

Sacramento Plastic Surgeon
4.9 out of 5 stars 110 reviews

Please explain capsule and implant. I thought it was one item. That the Saline (gel, etc)in its capsule is called an implant.

The capsule is essentially a layer of scar tissue  that forms around any foreign body,  including breast implants.  In regards to the need to remove capsules (capsulectomy) at the time of breast implant removal surgery:

In many areas of plastic surgery, including breast implant removal surgery, you will find many different (often strong) opinions as to the best way to handle a specific situation. In my practice, generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, I do not remove them. On the contrary (unless indicated), capsulectomy can expose you to additional risks, such as bleeding and some breast size loss. Your plastic surgeon, based on your physical examination, will be able to inform you whether the breast implant capsule is thickened or abnormal.


Hopefully, you have chosen your plastic surgeon carefully; do not hesitate to address your questions/concerns directly to him/her and ask about the rationale behind any decisions that you question. You may find the attached link, dedicated to breast implant removal surgery concerns, helpful to you as you learn more. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Implant, Capsule,Shell

Silicone and saline breast implants have rubberized silicone bags called "shells". Once implants are put in the body they develop a healing "capsule" made of collagen. Sometimes this capsule is thin and soft and can be left after removal of an implant. It will collapse and melt away with time. Other times the capsule is thick and scared and should be removed with the implant when the patient desires explantation. I commonly remove implants, repair the pectoral muscle, perform an internal purse string tightening of the breast (called an internal mastopexy) and then graft fat to restore fullness. Most patients also require an external mastopexy, or breast lift. With this protocol we can usually achieve a more attractive breast than before the implant was removed. Patients who want a larger breast will require a second fat grafting proceedure.

Robert D. Rehnke, MD
Saint Petersburg Plastic Surgeon
3.6 out of 5 stars 9 reviews

Capsule is the scar that surrounds the implant

The capsule is a scar that surrounds the implant.  The implant has a shell not a capsule. The capsule needs to be removed in addition to the implant.  A harmonic scalpel is a tool.  You don't tell the mechanic what tools to use to fix your car, you shouldn't be telling the plastic surgeon what tool to use to perform your surgery.  A harmonic scalpel is absolutely unnecessary and is gimmick.  

For explant surgery, it is almost always best to remove the capsule in its entirety.  This will allow the space to heal.  If you leave the capsule in place, it does not heal.  Fluid can accumulate in the space.  The situation that brings the patient to implant removal will have an affect on the decision.  This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns.  The body does not re-absorb the capsule.  Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule.  If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower.  If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 135 reviews

Capsule and Breast Implants

The capsule is your body's response to your implants. It may contain silicone gel, silicone shell fragments, bacteria, calcification, and inflammatory cells which have been mobilized by your immune system to react to different components of the implant. Research has shown that the capsule does not disappear on its own when only the implant has been removed (See Nancy Hardt's paper in Plastic and Reconstructive Surgery.) In addition, if you have pain around the implants, it is usually due to the pulling effect of the scar on surrounding muscle and tissue. If you have health problems that could be from the presence of the implants, removal of the capsule is critical in improving your health.  Linked is my en bloc video.

Lu-Jean Feng, MD
Cleveland Plastic Surgeon
4.6 out of 5 stars 92 reviews

Implant and Capsule

Thanks for your question.  I think you are confusing the implant "shell" with the "capsule" that your body makes around the implant. The shell is the outer surface or"bag" that the silicone is contained within.  The implant itself consists of an implant shell, which is solid silicone, and the material within it, saline or silicone. The capsule is the fibrous tissue that the body forms around the implant while healing.  When explanting, both the implant and the fibrous capsule are usually removed.  It is important to remove the capsule as not doing so can increase the risk of seroma formation.  Usually a drain is left after explantation until healing to avoid fliud accumulation. A harmonic scalpel is a device that uses high frequency vibration to cut and coagulate tissue.  I do not think that their is an advantage to using this device, but some surgeons may utilize it. Best Regards.

Anthony Deboni, MD
Syracuse Plastic Surgeon
4.9 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.