Is it necessary to remove the capsule during explant?

I have had gummy bear 220CC silicon implants for 3 years. I was previously a b cup. I am going to explant. Is it necessary to remove the tissue capsule surrounding the implants. Will the capsule be hardened and toxic?

Doctor Answers 9

Explantation without capsulectomy

The capsule is not toxic, it is human scar tissue.  It is not absolutely necessary to remove the capsules.

Is it necessary to remove the capsule during explant?

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Capsule Can Be Left in Many Cases after Implant removal

In most cases after just 3 years the capsule does not have to be removed unless there is a problem with it (e.g. calcified). Your plastic surgeon will give you specific advice.

Removing the capsule during explantation

The capsule is not always removed. Your surgeon will need to utilize his or her expertise to determine if the capsule should be removed based on if there is thickening or calcification.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 36 reviews

Is it necessary to remove the capsule during explant?

It is only necessary to remove the capsule if there is thickening or calcification.
A capsulotomy, scarring of the capsule, should be performed in order to allow the capsule to re drape and re adhere

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.9 out of 5 stars 12 reviews

Does capsule need removing in explantation?

The breast capsule is simply biologic scar.  If not infiltrated with silicon gel due to a previous implant rupture, it can generally be left during a simple explantation.

This makes the explantation procedure very simple and has minimal or no pain post op, which is great news.

It is important if the capsule is left in place that you wear a firm compression bra for about a month post op, day and night.  The space where the implant used to be might otherwise fill with fluid, called a seroma, and as it absorbs might create some distortion to the breast shape. Moulding your breast shape and position using compression garments is I think an important thing to do after explantation, for as I say, about four weeks.

If we go back in on patients who have been explanted years later, there is often little visible sign that there has ever been a capsule there. Your body has just removed it as it would soften and fade any long standing scar.

All the very best.

The breast capsule is made of your own tissue and it does not need removal

The breast capsule is made of your own tissue and it does not need removal.  Over time it will get resorbed by your body.  If it can be removed easily, than your surgeon may opt to remove it, but if removing a capsule means more extensive surgery, then the benefit does not outweigh the cost of the additional surgery (additional dissection, potential bleeding, a need for a larger scar etc)

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 415 reviews

Is it necessary to remove a capsule during implant removal?

You did not specifiy why you are having the implants removed. If you are removing an intact breast implant and the capsule is soft, there is no real reason to remove a capsule.  However, if the capsule is calcified or so thick that it deforms the breast tissue then that may be a reason for removal. If the implant is ruptured that ma be another reason to remove some or all of the capsule. Your plastic surgeon will be able to guide you ahead of time.  

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 29 reviews

Is it necessary to remove the capsule during explant?

Generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, there is no indication to have them removed. On the contrary, capsulectomy can expose you to additional risks, such as bleeding and some breast size loss.

Having said that, I often remove a small segment of capsule tissue when removing breast implants with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.

What your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).

Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.

Patience is definitely indicated after removal of breast implants; it will take many months for the skin to “bounce back” and for you to see the final appearance of the breasts.  In the meantime, I would suggest that you continue to follow-up with your plastic surgeon on a frequent basis;  he/she will be in the best position to rule out and treat complications such as fluid accumulation,  and will be in the best position to provide you with meaningful reassurance.

I hope this, and the attached link (dedicated to breast implant removal surgery), helps.

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.