Breast implant removal at 3 months after getting implants. Do I need to have the capsule removed? My PS said no

Question

I am scheduled to get my breast implants removed but am worried he is not removing my capsule.

Robert M. Wald, Jr., MD · Answer

If you're removing your implants at 3 months, a complete and well formed capsule is not present. It takes up to a year to have a mature capsule. There is no need to remove any capsule at this time unless there was a concern.

Chet Mays, MD · Answer

Thank you for your inquiry! An Explant does not require removing the capsules (Capsulectomy) as the capsules create support and structure to your breasts. It is personal preference whether the capsules are removed unless the capsules are bad. I recommend scheduling a consultation with a Board-Certified Plastic Surgeon so we can create a surgical plan for you based on your goals!

Jose Telich, MD · Answer

Dear Independent238326 thank you for your question.

The breast capsule typically fully develops around six weeks after implant placement. Initially, it is very thin, and removing it too early may cause harm to the surrounding tissue or increase the risk of bleeding. Therefore, surgeons often wait until the capsule has matured before considering removal.

Daniel Barrett, MD · Answer

Dear Independent238326,
in case your capsules are thin, then there is no need for removal. It is unlikely that capsules are thick only 3 months after surgery. 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

Shaher W. Khan, MD · Answer

Hello, thank you for your question. It is understandable to be concerned about whether or not the capsule should be removed during your breast implant removal surgery, especially if you have recently had your implants placed. Please watch the attached video that answers your question in detail. If your surgeon has recommended not removing the capsule and you're feeling unsure, it is a good idea to ask for more clarification on why they have made this recommendation. Ask about the risks and benefits of leaving the capsule in versus removing it and/or consider a second opinion. If you feel uncertain or uneasy, it is worth discussing your concerns in more detail with your surgeon or seeking a second opinion. Ultimately, the decision about capsule removal should be based on both medical necessity and your personal preferences.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Dallas Buchanan, MD · Answer

Thank you for your questions. The honest answer is "it depends." If your breasts are soft, there are no concerns for capsular contracture or any problems with the capsules themselves, then there is not a clinical indication to remove the capsules as this procedure carries with it extra time, risk, recovery, etc. that you may not need/want. If you have concerns about BII, then you may have some unanswered questions about the capsule and it's relation to your concerns. To be honest, nobody really knows the definitive answer there. Many in the BII community with assert that the capsule is associated with the diagnosis and the road to recovery and while I can understand the conclusion there, the early studies that have come out about capsulectomy and symptom recovery do not support this. One good study in particular actually showed that patients had improvement in symptoms regardless of type of capsulectomy (none, partial, full, en bloc, etc.) and that the type of capsulectomy had no association with the degree of symptom improvement. I would discuss your concern with your surgeon. Rely on his or her expertise to guide you. There is a reason you chose them, trust in your choice.
Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Ramiro Morales, Jr., MD · Answer

Thank you for your question.  In most circumstances, at 3 months, the capsule is still extremely thin and almost invisible.  Therefore, attempting to remove it would likely cause some damage and possible removal of native breast tissue while attempting to remove it.  The exception would be if you for some reason have already formed at significant capsular contracture and the capsule is thick, then it would be reasonable, although not necessary, to attempt removal.

Benjamin J. Cousins, MD · Answer

Thank you for your post. The scar or capsule that forms around implant generally should be removed as much as possible and depends on individual circumstances. The amount of original breast tissue removed with ex-plantation, and removal of capsules should be minimal as well. If a large amount of this thick scar capsule is left behind from implant removal (as I have seen from other patients referred to me) a seroma forms in the old breast implant pocket. After three months, the amount of capsule/scar should be pretty minimal and thin so extensive removal of this would likely do more harm than good (bleeding, muscle injury, pain) Hope this helps. Be sure to see a Board Certified Plastic Surgeon. 
Dr. Benjamin J. Cousins MD Board Certified Plastic Surgeon Miami/Miami Beach, FL

Syed M. Sayeed, MD · Answer

Hi the answer depends on a few things.
First why are you having the implants removed?
Two do you have a capsular contracture?
If you have a thickened capsule or a capsular contracture a capsulectomy may be indicated.3 months after a breast augmentation if there is no capsular contracture the capsule (Everyone gets at least a thin capsule) there may be a thin layer of tissue forming a capsule which is very difficult if not impossible to fully remove especially the layer on the ribs. In this scenario your surgeon may perform maneuvers to let the capsule stick together as opposed to remove it. 
Looking forward to your clarification.

Breast implant removal at 3 months after getting implants. Do I need to have the capsule removed? My PS said no

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