I am planning on removal of my implants. Should the capsule be removed?

Question

I am planning on removal of my implants. I had consultation with surgeon who said no need for capsulectomy. The breast seemed soft upon physical exam by surgeon. However, I do feel that I may have BII (brain fog, muscle aches, fatigue). Will leaving the Capsule behind hinder my recovery?

Alan Gonzalez, MD, FACS · Answer

Hello @Diligent99194, thank you for your question. . I believe that every time an explant is performed, the capsule must be removed. Complete capsulectomy. Whether it is en bloc does not matter as long as the whole capsule is removed and the tissue is sent for pathology after taking the capsule out. This will prevent future inflammatory responses from the body and hinder your recovery. To shed more light, I share a video. If you are considering a breast explantation, consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

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

Ryan Rebowe, MD · Answer

Leaving a non-pathologic capsule in place should not hinder your recovery. En bloc or other types of capsulectomy are not necessarily a normal part of an implant removal procedure as they can cause bleeding, pneumothorax, and other significant complications compared to a routine explant procedure. However, if leaving the capsule will cause you stress over the symptoms of breast implant illness, then this is something that I would speak with your surgeon about and ensure that this is something they are comfortable with. The procedure with capsulectomy may have additional cost associated with it since it is more work and more anesthesia time. Furthermore, I would make sure that you are utilizing a board certified plastic surgeon and an accredited operating room due to the increased risks.

Daniel Barrett, MD · Answer

Dear Diligent99194,
it is hard to tell for sure without an examination. 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

Yes, absolutely the whole purpose of explant surgery is to remove the whole capsule and all inflamed tissue. Leaving behind the capsule will leave behind silicone toxicity and recovery from BII will not be complete if done otherwise.

Zoran Potparic, MD · Answer

Unless capsule is thick and clinically looks questionable (ALCL), removal of the capsule is not necessery; capsulectomy may be very complex and bloody procedure. That should be discussed with your surgeon ahead of surgery. Good luck.

Jon S. Wilensky, MD · Answer

In some cases, surgeons may recommend removing the capsule (total capsulectomy) along with the implants. This decision depends on factors like the condition of the capsule, potential complications, and your overall health. It’s crucial to consult with a skilled surgeon who can provide guidance based on your specific situation.

Shana Kalaria, MD · Answer

This is a great question! Leaving the capsule behind will not hinder your recovery. As a matter of fact, removing the capsule when not indicated can be unnecessarily risky. I would only recommend partial capsulectomy with implant rupture, capsular contracture, concern for cancer, or BIA-ALCL. Be sure to visit with a board-certified plastic surgeon. Good luck!

Camille Cash, MD · Answer

It is recommended to remove the capsule along with the implant if it is thickened, if there is implant rupture, or if there are other concerns.  If you are experiencing BII symptoms you may want to consider having the capsule removed as well.  I have included a video on BII and implant removal that I hope you find helpful.

Peter Andolina, DO · Answer

In some patients capsules may not be completely formed or thick enough to formally remove. Also the placement of the implant dictates whether a complete capsulectomy can be performed. In some cases, just removing the implants may be enough. As long as the implants are intact and not too thick, I think you can get away with just removing your implants without causing any healing or recovery issues