What happens when implants & capsules are removed from behind pectoral muscle ?

When breast implants are removed along with the capsule in a subpectoral breast implant, some of the muscle fibers of the pectoral muscle are also removed. If you are requiring a new implant, the preferred method is to create a neosubpectoral pocket (a new pocket still under the muscle) to prevent the incidence of capsular contracture occurring again. If you have capsular contracture or feel you are in need of an implant removal/exchange, consult in person with an experienced plastic surgeon for a thorough exam.Best wishes,Dr.Bruno

When breast implants and capsules are removed from behind the pectoral muscle, the surgeon typically makes an incision, carefully removes the implant and surrounding scar tissue (capsule), and then assesses the condition of the surrounding tissues. The pectoral muscle may need to be adjusted or repositioned during the procedure. After removal, the surgeon may discuss recommendations on whether to replace the implants, adjust their size, or leave the breasts without implants. Together you two can make the decision on any other procedures. The specific details can vary based on individual cases and the surgeon’s recommendations. It’s important to consult with a skilled plastic surgeon for information and guidance.

Thank you for your question. When the implants are removed, there is a capsule or layer of scar tissue around the implant. This does not necessarily have to be removed, but should be if the capsule is irregular, painful, distorting the breast shape, is symptomatic or thickened. Removing very thin capsules may cause excessive bleeding and be associated with risks of injuring the chest wall muscles, ribs or other complications. After the implants are removed, any small capsule that is left will over time soften and dissolved/resorb and the breasts will settle into their post implant shape minus the skin stretch and original breast tissue and muscle shrinkage.Benjamin J. Cousins MD Board Certified Plastic Surgeon

Removal of the breast implant with removal of the capsule in the sub-muscular position can be done. Thick capsule is much easier to remove. Very miniscule amounts of muscle fibers may be adherent to the capsule but that does not affect the muscle or the function.The muscle needs to be re-attached to the chest wall in normal anatomic position and minimize the probability of deformity, such as animation.

Thank you for the question.  Breast implant removal and capsulectomy surgery for patients who have breast implants in the sub muscular position is not very different  compared to breast implant removal surgery for patients with breast implants in the sub glandular position.  Regardless of breast implant position, care must be taken during the capsule removal to avoid injury to surrounding tissues. One main difference between the two scenarios is that patients who have breast implants behind the pectorals muscle may have capsule tissue  densely adherent to her rib cage making overly aggressive surgery potentially very dangerous. In other words, care must be taken to avoid injury to intercostal structures and/or entering the patient's thoracic cavity.  Potential risks include excessive bleeding,  pneumothorax etc...Some general thoughts regarding capsulectomy surgery (frequently asked questions) may be helpful to you: Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en block removal of breast implants is a good procedure.









***On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). Again, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.











Recently I have become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy is always necessary and undergo unnecessary surgery associated with additional morbidity and unnecessary expenses.







 







 The good news:  breast implant removal surgery is a very well-tolerated procedure with minimal discomfort,  compared to first-time breast augmentation surgery. 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.







I hope this, and the attached link, helps. Best wishes.

When implants and capsules are removed from under the pec muscle, it is often necessary to tack the pec muscle down to its normal position on the rib cage.  If this is not done, the muscle sometimes "roller shades" superiorly with muscle contraction.  Removal of the implant and capsule also leaves a gigantic hole which surgeons call "dead space" between the breast and muscle and chest.  I always put in a drain to encourage everything to heal down and to prevent any fluid buildup.  Over the years, I have come to the conclusion that it is usually a good idea to remove as much capsule as can be done safely.  Retained capsules don't always disappear and can cause issues in the future such as a funny mammogram or a fluid collection.