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

Doctor Answers 6

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

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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. 

Breast Implant Removal

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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

Removing implants and capsules from under the pectoral muscles

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Thank you for asking about your breast implant and capsule removal.

  • I assume you want your implants removed and are wondering if the capsules should be removed also.
  • What is the capsule? It is your tissue that thickened because the implants were irritating.
  • Removing implants should lead to absorption of the capsule.
  • But we know there is a very very rare cancer associated with some implants.
  • And the pre-2006 gel implants did leak silicone - no question about it.
  • My approach is to remove the implant and capsule together ('en bloc) if the implant is pre-2006, or the breast is hard on examination or the capsule thick at surgery or my patient just wants the capsule out.
  • Removing the capsule does increase your risk of bleeding and visible changes in breast appearance.
  • if the capsule is thin and delicate, I leave it but take a biopsy to show it is normal.
  • After removing the implant, there is an open space - 
  • If the surgery was under the muscle, I put a few sutures to reposition the muscle on the ribs.
  • I may or may not use a drain, depending on how surgery went.

Always see a Board Certified Plastic Surgeon. Best wishes. Elizabeth Morgan MD PHD

Breast Implant removal with capsulectomy

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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.

Samir Shureih, MD
Baltimore Plastic Surgeon

Implant and capsule removal

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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,


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

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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.

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.