What is the best way to go about breast explant and muscle repair without capsulectomy?

Question

My implants are healthy, only very rarely will have intermittent shooting pain. I am looking to get them out without the invasiveness of a capsulectomy. How can I make sure the capsules stick together properly and the muscle is repaired properly? A doctor mentioned scoring, will that lead to uneven adhesions?

Emre Guvercin, MD, FEBOPRAS · Answer

Great question &mdash; and yes, what you’re asking for is absolutely possible in the right situation.Since your implants are healthy and you’re not dealing with rupture, chronic infection, or BIA-ALCL concerns, a non-capsulectomy explant with proper muscle restoration is a very reasonable and commonly used approach.First: when is capsulectomy NOT required?A full capsulectomy is not mandatory when:Implants are intact and not rupturedThere is no ongoing infection or inflammatory capsuleSymptoms are minimal or mechanicalThe goal is lower invasiveness and faster recoveryIn these cases, leaving the capsule behind is safe and often preferable.How the capsule is managed without removing itInstead of excising the capsule, surgeons rely on controlled collapse and healing:Once the implant is removed, the capsule naturally deflatesThe body gradually reabsorbs fluid and fibrosisThe anterior and posterior capsule layers adhere to each other over timeThis process happens reliably without intervention in most patients.What about “scoring” the capsule &mdash; is that risky?Scoring (strategic release incisions in the capsule) can be helpful when done correctly, but it must be used judiciously.Proper scoring:Is limited and symmetricPrevents the capsule from staying stiff or foldedEncourages smooth collapse and even adhesionPoorly planned or aggressive scoring can lead to:Uneven tetheringSurface irregularitiesSo the key is precision, not aggressiveness.How muscle repair is done properlyAfter under-the-muscle implants, the pectoralis major often needs restoration.A proper repair includes:Releasing abnormal adhesionsReturning the muscle to its anatomic resting lengthReattaching it without tensionAvoiding over-tightening (which causes pain and animation)This restores normal muscle glide and reduces long-term discomfort.Where a Push-Up Lift fits (optional but important)If your goal is not only removal but also long-term shape and stability, a Push-Up Lift–style reshaping can be added without implants and without capsulectomy.This approach:Repositions your own breast tissue upwardProvides internal support while capsules collapse naturallyReduces the risk of skin folding or lower-pole collapseDoes not interfere with capsule adhesion or muscle healingIt’s optional &mdash; but in many patients it significantly improves the final contour.

Richard Baxter, MD · Answer

In fact the muscle repair is more secure when the capsule is left in, at least the portion under the muscle and where it is re-attached. The capsule can be repaired with sutures if needed.

Daniel Barrett, MD · Answer

Dear Eclectic877785,
generally speaking, if your capsules are thin then you can only get implant removal. Capsules will scar and close with time. 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 good to hear that your implants are currently healthy and it is understanding that you want to approach the removal process carefully. Please see the attached video that answers your question specifically, in detail. When meeting with your surgeon, communicate your preferences clearly and ask them to explain the techniques they plan to use for the removal. Discuss your concerns about scoring and its potential effects on healing, as well as how they will ensure the muscle is properly repaired. It’s essential to choose a surgeon experienced in the specific techniques you desire for your implant removal to achieve the best possible outcome with minimal invasiveness.

Christine Fisher, MD, FACS · Answer

You can absolutely leave the capsule in place during an implant removal.  It is a great option whenever the implants are being removed for pain, aesthetic result, etc and not for capsule contracture (or thickening of the capsule).  If the capsule is thin, it can be left but I will typically do some type of sclerosing, or roughening up of the tissues with either a scratch pad that we commonly use during surgery and or a thermal sclerosing or tightening with the bovie or electrocautery device.  Some amount of roughening up of the tissues should be done so that the pocket will heal down on itself while not leaving a large space for a seroma or fluid collection.  Best of luck in your journey!

Alan Gonzalez, MD, FACS · Answer

Hi @Eclectic877785, thank you for your question. Capsule removal is key. I consider that every time an explant is performed, the capsule should be completely removed. It doesn't matter if it is en bloc, as long as the entire capsule is removed and the tissue is sent to pathology. This will prevent future inflammatory responses from the body because the capsules are not resorbed. 
Likewise, I believe that immediate breast reconstruction should be performed, in my case my BRALAN technique, to avoid tissue and muscle adhesions and deformities. Here is a video that sheds more light on the subject. Good luck!

Alan Gonzalez MD, FACS. Member of the American Society of Plastic Surgery (ASPS), Member of the International Federation of Adipose Therapeutics and Science (IFATS), Member of the Colombian Society of Plastic Surgery (SCCP).

Gary M. Horndeski, MD · Answer

Depending on where the muscle was cut, the muscle may not be able to be repaired. Also, if the muscle was cut then it has retracted and will not stretch again. It can be reattached at a different point but not at the original point. The capsules could be plicated with sutures but most people leave the capsules alone.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Chet Mays, MD · Answer

Thank you for your inquiry! An explantation of your implants can done without a capsulectomy. Your capsules can stay intact which will help with the shaping and creating aesthetically pleasing breasts. We would love to help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon so we can create a surgical plan for you!

James Knoetgen, III, MD · Answer

If you’re considering breast explant surgery with muscle repair but without a capsulectomy, here are the key steps to ensure a safe and effective procedure: 
1. Find a Skilled Surgeon 
•	Look for a board-certified plastic surgeon with experience in explant surgery and muscle repair. 
•	Review before-and-after photos of their work. 
•	Have a consultation to discuss your goals and concerns. 
2. Understand the Procedure
•	Explant Only (Without Capsulectomy): The implants are removed, but the surrounding scar tissue (capsule) is left intact. This is an option if there are no symptoms of Breast Implant Illness (BII), capsular contracture, or rupture. 
•	Muscle Repair: If the implants were placed under the muscle (submuscular), the surgeon can repair any distortion or stretching of the pectoral muscles during the explant process. 
3. Pre-Surgery Preparations
•	Get lab work and imaging (ultrasound or MRI) to check implant integrity. 
•	Stop smoking and adjust medications if necessary. 
•	Maintain a healthy diet and consider supplements for healing (if approved by your doctor). 
4. Post-Surgery Recovery 
•	Expect swelling, soreness, and limited upper body movement for a few weeks. 
•	Compression garments or surgical bras may be required for support. 
•	Follow your surgeon’s aftercare instructions for optimal healing. 
•	Physical therapy may be needed to restore muscle strength and function.

Connie Hiers, MD, FACS · Answer

The capsules have healed around the implants so scoring, partial, or complete removal makes raw areas that can heal together. Just removing the implants will leave healed capsules which might fill up with fluid.  If needed, the muscle can be sewn down and tightened.

What is the best way to go about breast explant and muscle repair without capsulectomy?

Answers (12)

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