Should the Capsule Be Removed During Breast Implant Removal?

The capsule is your body's response to your implants. It may contain silicone gel, silicone shell fragments, bacteria, calcification, and inflammatory cells which have been mobilized by your immune system to react to different components of the implant. Research has shown that the capsule does not disappear on its own when only the implant has been removed (See Nancy Hardt's paper in Plastic and Reconstructive Surgery.) In addition, if you have pain around the implants, it is usually due to the pulling effect of the scar on surrounding muscle and tissue. If you have health problems that could be from the presence of the implants, removal of the capsule is critical in improving your health.  Linked is my en bloc video.

The surgeon should decide how much of the capsule should be removed at the time of the surgery depending on the character of the internal scar.

There are situations when the capsules should be removed. These include instances where there are capsular contractures, calcifications or distortion of the breasts due to the capsules. In addition, if a patient has ruptured gel implants, then the capsules should probably be removed. However, if the breasts are soft, and the implants are intact and free of the above problems (capsular contractures, calcifications), then the capsules can generally be left in place. 

Hi, if the patient is experiencing firm capsular contracture, there are generally two ways to make the breasts soft. Capsulotomy refers to incisions within the scar tissue that release the capsule allowing more room for the implant. Capsulectomy is a more involved operation that removes all or most of the scar tissue creating a “new, fresh pocket” for the breast implant.
The specific procedure to be performed will depend on the complications experienced and the condition of the implants. I advise the best course of action based on each patient’s individual circumstances. Contact your surgeon for more in depth information about your case. #RealSelf100

Thank you for submitting your question.  I will remove the capsule if it is thickened and/or calcified from a capsular contracture or silicone rupture. Consult with a Board certified Plastic Surgeon.  Best wishes.

                  In
the vast majority of explantation cases, it’s not necessary to remove the capsule
that surrounds the breast implant. 
When these capsules are left alone they collapse upon themselves and the
implant pocket is eventually obliterated. 
In addition, capsule removal may be associated with secondary
complications such as bleeding.  For
this reason, removal of breast capsules is not undertaken without specific
indications. 

                  When
patients have ruptured silicone implants, calcified capsules or thickened
capsules with breast distortion, capsulectomy is usually indicated.  Under these circumstances failure to
remove the capsule will result in a persistent deformity.

                  In
someone who has only had implants for two years and isn’t
having problems, simple removal of implants without casulectomy is probably
reasonable.  Under these
circumstances, it’s important to discuss this issue with your plastic
surgeon.  Your surgeon should be
able to formulate an appropriate treatment plan.  

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. I have always favored a complete capsulectomy vía en bloc method.  Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today  A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure.  
If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence.  It is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  But, I completely believe in removal of the entire capsule, en bloc, for several reasons - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo.  These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space.   Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast, and suturing the muscle back to where it started from. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast.  Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time.  Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra.  Hope that this helps!  Best wishes!

Hi Littleagain,

I would remove the breast capsule. I would just remove the anterior portion of the capsule. I would leave the back wall of the capsule in place. Removing the back wall of the breast implant capsule, increases chances of complications. It increases the risk of bleeding and getting into the lungs.  I also believe by removing part of the anterior breast capsule, your healing and recovery will be faster.  A surgical drain should be placed.  The part that is removed would look like a half of a grapefruit. As you can see by other plastic surgeons answers,  there is a wide variety of opinions regarding what should be done.  Good luck with your surgery.  

The guidelines I recommend for my patients are pretty straight forward. If the capsule is very think and distorts the breast or is calcified it needs to be removed. The same for any ruptured silicone implants as it gives you the opportunity to remove traces of free silicone. On the other hand, if there is no rupture of a silicone implant, or a saline implant (ruptured or not) and the capsule has normal thinness I leave it alone. These guidelines have served me well over the past few decades.

Most of the time with explantation, the capsule need not be removed with the implant.  If a silicone gel implant has failed and the capsule has taken up some of the silicone, I will remove it.  It is generally thick and calcified which is no a health risk to the patient but could create some aesthetic problems.  If the capsule is thin and normal in appearance, it will generally resorb once the implant is removed.