Should the Capsule Be Removed During Breast Implant Removal?

I have only had my implants for 2 years. Silicone, places under muscle. I have had no trouble but would like them out. I am wondering if the capsule should be removed? I don't quite understand this process. En bloc? Thank you for your help.

Doctor Answers 27

Should the capsule be removed during #explantsurgery?

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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.

Cleveland Plastic Surgeon
4.6 out of 5 stars 95 reviews

Breast Capsule Removal (Capsulectomy) Guidelines

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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.

Breast implant removal usually does not require capsule removal

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As tempting as it is to perform capsule removal (capsulectomy) with implant removal, it is not routinely necessary. A surgical drain should be placed to provide negative pressure (a vacuum seal) and to remove any residual fluid. In the absence of a breast implant, most capsules will gradually shrink in volume, though they will never go away completely.

The difficulty with routine capsulectomy is that it adds time, expense, and significantly more pain without any tangible benefit.

When is a capsulectomy advisable (in conjunction with implant removal)?

1. When implants are being moved from a subglandular (above muscle) plane to a submuscular (below muscle) plane. If the subglandular capsule is left intact, it will interfere with implant expansion and make the implants feel hard.

2. When there is an extracapsular rupture of a silicone gel implant. This means that the silicone gel has penetrated through the implant capsule into the surrounding breast tissue. At least a partial capsulectomy should be considered to "clean out" the silicone gel.

Ronald Friedman, MD
Plano Plastic Surgeon

Removal of implants

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Typically, we don't recommend removal of the capsules around saline or the new gel implants unless the capsule is thick or calcified.  We do like to remove the capsule along with the old gel implants, since these implants bled through their bags. Removing the capsules does carry an increase risks of bleeding, more numbenss and can create more irregulaties in the breast. Your implants will probably easily slide out.  However, you may have a issue with loose redundant skin and sagging. This can be dfiscussed with your plastic surgeon.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 reviews

En Bloc breast implant removal

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The 'en bloc' removal is usually needed for silicone breast implants that have been in the body for many years. If your implants were placed prior to 1992 then it may be necessary for a capsulectomy. Since you appear to have the latest generation of Silicone gels implanted only two years ago, it may not be necessary for a capsulectomy. I suggest consulting with an appropriate surgeon who can examine the existing condition and give you a proper assessment.

Robert Vitolo, MD
Manhattan Plastic Surgeon

Capsule Removal

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It really depends. If there is any chance of the implant being ruptured then I like to do an en bloc remove of the implant with the capsule without entering the capsule so to not spill or have any of the silicone touch the breast tissue.

But this is probably not absolutely necessary. You could have the implants removed and have drains placed and allow things to heal without taking out the capsules and you will likely heal fine. The capsule will scar down and close off.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Depends on the capsule thickness

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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.

Capsulectomy at the time of implant removal

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If the capsule is removed it increases the risk of bleeding.  If a silicone gel implant has ruptured then removal of the capsule would be recommended otherwise I would leave it alone unless it was calcified.  If there is distortion of the breast after implant removal may also be a reason to remove the capsule.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Capsule removal

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Not all capsules have to be removed with implants.  If the gel has leaked then I usually try to remove it with the capsule intact.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

When implants are removed, the capsule does not necessarily have to be removed.

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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.

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.