Should the capsule be removed when breast implants are removed?

Question

What happens to the space after the implant and capsule are removed? Is there bacteria, inflammatory cells, and fragments of silicone left in the capsule after Explant? Is that why the capsule should be removed or do these particles wash away. I'm reading conflicting information on the removal of the capsule.

Farbod Esmailian, MD · Answer

Whether the implant capsule needs to be removed is usually determied on a case by case basis.  If the capsule is very thin, there is generally no need to remove the capsule as there is more downsides than upsides.  If the capsule is left behind, that "pocket" will close and heal together over time.  If the capsule is at all thickened or if there is a silicone implant rupture then the capsule is usually removed.
Some will guide you to removing the capsule on EVERY case and this is unnecessary surgery that can lead to unwanted complications such as cosmetic deformity, nipple sensativity loss, bleeding, etc...  Even in cases of BII, if the capsule is very thing the capsule can be left behind without issues.  This capsule is not foreign, in fact it is what your body has formed and will form if the capsule is removed.  Your body with form scar tissue (same as capsule) to heal the space after the capsule is removed.

Hope that helps.

Kenneth Hughes, MD · Answer

Removing a capsule unnecessarily could result in bleeding and slight tissue loss. Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted but must be removed carefully to prevent complications when stuck to surrounding tissue.

Nelson Castillo, MD · Answer

Thank you for sharing your question. Implant removal cases must be treated in a customized fashion. In some patients the capsules can be left in place (thin, pliable capsules), in others a partial or subtotal capsulectomy can be pursued (Some revision breast cases, patients with thickened/calcified capsules), a total capsulectomy in some patients with capsular contracture, and an enbloc in BIA-ALCL and patients with BII. Go on a series of consultations to get the best advice for your specific situation.

Gary M. Horndeski, MD · Answer

Removal of the capsule is determined by the surgeon frequently at the time of surgery. However, if you have a calcified capsule on x-ray or mammogram pre-operatively then the capsule will probably be removed. If at surgery there are signs of infection, bacteria, thickening or ruptured implant then the capsule is frequently removed.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear AnnJR,
as long as you don't have capsular contracture and your capsules are thin, there is no need for their removal and you can only remove implants. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

With the old gel implants, the capsule should also be removed to eliminate as much of the old gel as possible. The old gel implants leaked gel through the bag. The capsule around the saline implants or new gel implants can be left in place if it is very thin and might cause more damage and bleeding in trying to remove it. If the capsule is thick, or an infection is present, it is best to remove the capsule if possible. Once removed, most surgeons wash the area thoroughly to remove any excess bacteria or foreign material that might be present prior to closure.

Camille Cash, MD · Answer

If you have ruptured implants and/or if you are experiencing issues with your capsules such as thickening or pain then the capsules should be removed at the time of explant.  The implant and capsule can be removed as one unit during the en bloc approach.  If you are not experiencing issues with your implants or capsules, then it is an option to remove the capsules or leave them behind.

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