Should the capsule be removed when breast implants are removed?

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.

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.

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.

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.

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.