Is Capsulectomy Necessary for Capsular Contracture when Getting an Explant?

I have had silicone implants under the muscle for 5yrs and have developed capsular contracture in one and now want to explant (may reimplant at a later date). Is it necesssary to do a complete capsulectomy? If I leave the scar tissue in, what are the risks if any?

Doctor Answers 11

Breast explantation and removing breast capsules...

A "complete" capsulectomy is usually NOT necessary when performing explantation!

When a patient with a periprosthetic capsule is undergoing removal of her implants (explantation), the treatment of the capsule depends upon several factors:

  • The thickness of the capsule tissue
  • Whether the capsule has developed calcium deposits (only very long standing capsules)
  • Interior condition of capsule (infection, loose silicone or, simply, the old implant)
  • Location of the capsule (in front of or behind the muscle)
  • Degree of adherence between capsule and the adjacent breast tissue, muscle and ribs

In my experience with capsule management during explantation, it's almost always preferable to perform just a partial capsulectomy. Portions of the capsule typically allowed to remain are those which are firmly adherent to the muscle and ribs. Permitting them to remain is generally considered to be entirely safe. Attempted removal of those capsule segments unquestionably creates more bleeding and post-op pain, and, at an extreme, can risk inadvertent lung deflation (pneumothorax).

The surgeon should always be given the option to handle the capsule, during surgery, in whatever manner he believes to be in the patient's best interest.

Baton Rouge Plastic Surgeon
5.0 out of 5 stars 11 reviews

Capsulectomy with implant removal?

It is probably in your best interest to have the capsule removed to avoid problems such as firmness and irregularity. These problems may confuse self breast exam (for cancer detection). Furthermore, calcification in the capsule may confuse mammography use for breast cancer screening.

It is important during this process of removal of the capsule to avoid excision of normal breast or subcutaneous tissues

I hope this helps. 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Capsulectomy following explantation.

The main reason for removing the capsule following explantation is to prevent the occurrence of a seroma, or fluid collection. The entire capsule does not need to be removed, usually just the anterior surface. That being said, a total capsulectomy is not terribly difficult to perform, particularly for subglandular (on top of the muscle) capsules.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Capsulectomy Recommended

When a patient develops capsular contracture, it is a common assumption that it is the implant that is hard. In reality, it is the scar tissue/capsule around the implant that is causing the problem. To fix the problem, the capsule needs to be removed.

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 94 reviews

Capsulectomy for explant

One of the most common problems is breast capsule contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer implant. Nicotine users, such as smokers, have up to a 30x increased risk of capsular contracture.
Saline implants may deflate spontaneously. When the patient has significant symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is recommended to ensure adequate pocket dimensions.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Is Capsulectomy Necessary for Capsular Contracture when Getting an Explant?

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. 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 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 ruptured implant vs pain vs simple pocket adjustment, etc). Implants mayor may not be replaced depending on your discussion and reason for capsulectomy.

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to 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. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Most patients tolerate this procedure very well with minimal downtime. It is typically an outpatient procedure with most being able to resume activities within a few days along with restrictions for a week or so. Many surgeons will recommend a postoperative garment for several weeks postop as well. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Reason for Capsulectomy at Explantation Surgery

Breast Capsule Removal (Capsulectomy) Guidelines and Explanation
The guidelines I recommend for my patients are pretty straight forward. If the capsule is very thick, calcified or otherwise 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. 


The purpose of the Capsulectomy is to  Remove Abnormal Internal Scar Tissue. Without doing so it will remain. A Complete capsulectomy for all practical purposes means removal of all internal scar tissue. Your body as a part of natural part of healing under ideal circumstances will make a new thin and supple capsule  when the new implant is placed rather than a thick stiff one that was removed. 

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews


If you only want to remove the implant and not replace it at the same setting, then capsulectomy is not necessary.  If you want to replace the implant,  then you will need either a complete or partial capsulectomy.  Another approach would be to create a new pocket (neopocket) between the muscle and the scar tissue capsule.  Your surgeon should discuss all your options during your consultation.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.7 out of 5 stars 35 reviews

Capsule Removal for Capsular Contracture

No one has the final answer for what causes capsular contracture to harden breast implants.  One of the ideas that plastic surgeons are researching is that capsules can be caused by a biofilm. A biofilm is a secretion from   bacteria the live in the capsule where it is difficult for  antibiotic to penetrate.  If that theory is correct then leaving a capsule behind may set you up for a repeat capsule when a new implant is placed in that contaminated space. You and your surgeon may get away with an implant removal without capsulectomy but it is not as safe a choice.  Best of luck .

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 114 reviews

Capsulectomy at the time of explantation

If you have a thick capsule, at least the anterior portion of your capsule should be removed.  If the anterior capsule is not removed, you would feel irregularity and firmness of the capsule.  Performing a total capsulectomy decreases a risk of seroma (fluid collection) formation; however, it may increase a risk for bleeding.

Sugene Kim, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 76 reviews

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.