Capsulectomy or Not?

I have elected to have my implants removed. This will be my third surgery and last one. I have had two right side capsular contractures in the past. The implant is over the muscle, mentor saline, 250cc. One doc said to remove the entire capsule b/c it does not re-absorb. The other doc said he can do it under local anesthesia in the office and he would not remove the capsule b/c it will reabsorb. Who is right?

Doctor Answers 5

Why Capsulectomy ?

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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.

Breast Capsules do not get absorbed

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It is ridiculous to think that a breast capsule will absorb on its own. If you are removing your implants, I usually prefer to remove most if not all of the capsule. Doing so will reduce the likihood that you will form a seroma. However, there are certain cases where I would elect to leave the capsule intact.

Kevin Brenner, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 23 reviews

Why do a capsulectomy?

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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
4.9 out of 5 stars 116 reviews

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Capsulectomy with Breast Implant Removal?

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Thank you for the question.
When breast implants,  or any other foreign body,  is inserted into the human body,  the body forms a lining around it.  This lining is referred to as the “capsule”.   This capsule is normally very thin and soft;  however, it can become  thick and hardened in a process called encapsulation or capsular  contracture.

In the process of breast implant removal,  assuming the breast implant capsules are soft and asymptomatic,  there is no reason to remove them (capsulectomy). Removal of breast  implant capsular  tissue increases  the risks of surgery (for example bleeding).

Best wishes.

Capsulectomy with breast implant removal

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In most cases capsulectomy is not required when removing implants.  Sometimes the capsule will dissipate over time sometimes not, either way it is usually not of any consequence.  Are you having your implants removed because of two prior capsule contractures?  There are several options to help prevent contractures. Other methods are attempting to reposition the implant under the muscle or using Allograft in the pocket. Seek additional information on this unless you are fully committed to removing your implants.

Marialyn Sardo, MD
La Jolla Plastic Surgeon
4.0 out of 5 stars 6 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.