Should I get a capsulectomy or not?

Question

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?

Tyler Angelos, MD, FACS · Answer

With removal of breast implants (explantation) I recommend removal of the entire capsule of scar tissue which formed around the implant in a procedure called a capsulectomy. The reasoning for this is two-fold. First, the scar tissue associated with the implant will be removed yielding a much softer breast, especially if the scar tissue capsule had thickened or contracted. Second, once the implant is removed, if a capsulectomy is not performed, the two smooth scar tissue capsule surfaces will often not stick to each other and heal together properly. Fluid can build up between the surfaces in the space where the implant used to be which is called a seroma. Seromas can turn in to a chronic problem requiring drainage procedures and even more surgery. Seromas also run the risk of getting infected. For these reasons I recommend a capsulectomy when removing breast implants.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jed H. Horowitz, MD, FACS · Answer

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.

Larry S. Nichter, MD, MS, FACS · Answer

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.

Kevin Brenner, MD, FACS · Answer

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.

Camille Cash, MD · Answer

A capsule will naturally form around breast implants.  It's the body placing scar tissue between the implant and the rest of the body.  In some patients this scar tissue will begin to thicken or tighten around the implant.  It can cause the breast to feel and look hard, shift, or even hurt.  If you are having issues with your capsules they should be removed at the time of explant.  If they are not causing issues it is an option to take them out or leave them behind.

Tom J. Pousti, MD · Answer

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 &ldquo;capsule&rdquo;.   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.

Marialyn Sardo, MD · Answer

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.

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