Is capsulectomy not necessary because my implants are soft?

Question

Hello, I am a healed breast cancer patient who is scheduled to have an explant of my sub-muscular, saline implants next month. I got my first set of implants 15 years ago, and the implants I have now are from 2009. My surgeon would like to perform a partial capsulectomy; however, he said my implants are "very soft", and that "there is no evidence of capsule contracture". Is a capsulectomy truly necessary?

Peter J. Capizzi, MD · Answer

This is difficult question - and a good one -  because "partial" capsulectomy can mean very little up to 90% of the capsule.  Additionally, there is often an expert judgement call involved as to the thickness of the capsule, the degree of tightness, and - if an  implant is being exchanged - fluid around the capsule. If your implants are just being removed, it is possible that no capsule may need to be removed, in my experience. You are asking the right questions, CheekyGirl2. They key is being informed - and you are engaged in that process - and a relationship with a board-certified plastic surgeon who is an expert in breast reconstruction surgery AND revision. You are a survivor. Keep up the good work.

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

Tom J. Pousti, MD · Answer

Thank you for the question.Generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, there is no indication to have them removed. On the contrary, capsulectomy  can expose you to additional risks, such as bleeding and minimal size loss. Having said that, I often remove a small segment of capsule  tissue when removing breast implants with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I hope this, and the attached link, helps.

Scott L. Replogle, MD (retired) · Answer

There is a difference of opinion on this issue but in my opinion and experience, there is no reason to remove any of the capsule around an existing implant unless it is abnormal in some way. It's much like removing an old scar. There is no value in just removing a normal scar and a new one will form in its place. In the case of the scar around an implant, it is called a capsule and if removed there will be a new layer of scar where it healed, it just wouldn't be called a capsule. In my experience, there is no need to remove the capsule because of worries about seroma but a closed or open drain could be placed if this were a concern. Abnormal capsule that needs to be removed, particularly in the case of breast cancer, would include thickening, heavy calcification, pseudo-capsule, or any abnormal growth or appearance of the capsule. In my opinion there is no medical justification for removal of any part of a normal capsule around a cosmetic implant. Removing it adds time, complexity, and risk to the procedure of implant removal and doesn't accomplish anything.

Is capsulectomy not necessary because my implants are soft?

Answers (4)

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