Breast implant revision - should capsules be left in place?

Question

I have Allergan implants, Natrelle 410 cohesive gel implants. They are ten years old and an MRI showed a intracapsular and an extra capsular rupture. I need a revision obviously and the surgeon that I met with had not even looked at my MRI before or even during my appointment and he made a plan. He wants to leave the capsules and replace the implants. This seems to go against everything that I read. is this a safe way to proceed or should the capsules be removed. I am also concerned about Bia al-cl should I be?

Gerald Minniti, MD, FACS · Answer

Although the FDA has not recommended capsulectomy, because of a paucity of evidence that it decreases risk of future lymphoma. However, it stands to reason that removing the capsule with the T cells that are potentially in the process of transformation contained within it, your risk would be reduced. That is why I choose to remove the capsules in patients with Biocell textured Natrelle implants.

Steven H. Wiener, MD · Answer

Thank you for your question.  Your implants are 10 years old, and you have both a intra-capsular and extra-capsular rupture. In my practice, I recommend a total capsulectomy and implant exchange.  If you only exchange your implants, and leave the capsules, you will have a much higher incidence of capsular contracture in the future.

John LoMonaco, MD, FACS · Answer

Ruptured implants should be removed, and if I make the diagnosis clinically or the patient simplay wants implant removal or exchange I will skip an MRI as I will be there "in person" to see what is going on.

Implants were invented here in Houston, and during the early 2000s when I opened my practice many women were undergoing removal of the inferior Dow Corning implants. I did more removals than insertions in those days !  I was always trained to remove the capsule with very rare exceptions, and still do so to this day.

Capsule removal and inspection for implants that have been in place a long time in my opinion is mandatory if BIA-ALCL is suspected or needs to be ruled out.  If you have a fluid collection associated with the implants/capsule I would certainly completely remove and test the capsules.

Thomas A. Mustoe, MD, FACS · Answer

With evidence of implant rupture there will be small amounts of silicone oil  that have been absorbed I to the capsule. Unkess the capsule is removed there is a high chance of capsular co tracker.  Although the surgery is more involved a capsulectomy at the time of surgery will on average give a better long term outcome.

Breast implant revision - should capsules be left in place?

Answers (4)

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