Should implants be removed with a capsule or without? What are the risks? (Photo)

I am planning to have my 6 year old saline implants (430cc) under muscle, removed without a lift. I do not have a capsular contracture. Why do some surgeons recommemd removing the entire scar capsule and some do not? Will the removal of the capsule have a worse outcome on appearance? What are the surgical risks when performing a capsulectomy or en bloc? What are the risks of leaving scar tissue behind? Would I feel the scar tissue? Can it harden once left behind?

Doctor Answers 7

Implant removal with or without capsule removal

Each case is different. If you have a thickened capsule, most surgeons will remove the capsule to prevent persistent fluid fomation. If you have a very thin capsule, it is impossible to remove it all and most surgeons will close the pocket/capsule off with sutures. A drain will be used by most also. I would recommend having a consultation with an experienced, board certified plastic surgeon to determine your best option.

Should implants be removed with a capsule or without? What are the risks?

Based on the information provided, you do not need the capsules removed. In fact, saline implants can often be removed with just a local anesthetic but capsule removal requires deeper anesthesia. May want to get a second opinion. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 65 reviews

Dr Kayser

Thank you for your question. I don't believethere is any consensus on any particular method. I tend to remove the capsule, especially if it's thicker in order to facilitate closure of the pocket and minimize potential open space and fluid collection. It also allows me to resuspend the breast internally to facilitate better positioning. In your situation, expect that would likely end up with significant deflation and drooping that may be someone discouraging. Mastopexy will likely improve your outcome. If you are unhappy with an implant, the ability to transfer fat at the time of implant removal is an excellent choice for many patients who do not want to be completely deflated. Please see the attached video to further demonstrate these Concepts. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Capsule Removed with the Implants?

Thank you for your question, it is a very common one.


Leaving behind a capsule typically doesn't cause any issues down the road.  Some surgeons will remove the capsule (or do things to "roughen it up a bit") in order to get the area to close off and prevent a chronic fluid pocket from forming.  On the other hand, the additional surgery to remove the capsule can result in extra scarring, thinning of the breast tissue, change the sensation to the nipple, or possibly even threaten the blood supply to the nipple (rare for this to happen, and really only when the breast tissue is VERY thin below the nipple).

You may feel the capsule if it is already thickened.  Since you say you don't have a capsular contracture, your capsule is likely very thin and you shouldn't feel it.  It would be very rare for it to continue to thicken over time once you take the implant out, so I wouldn't worry about that.

You mention wanting to do an implant removal and no lift.  You may want to consider having your implants intentionally ruptured by your surgeon so that you can see what you look like without implants, and decide if that's a look you're happy with, or if you'd like a lift after all (or replacement with a silicone implant) prior to the surgery to remove your saline implants.  In my experience, there have been many times that women say they don't want a lift, we rupture the implant (in the office with local anesthesia and a small needle), they see their deflated ans sagging breast, and then desire the lift.

I recommend consulting with several plastic surgeons in your area for actual recommendations based on your physical exam and a more complete discussion of your goals.


Best,

Dr. Dan Krochmal

MAE Plastic Surgery

Northbrook, IL

Daniel Krochmal, MD
Chicago General Surgeon
5.0 out of 5 stars 19 reviews

Capsulectomy

If you have soft breasts and no evidence of capsular contracture then it is perfectly fine to leave the capsules behind.  There is no risk of hardening down the road.  A thick capsule may be palpable if it is left behind and that is the risk.  After you finish nursing your baby and have your implants removed you will be a great candidate for a breast lift, have you given it serious consideration?

Implant removal

Hello - These are great questions!

- The capsule is the layer of tissue that your body forms around any "foreign body" to "wall it off. " All implantable medical devices (pacemakers, knee replacements, etc) will have capsules surrounding them. The capsule itself isn't anything foreign or worrisome.

-If the capsule is thin and pliable (sometimes only a few cell layers thick), it can often be left in, especially with saline implants

-Full capsule removal can sometimes remove small amounts of breast tissue or muscle that are stuck to the capsule

-In my opinion, capsules should be removed fully when they are thickened, calcified, inflamed, or if they contained a ruptured gel implant

-Removal of the back part of the capsule, when the implant was under the muscle, can be more difficult since it sits right on the ribs and intercostal muscles. In these cases, it is often perfectly fine to leave the back part of the capsule so as not to injure the chest wall.

-Thin capsules left behind will not usually cause problems and wont usually be felt. Thickened capsules might be better to be removed.

I hope that helps!


Breast implant removal

If you are not having any issues with your capsules, it is fine to leave them behind.  It makes the surgery less complicated as there is less stress to the breast tissues.  It also shortens the surgical time.  

Camille Cash, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 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.