Breast implant removal of smooth, saline (Capsulectomy vs implant removal). Any suggestions?

Question

I've had Mentor saline, smooth implants under muscle (325cc), for 16 yrs. and am ready to explant no replacement. I've had 3 consults and all say a capsulectomy is not necessary since I do not have any breast implant illnesses. I have researched and some Dr.'s feel the capsule must be removed to prevent misreadings on mammograms, lumps from the capsule, a rare form of cancer caused by leaving the capsule in, and poisoning of the body from toxins leached from the implant shellAdvice appreciated.

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

David J. Wages, MD · Answer

Thank you for your question.  If one has a thin capsule and not had any issues then the capsule does not need to be removed.  Once you decide on your surgeon this is a decision that you and your surgeon should have.   good luck

Camille Cash, MD · Answer

When removing implants it is recommended to have the capsules removed along with the implants if they are silicone and have ruptured, or if the the capsules are thickened or causing issues.  If they are thin and not causing concerns then it is an option to leave the capsules behind. If you are still unsure about the advice you have received return to the board certified plastic surgeons you have seen.  You can ask further questions based on your exam and circumstances.

Tom J. Pousti, MD · Answer

Thank you for the question. Don't be surprised if you receive a variety of differing responses.Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic),  are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary.  For these patients, en block removal of breast implants is a good procedure.On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications.  In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity. Recently I have  become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy  is always necessary and undergo unnecessary surgery  associated with additional morbidity and unnecessary expenses. I hope this, and the attached link, helps. Best wishes.

Myles Goldflies, MD · Answer

Even if you did not have any illness from the implants, if you had contracture and/or persistent pain (even if low grade) it would be of benefit to take out most of the capsule in case there was a low grade yeast or mold in the capsule.  Some have that without being sick.  If they were under the muscle, the capsule under the implant could be left in there.  Sometimes we find a fair amount of "eggshell" calcium deposits on the outside of the capsules that was not appreciated on the mammogram.  Again, it would be better for you in the long term to have this taken out.  But if everything looks absolutely benign in there, the capsule can be left.  The only thing about leaving the capsule is a slight risk of fluid accumulation (serum) in the old pocket.

Peter A. Aldea, MD · Answer

The scientific and ethical practice of Plastic Surgery dictates that we operate based on REAL scientific reasons (ie INDICATIONS) not urban legends. Except for a few fringe opinions some of which may capitalize on women's fears, the overwhelming opinion in our field is that a THIN, noncalcified scar capsule around an implant need NOT be completely be removed. (Most of us would remove the top part and leave the one on the floor, on the ribs alone). The pocket is copiously irrigated with antibiotic solution, the scar tissue is patrially removed and the pocket heals perfectly in the bast majority of cases WITHOUT a radical operation.However, IF the implants are removed for infection, calcification (visibility on mammograms or chest films) severe contracture a larger portion of the scar is removed BUT such operations are bloody and MAY be associated with entry into the chest cavity and lung deflation. The pockets are irrigated with large amounts of antibiotic containing fluid and drains are usually used.IF you are being operated on for ALCL, the EXTREMELY rare cancer you referred to, you usually suffered a sudden increase in one or both breasts by a sudden fluid collection. REmoval of the implants with much of the capsule is a cure in the vast majority of the cases.Good Luck.Peter ALDEA MDMemphis, TN

Connie Hiers, MD, FACS · Answer

If the capsule is very thin, it can be left in place. However, if it is thick or calcified, removal would be best. With old gel implants, it is always best to remove the capsule.

Theodore Nyame, MD · Answer

Thank you for your question. The decision to do a capsulectomy can be debated both ways. Some of the decision should be based on the nature and quality of the capsule. If your preference would be to have the capsule removed I would request this from your surgeon if it is technically feasible. Best WishesTheodore T. Nyame MD

Alan M. Engler, MD, FACS (retired) · Answer

With 3 surgeons saying the same thing you're already getting some useful advice.And I would agree with that.  In general, capsules don't have to be removed unless there is some sort of a problem with them.  That includes thickening, pain, calcification, fluid production (repeated seromas), etc.  In your case, it sounds like simple removal of the implants is all that is warranted at this point; you can always consider removing the capsule if in the future you have or develop problems, such as those noted above.You should discuss all of this, along with what your likely post-operative appearance may be, with your own plastic surgeon or another who can examine you in person.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf500

Susan Kolb, MD - Account Suspended · Answer

Removal of the capsule is needed in order to avoid complications later.  Most surgeons do not realize this as when the patient has problems, they come to us in Atlanta in order to be treated.  It is more likely to have problems if there is bacteria or fungus in the capsule, but positive cultures even in asymptomatic patients are not that unusual (most surgeon do not do cultures so they wouldn't know this).  Biofilms exist around many implants as well according to the peer reviewed literature.  Older implants can leach chemicals that are carcinogens and neurotoxins.  The rare lymphoma is due to textured implants not smooth.  See the information online about this topic from interviews that I have done please for more information.

Breast implant removal of smooth, saline (Capsulectomy vs implant removal). Any suggestions?

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