Should the capsule also be removed when I have my implants taken out?

Thank you for your question -- a lot of women are wondering the same or similar things.My short answer to you is remove the implants (this can usually be done in the office, under local anesthetic, and you can drive yourself to and from the appointment).  I would suggest not doing anything at all with the capsule -- not even cauterizing it.I have a very different view on things than most people you have read on the internet.  I do believe that my opinions are based in science and reflect data that is likely to emerge as we gain a better understanding about something called "biofilm".If the reason you want the implants out is because they feel "foreign", then just remove them and that should correct the issue.  Women who believe that they have symptoms related to their implants I give the same advice; remove the implant and that should correct the issue if the implants are to blame.  I do not understand how removing the capsule (which is tissue that your own body has produced) contributes to alleviating symptoms.Implants can develop something called "biofilm".  This means that the implant has become contaminated by bacteria (the most likely source is from bacteria that was on your skin at the time of surgery since we cannot completely sterilize your skin), but has not become truly infected.  Bacteria can produce this biofilm on the surface of the implant that protects the bacteria from your body's defenses and any antibiotic that may be circulating in your blood.  This biofilm allows the bacteria to continue to live and produce proteins that can induce symptoms in your body (the biofilm itself is a protein that your body may be reacting to as well).  Simply removing the implant will remove the biofilm (and the bacteria) and should resolve the issue.  Biofilm cannot exist without a foreign material in your body and the capsule is not a foreign material -- it was produced by your body in reaction to the foreign material (the implant).  Without the foreign material your body's defenses can remove any and all remaining bacteria with ease.I know that there is a lot of information on the internet right now about en bloc resection of the capsule and implant.  I'm sorry to say that I think it is scaring a lot of women who are looking for relief from symptoms into having a much more invasive and extensive operation than they really need to.  I do perform en bloc resection for women who are convinced that it is necessary for them despite my explanation to the contrary.  I really do think that taking out the implant alone is all that is necessary.Hopefully that helps and hopefully that doesn't overwhelm you with information.Richard H Fryer, MD FACSBoard Certified by American Board of Plastic Surgeons (ABPS)member American Society of Aesthetic Plastic Surgery (ASAPS)member American Society of Plastic Surgery (ASPS)

Thanks for your questions. As is often the case there is no one "right" answer. There are situations when it is reasonable to remove most or all of the capsule such as severe capsular contracture or at the patient's request for any number of reasons. However, many surgeons effectively remove implants without removing the capsules. Finally, there is usually an option for partial capsulectomy and that is the most common procedure in my practice . There are often areas of the capsule that are difficult or even dangerous to remove and the risks of removal outweigh those of leaving the capsule. Regarding a second opinion, I always encourage patients to obtain another perspective. Most surgeons understand that additional evaluations will help the patient feel more comfortable with a treatment plan if see agreement among doctors. On the other hand, in difficult cases the more minds evaluating the situation the more likely the patient will arrive at the best treatment option. Good luck. BRK

Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.  A number of scientific studies have demonstrated the safety of silicone implants; yet, many patients continue to have anxiety about their use.
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

I
do not recommend routine capsule removal. 
If there is an indication such as infection or calcification then it is
indicated.  Unfortunately, the most
frequent complication after explantation is dissatisfaction with the saggy skin
and you will probably need a simultaneous lift. 
You have not provided photographs or told us your bra size but this may
be more important than capsule removal. 
The lift I recommend is The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness, elevate them higher on the chest wall and more medial to
increase your cleavage.  Vertical scars
are avoided, nipple sensation and the ability to breast feed are maintained, if
not injured during your previous surgery. 
At the same time or later, fat transfers can be performed if additional
volume is desired.  Best Wishes,Gary Horndeski, M.D.

Dear lrhealth,I understand your concern. However, without a proper assessment it would be difficult to determine the best course of action. Some plastic surgeons remove capsules, others don't. If you are concerned, I suggest you to visit another plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If there is a hard capsular contracture, I prefer to remove as much as safely possible of the entire capsule.  I have seen patients with capsules left behind develop problems with fluid collecting in the pocket later, resulting in further surgery needed.
Always consult your board certified plastic surgeon.  
Hope this helps, best of luck!

If you are having issues with the scar capsules such as thickening, pain, etc then the capsules should be removed when you remove the implants.  If you are not having issues and the capsules are thin then it is your option whether or not to remove the capsule.

Thank you for the question.  
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 bloc removal of breast implants is a good procedure.
On the contrary, capsulectomy can expose you to additional risks, such as bleeding and minimal size loss.  In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity).
 I hope this helps. Best wishes.

Thank you for your question.  The decision to remove your capsule(s) completely, partially, or to leave them in place will depend on the specifics of your case especially the thickness or severity of your current capsule.  I know that this can be confusing for many patients as there is no universal rule when it comes to management of breast capsules upon implant removal or exchange, so I would encourage you to meet with your plastic surgeon again to discuss the recommendation that he made for you.  My assumption would be that your physical exam shows a very thin capsule and that he does not feel as though it will cause any issues if left in place after removing your implants.  Bring your concerns to your plastic surgeon as I am sure he would be happy to discuss it with you further.  I hope this helps!

In general, there is no reason to remove the existing scar capsule around an implant unless it's abnormal or causing problems. It's just a layer of scar tissue -- the way the body heals internally and a new scar layer will form if the old one is removed. Also removing part or all of the old capsule adds to the magnitude of the surgery and the risk of bleeding. Exam is required to make sure the scar capsule is not thickened, enlarged, or in some way causing problems and would thus require at least a partial capsulectomy.