Is capsulectomy appropriate 9 months after explantation?

I had my implants removed (not replaced) nine months ago. I did have a capsular contracture/rupture on the right. The capsule was left behind and has been full of fluid (mostly blood per pathology) for four months. There was no injury or trauma, just a rapid development of a hard lump five months post op. I had a needle aspiration but the fluid returned. Is a capsulectomy the only option at this point? Should a capsulectomy have been performed at the time of explantation?

Doctor Answers 4

Capsulectomy after implant removal

Thank you for asking about your breast implant removal.

  • Since you had an implant and rupture, I would probably have removed the capsule at the time of surgery.
  • Not every surgeon does not - it is a matter of judgement.
  • This is unusual enough a response however that I would now recommend a capsulectomy, pathologic examination of the tissue and the fluid and culture of the fluid.
  • An alternative would be to place a drain until the fluid stops forming but that would not be my preference.
  • It is possible that the fluid is forming in response to retained free silicone - hence the need for capsulectomy.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Capsulectomy

Thank you for your comments and very sorry to hear of your troubles. Since you continue to have build up of seroma fluid, it may be beneficial to have a capsulectomy to remove the capsule as well as closed suction drainage to seal down the tissues and help prevent a recurrent seroma. The capsule does not necessarily have to be removed at your initial implant removal, but it should be if the capsule is irregular, painful, distorting the breast shape, is symptomatic or thickened. This may be a "game time" decision for your PS. Removing very thin capsules may cause excessive bleeding and be associated with other risks of injuring the chest wall muscles, ribs or other complications.

Best wishes,

Benjamin J. Cousins MD

Benjamin J. Cousins, MD
Miami Beach Plastic Surgeon
5.0 out of 5 stars 9 reviews

Explantation and capsulectomy

Many variables enter into the decision regarding capsulectomy at the time of explantation. This is a judgement decision made by the operating surgeon after assessing the risks and benefits of the procedure. At this point as you are having a problem with seromas, your options include futher aspirations and capsulectomy. I would favor the capsulectomy but this is something that should be discussed thoroughly with your surgeon. 

Wayne I. Yamahata, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 41 reviews

Is capsulectomy appropriate 9 months after explantation?

At this point, a capsulectomy with drain placement will be your best solution to stop the build up of fluid within your old breast implant pocket. In general, I would recommend a total capsulectomy when implants are removed because of capsular contracture. Thank you for sharing your question and concerns. Best wishes. Dr. Gregory Park, San Diego Plastic Surgeon.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 158 reviews

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