Explant with capsule left: How long is there a risk for fluid build up? Drs. that leave their patients in, do you see often?

Question

How high is the risk for fluid to build? How will you know? What’s the protocol if that happens? What issues does leaving a capsule behind cause?

Leland Deane, MD, FACS · Answer

The decision to leave some of the capsule behind is up to the surgeon and it is not unusual to have some fluid formed but it should not be clinically significant. I there is a lot of fluid and is detectable, then it should be aspirated/drained and treated.Hope this helps.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Though fluid accumulation is not common its greatest chance of occuring is in the first two weeks after surgery.  Typically the fluid can be removed with a Synge and needle but rarely a drain placement is required.  Hope this helps.

Patricia A. McGuire, MD · Answer

A capsule is connective tissue that forms around any foreign material in the body, whether a breast implant or a pacemaker. When an implant is removed, the capsule can be removed or left in place. Fluid collecting in the space which had been occupied by the implant can occur whether the capsule is removed or not. Drains are usually placed during surgery to lower that risk. I usually try to remove the capsule with implant removal, as long as removal doesn’t cause damage to the surroundings tissues. Fluid collection requiring treatment occurs  around 5% of the time after implant removal and can happen any time from days to a few weeks after surgery. The Treatment is usually placing a needle into the space and drawing off the fluid. Rarely would this require returning to the operating room. Your surgeon should discuss the advantages and risks of removing the capsule at the time of implant removal so you can make an informed decision.

Camille Cash, MD · Answer

Capsules are sometimes left behind when they are not thickened and there is no rupture of silicone implants.  There is a risk of fluid buildup after explant surgery.  It is usually well controlled with using compression after surgery.  If a fluid pocket does develop it can be aspirated in the surgeon's office.

Tom J. Pousti, MD · Answer

Thank you for the good questions.In many areas of plastic surgery, including breast implant removal surgery, you will find many different (often strong) opinions as to the best way to handle a specific situation. In my practice, generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic,  I do not remove them.  On the contrary (unless indicated), capsulectomy can expose you to additional risks, such as bleeding and some breast size loss.  Your plastic surgeon, based on your physical examination, will  be able to inform you whether the breast implant capsule is thickened or abnormal.
Having said that, I often remove a small segment of capsule tissue when removing breast implants ( even when not encapsulated) with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.   Seroma formation is unusual.  If it does occur, aspiration of the fluid with a needle may be necessary.Hopefully, you have chosen your plastic surgeon carefully; do not hesitate to address your questions/concerns directly to him/her and ask about the rationale behind any decisions that you question. Best wishes.

Karol A. Gutowski, MD, FACS · Answer

Significant fluid in the capsule after implant removal is very rare. If it happens, it can be drained with a needle or drain.

Explant with capsule left: How long is there a risk for fluid build up? Drs. that leave their patients in, do you see often?

Answers (6)

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