Explant - Is it safe to leave capsules in long-term? (photos)

Question

Hi, I'm going t have my implants removed in around 2 weeks time. I've had them for about 5 months then. I don't have any hard capsules- they are soft. I don't like the feeling of having implants nor how mine turned out unfortunately:/ I can see a lot of people argue that capsules "need" to be removed but I can't find any research for this. I'd prefer the least invasive surgery. Will keeping the capsules in be bad long term? Also maybe this will give some more volume due to my tiny boobs? Thanks

Gary M. Horndeski, MD · Answer

If the capsules are normal they can be left long term with no concern. If the capsules are infected or calcified then they need to be removed at the time of implant removal. You may need a lift due to hanging skin.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Alan Gonzalez, MD, FACS · Answer

Hello Dear @Lapiz_Lazuli Is not safe to leave the capsules after removing breast implants. After 21 years of experience and several breast implant removal surgeries I suggest taking out the whole capsule. After so many explants I can attest that when a patient comes for an explant and had has a change of prostheses without the removal of the first capsules, when I perform surgery I find 2 capsules: The ones left there from the first surgery and the capsules of the new prostheses. So every time we change prostheses we also remove the capsules because that way the mammary tissue can recuperate better and avoid a future inflammatory response from the body or an autoimmune syndrome like Asia Syndrome. Best wishes! Alan Gonzalez MD FACS

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 Surgeo

Best, 
Dr. Karamanoukian
Realself100 Surgeo

Irena Karanetz, MD · Answer

Hello, 
And thank you for the question and the photos.
If the breast capsules are soft without any issues or evidence of capsular contracture, it is safe to just remove the implants without performing capsulectomy. 
Following removal of breast implants without replacement, a patient may choose one of two options: do nothing and see how much the skin retracts and then decide about fat grafting or breast lift at a later point, or undergo a breast lift and fat grafting at the same time. 
Since you had small cup size breasts prior to undergoing breast augmentation, the breast volume and size will be similar after removing the breast implants, and the breasts may look more droopy (due to thinning of the tissues from the weight of implants). 
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.
Best, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Richard Baxter, MD · Answer

You don't need to have the capsules removed, but if your implants are under muscle then make sure it is re-attached. You are correct that there isn't any research that supports routine capsule removal.

Daniel Barrett, MD · Answer

Dear Lapiz_Lazuli,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

I'm sorry that you are unhappy with your breast augmentation.  As you've had your implants in for only 5 months your capsules will be very thin.  You can elect to have the implants removed and leave the capsules behind.  This will be the least complicated option.  I encourage you to discuss your concerns with your surgeon.

Connie Hiers, MD, FACS · Answer

If your implants are soft and the capsules are thin, the capsules can be left in with fewer risks. However, you may need drains to minimize the risk of a seroma. Many capsules, especially with saline implants, then to dissolve over time.