Is an en bloc capsulectomy procedure easier over the muscle than under it?

Capsulectomy is indicated when there are abnormalities of the capsule secondary to a breast implant. I had a case today of a calcified capsule I removed in it's entirety. I believe it is best to remove any capsule that has abnormalities. Whether the capsule is above or below the muscle has little effect on the ability of a qualified plastic surgeon to remove it.

Dear klmtc,
Generally speaking, it is a bit easier to remove implants and capsules when they are located over the muscles. But for a board-certified plastic surgeon, even under the muscle implants placement should be no problem. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If the implant is completely placed over the muscle then it is easier to do since there is less risk of injury to the underlying ribs.  However, often times retro-pectoral are only partially retro-pectoral and sometimes they have extruded inferiorly and laterally.Best Wishes,Gary Horndeski, M.D.

In theory the en bloc capsulectomy ensures the maximum amount of silicon is removed without contaminating the body further. It also allows your breast tissue to return to its natural and normal state.  Over, rather than under, the muscle may be easier; but a board certified PS should not find either procedure difficult

Thank you for sharing your excellent question.  Because of the separation of tissue planes present it is easier for an en bloc over the muscle, compared to under.  Hope this helps.

It will pretty much be the same to you either over or under the muscle. If you are under the muscle, your muscles have already been stretched. If you are over the muscle, the muscles won't be stretched.

Yes, it is easier to remove the capsule and implant en bloc when they are on top of the muscle.  When the capsule is underneath the muscle, the bottom portion of the capsule is stuck tightly to the ribs.  Removal from underneath has a higher chance of bleeding and the possibility of entering the lung cavity.  

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) Total capsulectomy is never an "easy" procedure. It depends on the surgical approach, the thickness of the capsule, and how adherent the capsule is to the surrounding tissue (to name a few factors). 
If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!
Matthew A. DelMauro, M.D.

 First of all there is nothing easy about en bloc capsulectomy. Secondly over the muscle runs a higher risk of damage to the underlying skin which is usually very thin and just over the capsule. It’s a less risky operation if the implant in pocket is under the muscle. Best regards

Thank you for the question. Yes, capsulectomy surgery is "easier" for breast implants above pectoralis muscle compared to breast implants in the sub pectoral space.  In the sub pectoral space, the posterior surface of the capsules may be attached to the patient's rib cage: capsulectomy surgery exposes patients to risks such as increased bleeding and/or entrance into the chest cavity ( causing complications such as pneumothorax). I hope this helps.