Help deciding what type of procedure to remove 6 month old silicone implants?

What is the difference between the types of removals? Removal of capsule vs removal of scar tissue vs. capsulectomy vs capsulotemy? Confused as to what I need/want to have performed when I explant. I want to have my 100% natural body back without leaving any trace of implants behind. Are drains necessary? No complications or abnormalities with current implants, just regret my decision to get them and want them out ASAP!

Doctor Answers 10

Implant Removal

Thank you for your question, and very sorry to hear of your troubles. When the implants are removed, there is a capsule or layer of scar tissue around the implant. Capsulotomy is cutting or releasing a tight constricted capsule. A capsulectomy is removing the breast capsule which is usually not needed if it is soft, immature and asymptomatic. This capsule does not necessarily have to be removed, but 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. After the implants are removed, any small capsule that is left will over time soften and dissolved/resorb and the breasts will settle into their post implant shape minus the skin stretch and original breast tissue/muscle shrinkage which should be minimal in someone with implants in for only 6months.

Benjamin J. Cousins MD Board Certified Plastic Surgeon

Miami Beach Plastic Surgeon
5.0 out of 5 stars 10 reviews

Implant Removal

I am sorry you are not happy.  If the implants are soft (no capsular contracture), the implants can be simply removed usually under local anesthesia.  Often times, a breast lift may be needed depending on your skin quality and amount of droop after the implants are removed.  In my opinion, this is always done best secondarily (3-6 months after removal).  

Joshua A. Greenwald, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 135 reviews

Implant removal

Thank you for your question. Entirely depends on the size of the implants and how much your skin is stretched which I assume can't be much because of the short amount of time, however it depends what you started with. Generally speaking the capsule does not have to be removed as long as it's soft. I routinely put drains in to close the empty space for about a week. Best of luck.

Payman Danielpour, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 36 reviews

Help deciding what type of procedure to remove 6 month old silicone implants?

Thank you for your question.  I would recommend starting with a board certified plastic surgeon to consult and have advice regarding your specific exam and concerns.  Generally, one does not need to have a complete capsulectomy unless there is significant scarring or thickening of the capsule.  It would be uncommon to have this after just six months.  The use of drains are surgeon and condition dependent variables.  Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 23 reviews

Breast capsule

The capsule that forms around any implant (breast, chin, knee etc) varies tremendously.  The tissue can be thin and pliable or thick and calcified.  In the case of an implant that has been in for six months the tissue should be thin and in that case can be difficult to completely remove.  It is often safer and better for the surrounding tissue to leave some or all of the capsule. Discuss with your surgeon, hope this helps. Jane

Jane M. Rowley, MD
Lubbock Plastic Surgeon
5.0 out of 5 stars 38 reviews

Help deciding what type of procedure to remove 6 month old silicone implants?

The decision to do an implant removal only v capsulectomy (removing the capsule) v capsulotomy (weakening the capsule) is made together with your surgeon. If the capsule is causing problems then it is best to remove it entirely. However, if it is not causing you problems then it might be OK just to do an explantation of the implant. In your case you a capsulotomy is not required, so either you have it removed completely which is what I think you say want v just taking the implant out. The decision to put drains in is made during the surgery. This needs a good in depth discussion with a board certified plastic surgeon who is experienced in this kind of surgery and decision making tailored to individual patients.

Mo Akhavani, MD, FRCS(Plast)
London Plastic Surgeon
4.8 out of 5 stars 17 reviews

Help deciding on what type of procedure to remove 6 month old silicone implants?

Thank you for sharing your question.  Though opinions will vary tremendously I would recommend implant removal and total capsulectomy.  This will restore your breasts to their pre-augmented state.  Depending on the size of implant you have and the amount of scar tissue removed you may need a drain in each breast for a few days after surgery.  Hope this helps.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 reviews

Help deciding what type of procedure to remove 6 month old silicone implants?

 I am sorry to hear about your concerns after breast augmentation surgery. Based on your history of having heavy breast implants for six months (without breast implant or capsule related complications),  removal of the breast implant capsule does not sound like it would be necessary in your case.

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 block removal of breast implants is a good procedure.

***On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.

Recently I have become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy is always necessary and undergo unnecessary surgery associated with additional morbidity and unnecessary expenses.

Drain usage will vary from one practice to another. I almost always use drains for breast implant removal surgery procedures.

 The good news:  breast implant removal surgery is a very well-tolerated procedure with minimal discomfort,  compared to first-time breast augmentation surgery. Patience is definitely indicated after removal of breast implants; it will take many months for the skin to “bounce back” and for you to see the final appearance of the breasts.

I hope this, and the attached link, helps. Best wishes for uneventful surgery and an outcome that you will be very pleased with.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Capsulotomy, capsulectomy and scar removal with breast implant explantation at 6 months after placement

Hi there and thank you for the question. 

All breast implants are seen as foreign and so the body reacts by weaving a cocoon like shell around the implant called a capsule. On its own this is not harmful but in some patients it can become thicker and harder which can then mar the result and can on occasion be sore; this is capsular contracture. If the implants are to be removed then the cause of any thickening or scarring (i.e. the implant itself) will also be removed so it is not always necessary to be radical in removal of scar / capsule / contracture tissue. If implants are to be changed or replaced then it is always best to make a fresh start and remove all the previous implant related capsule. Removing the capsule of an implant completely  is known as capsulectomy. If implants are being replaced and the previous capsule is thin and soft then it may be appropriate to only make a hole in the capsule through which the old implants can be removed and the new ones placed and then this is called a capsulotomy. If you have decided to remove the implants and they were placed only 6 months ago there will not be much of a contracture developed but this would be seen and assessed at operation but in your case the operation should be  straightforward.

I hope that you have found this information to be helpful.

Best wishes

Tariq Ahmad, MBBChir, FRCS(Plast)
London Plastic Surgeon
5.0 out of 5 stars 11 reviews

Help deciding what type of procedure to remove 6 month old silicone implants?

Removal of breast implants is a relatively easy procedure.  Removal of the scar tissue is based on the thickness and if you are having pain.  Regardless, I try to remove all scar tissue when possible.  Drains are used on occasion, but the decision is usually made during surgery.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.