Capsules - should they stay or should they go?

Question

35yoF s/p submuscular HP mentor memory gel 450cc silicone breast implants placed in 2016, initially 32A, now 34D wanting breast implant removal for heaviness/back discomfort after pregnancy/breast feeding x2 and thus skin no longer supporting the weight of the implants. No intention to reimplant but understand I will need mastopexy. Have gotten mixed opinions on whether to proceed with capsulectomy or not. Will capsulectomy affect aesthetic result? I am thin with little breast tissue.

Richard Baxter, MD · Answer

Capsulectomy adds significantly to the risk of bleeding and other issues and will prolong recovery. It also makes it risky to do a breast lift at the same time. Considering also the fact that it removes some tissue, there is a definite possibility that it could compromise the eventual result especially if you are thin.

Sean T. Lille, MD · Answer

As long as you don’t have a capsular contracture I would leave the capsules alone. Having thin skin and removing the capsule could affect the blood supply to the flaps and May result in Irregular adhesions of the tissue to the chest wall creating deformities. I only remove the capsule if there is something wrong with it. All the best!

Kevin Brenner, MD, FACS · Answer

Performing capsulectomy, especially on a very thin woman, can result in scarring down of the skin to the chest wall. However, whether or not you choose to remove your capsules really should be dictated on your clinical presentation, and whether or not you have any symptoms of breast implant illness.

Brian K. Reedy, MD · Answer

Thanks for your question! I think that doing a total capsulectomy might be overkill. Some of the capsule will be removed with the implant, but what remains will likely not cause any health issues. Good luck!

Shaher W. Khan, MD · Answer

Hello, thank you for your question. Please see the attached video that answers your question specifically in detail. Not every patient may need a mastopexy after explant and is done on a patient to patient basis. A lift done at the same time as explant poses many risks including amount of time under anesthesia. I hope this helps!

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 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Mario Arturo Moran Romero, MD · Answer

The decision to perform or not to perform a capsulectomy entails a complex process. When there is evidence or suspicion of capsular pathology from the medical history, imaging studies, ultrasound, or MRI, I would recommend performing a total capsulectomy. Capsule gives blood supply to the tissue, and its preservation allows me to have more tissue to work. Performing a capsulectomy in submuscular implants harbors an increased risk of thoracic or lung injury. Clinical studies have not shown a clear benefit to performed capsulectomy against capsulotomy or capsulorrhapy. But you have to remember that the last evaluation of the capsule is made at the moment of surgery. During surgery, we can see and feel the pill. Bottomless, I must have an excellent reason to perform a capsulectomy, and it is not based on the aesthetic outcome.

Daniel Barrett, MD · Answer

Dear saraaa_,
generally speaking, if you don't have capsular contracture or thick capsules then you can get only implants removal. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Alan Gonzalez, MD, FACS · Answer

Hello @saraaa_, thank you for your question.  In my opinion the ideal approach to remove the capsules, all of them (total capsulectomy) during the explantation procedure since it is not known what can be found in the tissue. Afterward, it would be necessary to carry out a preventive biopsy on each capsule. The removal of the capsules avoids any future inflammatory process. I linked a video about en bloc and total capsulectomy that will shed some more light.   The most appropriate course of action is to consult one or several board certified plastic surgeons. This will allow you to get more information and options tailored specifically to your needs.  Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science Member (IFATS),Colombian Society of Plastic Surgery member (SCCP).

Finny George, MD · Answer

Hi, thank you for sharing your question. The decision to remove the capsules will depend on whether you have symptoms, whether they are deforming the pocket and whether they have any abnormal findings. It is a decision made together with your surgeon. Capsulectomy can impact the aesthetic outcome especially in patients with thin breast tissue.