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What happens with the capsule being left in when implants explanted under local?

My saline implants are intact and very soft, with no contracture or rupture. Had a consult, and surgeon said he could remove them under local, in his office which kind of freaked me out. After thinking this over, I do like the idea of the local better...but what about the capsule being left inside me? Does it shrink up and get lumpy? Will it obscure the view for mammograms? Can it contract after implant removal?

Doctor Answers 7

Some Times the Capsule Melts Away

September 13th, 2016
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Once implants are put in the body they develop a healing "capsule" made of collagen. Sometimes this capsule is thin and soft and can be left after removal of an implant. It will collapse and melt away with time,once the implant is removed. Other times the capsule is thick and scared and should be removed with the implant when the patient desires explantation. I commonly remove implants, remove 60-70% of the capsule, repair the pectoral muscle, perform an internal purse string tightening of the breast (called an internal mastopexy) and then graft fat to restore fullness. Most patients also require an external mastopexy, or breast lift. With this protocol we can usually achieve a more attractive breast than before the implant was removed. Patients who want a larger breast will require a second fat grafting proceedure.

Robert D. Rehnke, MD


Saint Petersburg Plastic Surgeon
3.8 out of 5 stars 10 reviews

September 13th, 2016

Some Times the Capsule Melts Away

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Once implants are put in the body they develop a healing "capsule" made of collagen. Sometimes this capsule is thin and soft and can be left after removal of an implant. It will collapse and melt away with time,once the implant is removed. Other times the capsule is thick and scared and should be removed with the implant when the patient desires explantation. I commonly remove implants, remove 60-70% of the capsule, repair the pectoral muscle, perform an internal purse string tightening of the breast (called an internal mastopexy) and then graft fat to restore fullness. Most patients also require an external mastopexy, or breast lift. With this protocol we can usually achieve a more attractive breast than before the implant was removed. Patients who want a larger breast will require a second fat grafting proceedure.

Robert D. Rehnke, MD


Saint Petersburg Plastic Surgeon
3.8 out of 5 stars 10 reviews

Capsulectomy

June 5th, 2016
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Nothing will happen.  You would need a capsulectomy. For explant surgery, it is almost always best to remove the capsule in its entirety. This will allow the space to heal. If you leave the capsule in place, it does not heal. Fluid can accumulate in the space. The situation that brings the patient to implant removal will have an affect on the decision. This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns. The body does not re-absorb the capsule. Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule. If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower. If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.

Web reference: http://www.plasticsurgery-sanantonio.com/breast/revision/

Gary Lawton, MD, FACS
June 5th, 2016

Capsulectomy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Nothing will happen.  You would need a capsulectomy. For explant surgery, it is almost always best to remove the capsule in its entirety. This will allow the space to heal. If you leave the capsule in place, it does not heal. Fluid can accumulate in the space. The situation that brings the patient to implant removal will have an affect on the decision. This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns. The body does not re-absorb the capsule. Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule. If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower. If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.

Learn more: http://www.plasticsurgery-sanantonio.com/breast/revision/

Gary Lawton, MD, FACS

Leaving capsule

May 30th, 2016
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You would need a GA to remove the capsule and GA is my preference for explantation- although in the UK there are few saline implants placed and my explantation experience is mainly with silicone cohesive gel implants.

Local is an option for saline implants and if the capsule is thin (best assessed on an examination) then there are less perceived risks of leaving the capsule - however you won't 100% know until the operation. The problem is that during the op if you need the capsules removed this may not be possible.

Web reference: http://www.garylross.com/breast/breast-augmentation-removal/

Gary L. Ross, MBChB, FRCS
May 30th, 2016

Leaving capsule

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You would need a GA to remove the capsule and GA is my preference for explantation- although in the UK there are few saline implants placed and my explantation experience is mainly with silicone cohesive gel implants.

Local is an option for saline implants and if the capsule is thin (best assessed on an examination) then there are less perceived risks of leaving the capsule - however you won't 100% know until the operation. The problem is that during the op if you need the capsules removed this may not be possible.

Learn more: http://www.garylross.com/breast/breast-augmentation-removal/

Gary L. Ross, MBChB, FRCS

Leaving the capsule with a simple removal of breast implants.

May 29th, 2016
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There is a great deal of misunderstanding about what a breast implant capsule is and what happens to it upon removal of breast implants. 
The so-called capsule around breast implants is simply a layer of scar tissue. It is the way the body heals around any synthetic object that it cannot heal into. It is only a "capsule" because it is spherical around the spherical implant. If a flat silicone plate were put in the tissues the capsule would be flat. It is also true that a new layer of scar tissue heals where the capsule was if the implant and existing capsule are removed. It is no longer spherical but it's still a layer of scar tissue left where the implant pocket was. 
There is no medical reason to remove normal scar tissue or capsules around an implant if they are normal. If they are calcified, thickened, rigid, or possible containing a layer of biofilm or infection then it makes sense to remove them. In your case there is no need to remove the capsule and add to the cost, complexity, and risk of the explant procedure. The scar tissue layers will collapse and do nothing more than a layer of scar tissue for other reasons would. It will not obscure a mammogram and it can't contract because there is no longer anything to contract around. I have yet to see fluid build up in the capsule space after simple explant of saline-filled implants but if it occurs it is not hard to aspirate or drain with no implant to worry about. 
Scott L. Replogle, MD

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

May 29th, 2016

Leaving the capsule with a simple removal of breast implants.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is a great deal of misunderstanding about what a breast implant capsule is and what happens to it upon removal of breast implants. 
The so-called capsule around breast implants is simply a layer of scar tissue. It is the way the body heals around any synthetic object that it cannot heal into. It is only a "capsule" because it is spherical around the spherical implant. If a flat silicone plate were put in the tissues the capsule would be flat. It is also true that a new layer of scar tissue heals where the capsule was if the implant and existing capsule are removed. It is no longer spherical but it's still a layer of scar tissue left where the implant pocket was. 
There is no medical reason to remove normal scar tissue or capsules around an implant if they are normal. If they are calcified, thickened, rigid, or possible containing a layer of biofilm or infection then it makes sense to remove them. In your case there is no need to remove the capsule and add to the cost, complexity, and risk of the explant procedure. The scar tissue layers will collapse and do nothing more than a layer of scar tissue for other reasons would. It will not obscure a mammogram and it can't contract because there is no longer anything to contract around. I have yet to see fluid build up in the capsule space after simple explant of saline-filled implants but if it occurs it is not hard to aspirate or drain with no implant to worry about. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Can leave capsule

May 29th, 2016
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It is OK to leave the capsule and remove the implants under local.
The capsule shrinks and tends to go away.
If there are problems later, a bigger operation can then be performed.
Most likely you will be fine with the smaller operation.
Keith Denkler, MD
May 29th, 2016

Can leave capsule

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is OK to leave the capsule and remove the implants under local.
The capsule shrinks and tends to go away.
If there are problems later, a bigger operation can then be performed.
Most likely you will be fine with the smaller operation.
Keith Denkler, MD

What happens with the Breast Implant scar capsule after the Breast Implants are removed?

May 28th, 2016
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Our literature has repeatedly demonstrated that when implant are removed with a soft, invisibly or barely palpable breast implant scar (ie Baker I and II class), nothing happens. As a matter of fact, removal of scar is done minimally (usually just over the roof of the implants NOT under them) in these cases to avoid the real complications of complete capsulectomy.
IF you have hard and or painful capsules (probably infected or colonized) especially calcified ones, then serious consideration needs to be given to removing as much of the breast capsule as possible.

Peter Aldea MD
Memphis, TN
Peter A. Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.8 out of 5 stars 114 reviews

May 28th, 2016

What happens with the Breast Implant scar capsule after the Breast Implants are removed?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Our literature has repeatedly demonstrated that when implant are removed with a soft, invisibly or barely palpable breast implant scar (ie Baker I and II class), nothing happens. As a matter of fact, removal of scar is done minimally (usually just over the roof of the implants NOT under them) in these cases to avoid the real complications of complete capsulectomy.
IF you have hard and or painful capsules (probably infected or colonized) especially calcified ones, then serious consideration needs to be given to removing as much of the breast capsule as possible.

Peter Aldea MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon

Explantation without capsulectomy

May 28th, 2016
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The peer reviewed literature in plastic surgery recommends removal of capsules to avoid complications later.  Fluid collections, infections and difficulty detecting cancer are noted.  Also, I have found that biofilm problems with bacteria and fungi in the capsule will not resolve without capsulectomy.
Susan Kolb, MD
May 28th, 2016

Explantation without capsulectomy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The peer reviewed literature in plastic surgery recommends removal of capsules to avoid complications later.  Fluid collections, infections and difficulty detecting cancer are noted.  Also, I have found that biofilm problems with bacteria and fungi in the capsule will not resolve without capsulectomy.
Susan Kolb, MD

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.