What happens with the capsule being left in when implants explanted under local?
Doctor Answers 7
Some Times the Capsule Melts Away
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.
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.
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Leaving the capsule with a simple 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.
Can leave capsule
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.
What happens with the Breast Implant scar capsule after the Breast Implants are removed?
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
Explantation without capsulectomy
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