Augmentation 5 Years Post Explant - Will the capsules left behind a few years ago pose a problem, cosmetically speaking?

You need a thorough evaluation before considering putting in new implants. The remaining capsule is soft and will not pose a huge problem but the surgeon should be experienced. Also, you need a good evaluation to see if a breast lift would give you the fullness you want with minimal scarring. A virtual consultation might help and I'd be happy to do this.
Best of luck.

Dear BAMAgain,

it is hard to tell for sure without an examination, but most likely your previous surgery scars will not be an issue. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

The old capsules would probably not create any problem. Plastic surgeons who specialize in breast surgery would be able to manipulate the old capsule to give you a natural appearance. Sometimes the capsule would not even have to be addressed, and you would have a beautiful result. Often the implant can be put in the same place as the old capsule, or some surgeons may consider placing the implant above the muscle. Good luck with everything. I suspect he will not have any significant issues.

After removal, the old implant pocket will shrink over time. While still present, they do not present a cosmetic issue.

In the setting of repeat augmentation, a surgeon may create a neo-pocket or attempt to re-enter the prior pocket re-expanding it. Regardless, this is unlikely to have a significant impact the final cosmetic result.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

We know that most of the implant related capsule will be absorbed by the body in time. However, some parts may be still present if your surgeon will use the same submuscular plane to place new implants. There are multiple options to avoid this by placing implant into new pocket on top or beneath the muscle. In any case, whatever is left of old capsule should not affect shape of the breast. This is something you should discuss with your surgeon. Good luck

Thank you for your question. If the capsules were soft at the time of explantation, they should not pose a problem during your new surgery. Oftentimes, the surgeon may elect to use the same pocket, though it may require some mild expansion, or decide to use a neo-pocket. As always, a consultation with a board-certified plastic surgeon will help you define your goals to optimize the results. Good luck on your journey!

Yes, the old capsules can potentially affect your new augmentation cosmetically and structurally but not always. It depends on the condition of the capsules and how your body heals. Let’s break this down:
What are the Implant Capsules?
Capsules are scar tissue your body forms around implants. If your explant surgery did not remove them (no capsulectomy), they are likely still intact to some degree.
Potential Issues with Keeping the Old Capsules During Re-Augmentation
1. Distortion or Irregular Shape
If the old capsule has contracted (capsular contracture) or is uneven, it can distort the shape of the new implant. This might not be visible now because there’s no implant pushing against it.
2. Implant Malposition
The capsule can guide or restrict where the new implant sits, possibly making the implant appear too high, low, or to the side.
3. Palpability or Rippling
A thick or uneven capsule could show through the skin more if the implant is placed again especially if you’re thin or using saline implants.
4. Unknown Integrity of the Capsule
After 5 years, capsules may be calcified, thickened, or fibrotic, not ideal for a smooth, natural look.
What to Consider
• If your breasts look normal now and the capsules aren’t contracted, there’s a chance they won’t pose a major issue, but it’s not guaranteed.
• If you want a different size, shape, or type of implant, the capsule may not fit properly and should be modified.
• If you had any symptoms of capsular contracture before, removing or releasing the capsule is more strongly recommended.
You can get new implants after explant without capsulectomy but the old capsules may need to be addressed during surgery. Most likely, an experienced surgeon will inspect them and adjust as needed to ensure your cosmetic result is smooth, symmetrical, and natural-looking.

Since you did not post any photos, a virtual or in person consultation is needed specifically a virtual consultation. Most likely an ultrasound of the breast with a mammogram is required, looking for the effect of the capsule of any. Afterwards conceptually aSince you did not post any photos, a virtual or in person consultation is needed specifically a virtual consultation. Most likely a ultrasound of the breast with a mammogram is required, looking for the effect of the capsule of any. Afterwards, conceptually a combination called a composite augmentation would most likely be the better alternative. The composite augmentation is a combination of breast implants with fat grafting. Expect fees to range from $15,000-$20,000. Additionally, if the capsule appears as a potential issue a capsulectomy or partial capsulectomy of the areas in question is indicated. Again virtual consultation would add to this discussion.

When patients ask to have their breast implants removed, I asked them to really think this through and give me a solid reason why they no longer want the implants.
Changing your mind and wanting to re-augment again it’s a poor strategy.
Each time you have surgery things become more complicated and difficult.
During the second procedure, the surgeon is not working with virgin native tissue, but instead has to operate through layers of scar tissue.
Scar tissue behaves very differently than the tissues during the primary procedure.
Capsulectomy is indicated when removing implants if the patient has a significant degree of capsule contraction.
If the capsule is very thin, and there’s no evidence of capsular contraction than the capsule should not be removed because doing so has no benefit and tear us up the pectoral muscle.
If there is no capsule or the capsule is microscopically thin, then dissecting the capsule from the muscle just beats up the pectoralis muscle. However, if there’s a thick capsule, then separating the capsule from the pectoralis muscle and or the rib cage becomes technically easier and should be done.
A thick capsule can distort the shape of the breast when the implant is removed.
Each plastic surgeon has their own way of doing this.
Even if you had the capsule removed, they’re still going to be a layer of scar tissue after the implant was removed.
The potential outcome of a secondary breast augmentation depends on a number of variables.
As always provider selection and patient candidacy are the two primary variables that determine potential outcome.
In your case, if the first procedure was done in a technically excellent manner and you didn’t develop thick capsules then re-augmentation may be fairly straightforward.
There is however, going to be scar tissue and the scar tissue can deform or change the shape of the breast.
It very much depends on each situation, which can be unique.
For others who may be reading this post, I recommend really thinking through the idea of removing breast implants, unless there’s a really good reason.
Patients who are not having complications often, regret, removing the implants, and do not realize what their appearance will be like after explanation.
I hope my post doesn’t come across as lecturing.
Hopefully you’re in the hands of a talented provider and should expect a good outcome.