Is it safe to leave the capsules in after removing silicone implants? (Photo)

Question

Lots of women say they are sick and its from implants. I am reading alot of horror stories and i am scared if I don't remove my capsules with my removal i will get cancer or be as sick as these women that claim breast implant illness! Please guide me in what is true about this!

Yannis Alexandrides, MD, FACS · Answer

This is something to be discussed with your surgeon. If there are no other concerns with your breast and you just want to remove the implants then it is safe to leave the capsule in. If there have been any concerns about other problems with your breasts that arise from your capsule of the breast then you should discuss capsulectomy with your surgeon.

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

Kenneth Hughes, MD · Answer

Capsulectomy does not have to be performed in the instance of thin, pliable capsules.  Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.  A number of scientific studies have demonstrated the safety of silicone implants; yet, many patients continue to have anxiety about their use.
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

Donald R. Revis Jr, MD · Answer

Good afternoon!I think it is a good idea to remove the capsules for several reasons- it helps get rid of the space your implants occupied- in other words it is easier for the space to heal closed and your breasts go back to normal without distortion or fluid collections, etc.

Gary M. Horndeski, MD · Answer

At
the time of surgery, the surgeon can determine whether the capsule needs to be
removed.  If your implants are
retro-pectoral and there is a firm capsular attachment to the ribs, it is
possible to get a pneumo-thorax from posterior capsule removal or
bleeding.  It is for these reasons some
surgeons leave the capsule behind. 
However, if you do undergo explantation you will need a breast
lift.  The technique I recommend is The
Bellesoma Method.  This will reshape your
breast tissue creating upper pole fullness without implants, elevate them
higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation
and the ability to breast feed are maintained, if not injured during your
previous surgery.  At the same time or
later, fat transfers can be performed if additional volume is desired. Best Wishes,Gary Horndeski, M.D.

Anita Patel, MD, FACS · Answer

Please don't be in a panic about your implants from reading horror stories! It is entirely understandable that if someone had no symptoms before implants, and developed new symptoms after, the fear will be that the implants were the cause. This does not mean the implants were necessarily the cause, or even related. Think of any disease process, and how before the disease began, the patient did not have symptoms, and after it started, they did. Whether or not any given patient's illness is related to the implants requires an in-depth history and physical. The symptoms experienced may not have an easily identifiable cause or have anything to do with the implants themselves. In cases where there is no identifiable cause, implant removal is still a reasonable consideration. Even in cases where the symptoms are not thought to be due to the implants, if the patient needs implant removal for peace of mind, then the implants can be removed. If you are not having any illness, do not have capsular contracture, and want your implants removed, there are different options for the capsule. You can either have a total capsulectomy (the entire capsule is removed along with the implant), a partial capsulectomy (part of the capsule is removed), or leave most of the capsule in place. There are risks and benefits of each. Leaving part of the capsule behind is not thought to increase your breast cancer risk, or cause illness. However, it is possible to have things like seroma or infection involving the capsule. On the flip side, depending on how much breast tissue you have, aggressive removal of the entire capsule can create scarring that is visible as a contour depression, or uneven surface. This conversation is best had after seeing a plastic surgeon in person for a consultation, who can take into account your full history and physical, hear all of your worries and concerns, and discuss your options so that you can together make the best decision for your goals.

Daniel Barrett, MD · Answer

Dear Emotional3,There have been numerous studies on the safety and efficacy of silicone breast implants. The FDA has approved them to be safe and breast augmentation is the most common cosmetic surgical procedure performed in the United States every year. Implants are much different than they used to be with rigorous testing and cohesive gel. I can't tell you how happy my breast augmentation patients have been with their implants.
I would recommend a consult with a plastic surgeon to go over all of your concerns. Saline implants are also a perfectly good option if you are still concerned and are less expensive.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Douglas J. Mackenzie, MD · Answer

If you have no issues other than wanting your implants out, and your capsules are not contracted, then performing a capsulectomy is meddlesome and risks contour irregularities for no reason.  There is also no risk for cancer from a capsule left behind.  However, if you have capsular contracture, then you should have a capsulectomy.  And if you have systemic issues that may be related to the implants, so-called breast implant illness (BII), then an en bloc capsulectomy is done. This is a complete capsulectomy, where we try to remove the capsule and implant in one piece.  BII is a controversial topic, but most patients improve their symptoms significantly after surgery.

Camille Cash, MD · Answer

Typically it is up to the patient's discretion to have or not have the capsules removed as long as the capsules are not thickened, are not causing issues, and no implant rupture is detected.  If any of those scenarios is present the capsules should be removed.  With that being said, if you are worried about what you've read you can choose to have the capsules and implants both removed for your peace of mind.

Tom J. Pousti, MD · Answer

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 bloc or complete capsulectomy and 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.
 
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well. Working together you will come up with a good plan.   Best wishes.

Is it safe to leave the capsules in after removing silicone implants? (Photo)

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