Capsulotomy under local anesthesia possible?

Question

I am scheduled to have my implants removed at the end of October . My surgeon said she can remove my implants and preform a capsulotomy under local. Is this typically advisable under local? I understand a capsulectomy must be done under general but wasn't sure about capsulotomy. Also is s capsulectomy needed? One of my breast is very soft the other fairly firm but no real pain

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.Since you are dealing with implants which may be below your muscle, my recommendation is to not do this under local.If a capsulectomy is needed, I definitely recommend anesthesia as removing the capsule near muscle without relaxation can cause a lot more bleeding and muscle trauma.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

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

Nelson Castillo, MD · Answer

Thank you for your question.  Implant removal alone can be safely done under local anesthesia, assuming the capsule around the implant does not need to be removed.  In cases where the capsule has thickened and is firm, it is best to remove the capsule but this is best done under general anesthesia for your safety.  Hope that this helps.

Stuart A. Linder, MD, FACS · Answer

It's not recommended to remove your implants under local anesthesia. General anesthesia is preferred for your safety and cimf

Francis Johns, MD · Answer

In cases where we are just removing implants and releasing the capsule (capsulotomy), we do them with local without any problem.  It all depends on the patients pain tolerance, but once the local injections are done you will feel very little discomfort.  This is a quick procedure, doing it with local anesthesia helps speed up recovery for you as well. In regards to the capsulectomy, as long as the capsule is thin you can leave it in place.  The body will reabsorb it without any problem and you don't have to worry about any problems in the future.

Andrea Marando, MD · Answer

Thank you for your question. A capsulotomy is a relatively less invasive procedure compared to a capsulectomy (in the capsulotomy the capsule is incised and released but not removed, in a capsulectomy the capsule is incised and removed). In my practice in Manchester and London I do routinely perform capsulectomies and capsulotomies under local anaesthetic and sedation (twilight anaesthetic) as I find that a pure local anaesthetic might not be sufficient to keep the patient comfortable during the procedure. However I would advice you to ask your surgeon what is the exact surgical plan and what is expected, so that you can make the most appropriate decision. Best of luckAndrea Marando

Tom J. Pousti, MD · Answer

Thank you for the question. As you likely know, different plastic surgeons have different ways of doing things. In my practice, breast implant removal alone (under  local anesthesia) is a possibility but I would not suggest that the procedure performed under local anesthesia if capsule work is also planned. Best wishes.

Connie Hiers, MD, FACS · Answer

Your surgeon, who has examined your breasts, will be the best one to tell you if a capsulotomy can be done under local anesthesia. If the capsules are fairly thin, most are left in place, unless you have the old gel implants. I have removed many implants and performed a capsulotomies and even capsulectomies under local anesthesia with sedation. I have removed implants just under local anesthesia when the capsules were very thin. I suggest discussing any concerns you have with your surgeon.

Michael J. Brown, MD · Answer

Hi,

Thanks for posting your question. I am happy to try and help you. It is
important to remember that a board certified plastic surgeon will be your best
resource when it comes to an accurate assessment of your situation, and
concerns.

Having said that, people get confused trying to use medical terms they do not understand. You are better off not trying to use these terms and learn what the doctor is actually telling you. Simply put: any word with 'ectomy' at the end of the word means to remove, so tonsilectomy, appendectomy, mastectomy all mean to remove the organ. So these would be to remove the tonsils, appendix and breast, respectively. Any word with 'otomy' at the end of the word means to open or make a hole in. So in terms of a breast implant capsule, a capsulotomy simply means they are going to cut a hole in the capsule to pull the implant out. There is no removal, just open. Obviously, if you want the implant removed, exchanged, pocket surgery, etc they all start with the 'otomy'. Thats it. So a capsulotomy under local anesthesia or light sedation is absolutely fine. For breast implant removals, as long the capsule is thin, soft and without calcium deposits, it is fine to leave them in. The body will reabsorb the thin layer over time. This is of no consequence and is entirely safe. I hope all goes well with your surgery.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

Camille Cash, MD · Answer

Yes.  However it depends on the severity of capsule.  I would recommend a second opinion to determine if you are a candidate for mesh to assist in preventing any future capsules.  If this is the case you would need general anesthesia.