375cc, silicone implants, should I leave the capsules in or take them out?

Hello @Somebodycool, thank you for your question. I believe that every time an explant is performed, the capsule must be removed. Complete capsulectomy. Whether it is en bloc does not matter as long as the whole capsule is removed and the tissue is sent for pathology after taking the capsule out. This will prevent future inflammatory responses from the body because capsules do not get reabsorbed. A capsule will always form around a prosthesis because it surrounds it and isolates it, since the prosthesis is a foreign tissue. To shed more light, I share a video. If you are considering a breast explantation, consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

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

A few factors may affect the decision to have a capsulectomy along with implant removal. If you have smooth surface implants, then there is virtually no chance of developing anaplastic large cell lymphoma in the capsules. But if you have textured implants, I would certainly remove the capsules. Since your implants are only 2 years old, there is very little chance of any gel bleed off the implant surface into the capsules, so once again, capsule removal isn't necessary from the point of view of silicone particles. Finally, if you are slender with very little soft tissue padding over your chest wall, then removing capsules might thin your breasts and chest wall a little more creating an uneven contour. For these reasons, I would consider leaving the capsules if you fit the categories I mentioned. But if you don't, or you have any symptoms of Breast Implant Associated Illness, then I would certainly have the capsules removed.

You should always have 100% of the capsule removed. This is the barrier around the implant that holds the silicone toxicity. All of the capsule plus any abnormalities and ALL inflamed tissue MUST be removed.

Dear Somebodycool,
it is hard to tell for sure without an examination. If your capsules are thin and you don't have capsular contracture then they can be left inside. In case of thick capsules, they should be removed. 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

If your implants are smooth and the capsules are very thin, sometimes the capsules will dissolve once the implants are removed. For very thin capsules, sometimes more tissue damage and bleeding occurs in trying to remove them. If you have textured implants, I would suggest trying to remove the capsules.

If removing the capsules along with your implants will bring you better peace of mind, then have them both removed unless there is a contraindication. Typically if there are no issues with the implants or the capsules it is an option to remove the capsules or leave them behind.