Will an implant removal without capsule removal cause problems in the future? What should I expect from scarring?

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

The capsule has in it the impurity and the toxicities of silicone that has leeched from not only from the silicone breast implant, but also the saline breast implant. Leaving the capsule behind will inevitably leave the silicone toxicity behind that will continue to harm the body. Explant surgery mandates removal of all capsule; that is the entire operation in itself, plus the removal of not only the capsule, but all inflamed tissue, along with the implant. If any of the capsule is left behind, that is considered incomplete surgery. We can tell this from not only the many pathology reports that show silica within the capsules, but also the many patients who have had residual silicone capsules removed, an ultimate improvement in their health. This is not an easy operation, and not everyone can do it.

Plastic surgeons do not routinely remove the capsules unless there is indication such as infection or calcification. Also, en bloc is used from cancer patients not for explant and lift patients. Depending on the size of your implants, one of the issues you may encounter is sagging of the breasts. Often times, patients require a lift at the time of explant. The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Hello @Crafty1227, 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 as the capsule does not get reabsorbed by the body as previously believed. To shed more light on the scarring process, 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.

I remove implants typically under local through a small incision under the breast, oftentimes the access scar for the augmentation procedure. If the implants are smooth implants and soft, then no question capsule does not need to come out.
I hope this helps!

Dear Crafty1227,
generally speaking, if your capsules are thin and cause no issues, then they can be left inside. 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 capsules are very thin, they should not be a problem to leave in place. With some implants, the capsules may even dissolve over time. En bloc surgery is not for removal of capsules, but a more extensive surgery to remove surrounding breast tissue to treat cancer. You would not have en bloc just for implant removal with or without capsules.

I routinely leave the capsules in on any breast explanation that has no issues. There is no reason to remove the capsule unless there is cancer or thickening.

Capsules should be removed if they are thickened, causing issues, or if there is a rupture with the implant. Otherwise it is an option to remove them or leave them behind. As long as they are thin the capsules should not negatively impact your recovery or how your breasts appear after healing is complete.

When breast implants are removed without removing the surrounding scar tissue capsule, it's called "en bloc" or "total capsulectomy" removal. However, not all cases require or benefit from en bloc removal. The decision to remove the capsule along with the implant depends on various factors, including the condition of the capsule, the type of implant, and the reason for removal.
Here are a few points to consider:
1.) Capsule Integrity: If the capsule around the implant is intact, not causing pain, and not showing signs of contracture or other complications, some surgeons may choose not to remove it, especially if it's not causing discomfort.
2.) Reason for Removal: If the implants are being removed due to complications like rupture, leakage, infection, or discomfort, the surgeon will evaluate whether capsule removal is necessary based on the specifics of your case.
3.) Scar Tissue: Scar tissue that remains after implant removal can lead to a variety of outcomes. It's possible that the scar tissue may shrink over time, potentially causing the breasts to change shape or feel firmer. In some cases, the presence of scar tissue may not cause any issues and may go unnoticed.
4.) Future Complications: There's no definitive answer to whether leaving the capsule in place could cause problems in the future. Some women have reported feeling more comfortable and experiencing better outcomes with capsule removal, while others have not noticed significant differences.
5.) Consultation with a Surgeon: It's important to have a thorough consultation with an experienced cosmetic surgeon who can assess your individual situation. They can discuss the benefits, risks, and potential outcomes of different approaches to implant removal and capsule removal.
As for scarring, any surgical procedure will result in some degree of scarring. The extent of scarring can vary based on factors such as genetics, skin type, and the surgical techniques used. Surgeons aim to minimize scarring by placing incisions in discreet locations and using proper wound care techniques. Over time, scars tend to fade and become less noticeable.
To get accurate and personalized information about implant removal, potential capsule removal, and scarring, it's best to consult a qualified plastic surgeon who can provide guidance based on your individual circumstances.