When replacing implants is it common practice to use the capsule from the old implant as an internal bra?

Question

When replacing implants is it common practice to use the capsule from the old implant as an internal bra in lieu of galaflex? I would personally think galaflex or internal mesh is the best possible option for implants.

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question. 
Yes, it is possible to use the existing capsule without the addition of mesh. The decision to use mesh reinforcement depends on the quality of the capsule present. If you have implant malposition, this is often corrected with repair of the capsule using what's called a " capsulorraphy". This procedure involves suturing the capsule together to modify the implant pocket. If the capsule is very thin and wispy, there's a high likelihood that the repair will not hold over time. In these instances, I utilize a mesh like galaflex to provide additional support.. For best results, you should choose a plastic surgeon certified by the American Board  of Plastic Surgery with extensive experience in revisional breast surgery. I hope this helps. Good luck.

Wayne I. Yamahata, MD · Answer

Years ago, before ADM type mesh became available, surgeons routinely used the capsule to provide support to implants. Many of us will still use the capsule rather than a mesh if the capsule has the proper integrity.

Daniel Barrett, MD · Answer

Dear sparklejumpropekween,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

The reason for implant replacement can be many, and depending on that reason a partial or total capsule removal may be indicated. From a purely general point of view though, leaving the capsule alone is always better than removing it, especially if it is normal in size and shape (allowing the implant to sit where it's supposed to be). In situations like capsular contracture, it should always be removed completely. For silicone gel implant leakage, there is more of a tendency to remove it, especially for suspected long term leaks or leaks from old implants with less viscous gel (low cohesivity). For implant malposition, the capsule should not be removed, but instead it should be tightened with cautery and oversewn with sutures. The use of mesh to overlay on the repair may also be indicated, depending on tissue laxity and the degree of implant malposition. This latter situation is known as an 'internal bra'.

Richard Baxter, MD · Answer

It is common to use the capsule if it is a strong enough layer, all depending on the individual circumstance, size of implants, reason for exchange, and other things. If there is no reason to remove the capsule but more support is needed, the Galaflex would be used without removing the original capsule.

Gary M. Horndeski, MD · Answer

The capsule after implant removal is made of collagen and is permanent. It can be used as an internal bra. Also, GalaFlex is not permanent. Permanent mesh is not used because it can be confused with breast cancer later.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Farbod Esmailian, MD · Answer

Every case is different and it just depends on what the surgeon is trying to address.  In some cases I will used a mesh for support.  In other cases the patients own capsule can be manipulated to get the desired result.  And in some cases I will do both.

I would not worry too much about what is being done, long as you trust the surgeon and believe in his/her work it really doesnt matter.

Hope that helps.

Dana Goldberg, MD · Answer

In many patients, the existing capsule can be manipulated to help support the implant. However, in some cases, the capsule is thin and stretchy or the pocket was made too large. In these cases, a mesh support can be helpful. Unfortunately, the mesh is still sutured to the patient's tissue, and the interface can stretch, so grafts don't have 100% success rates either.

Connie Hiers, MD, FACS · Answer

Yes, the capsule is often used for better support or control of the pocket, and it is your own tissue. If needed, the mesh can be added.  With mesh, there is more foreign material and a greater chance of developing a thick hard capsule.  In a first-time repair, we often try using the capsule and permanent sutures.

Jason Pozner, MD · Answer

There were some publications about capsules for support about 20 years ago. Its a decent idea if the capsule is the right thickness but if too soft - wont work and if too firm wont look great either. Galaflex or other mesh is your best bet at this time

When replacing implants is it common practice to use the capsule from the old implant as an internal bra?

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