Is a Capsulectomy necessary with Explantation of 19 year saline subglandular implants and Stage 2 capsular contraction? (photos)

Question

Hello, I will be satisfied with my body with very small breasts and want this to be my final surgery on my breasts. My incision was on the lower half of my areola. I do not want to lose more sensation. I already lost most on one breast. I was originally a 34A. I am currently a 34B (full). My implants are filled with 240 CCs. My areolas hang low at 23 cm and 22 cm. I am 52 years old and have 2 children and am beginning menopause.

Camille Cash, MD · Answer

If the capsules are thickened or causing issues such as pain or distortion, they should be removed at the time of explant.  If they are thin and not causing issues then it is an option to leave them behind when the implants are removed.  Your surgeon will guide you after an examination and discussion of your goals.

Benjamin J. Cousins, MD · Answer

Thank you for your question, and wish you the best. When the implants are removed, there is a capsule or layer of scar tissue around the implant. This capsule does not necessarily have to be removed, but should be if the capsule is irregular, painful, distorting the breast shape, is symptomatic or thickened. This may be a "game time" decision for your PS. Removing very thin capsules may cause excessive bleeding and be associated with other risks of injuring the chest wall muscles, ribs or other complications. After the implants are removed, any small capsule that is left will over time soften and dissolved/resorb and the breasts will settle into their post implant shape minus the skin stretch and original breast tissue/muscle shrinkage.

Tom J. Pousti, MD · Answer

In many areas of plastic surgery, including breast implant removal surgery, you will find many different opinions as to the best way to handle a specific situation. In my practice, generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic,  I do not remove them.  On the contrary (unless indicated), capsulectomy can expose you to additional risks, such as bleeding and some breast size loss.  Your plastic surgeon, based on your physical examination, will  be able to inform you whether the breast implant capsule is thickened or abnormal.

Having said that, I often remove a small segment of capsule tissue when removing breast implants ( even when not encapsulated) with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.   Hopefully, you have chosen your plastic surgeon carefully; do not hesitate to address your questions/concerns directly to him/her and ask about the rationale behind any decisions that you question. Best wishes.

Allen M. Doezie, MD · Answer

If there is a capsular contracture it is usually a good idea to remove the capsule.  Also, your nipples are a little bit lower and it is possible you may want a breast lift in the future.  To maximize the circulation to the nipple and prevent complications, it would definitely be better to remove the capsule because this will allow new pathways of blood flow to develop to the area of the nipple.  You probably will not lose additional sensation, but there is never a guarantee of that.

Connie Hiers, MD, FACS · Answer

If the capsule is hard or calcified, it will need to be removed. If you have minimal tissue, normal thin capsules are usually left to minimize the risks of bleeding and numbness. Your surgeon will the be the one to let you know if the capsules need to be removed.

Vincent P. Marin, MD, FACS · Answer

From your photographs, it does not appear that you have to undergo a capsulectomy. However, if the capsule is firm or calcified that it may be beneficial to remove this during the explantation. This would need to be determined after a physical examination. Keep in mind that the nipple will be even lower on your chest after removal of the implant.
You should see a board-certified plastic surgeon in your area to get a formal opinion through an in-person consultation.
Best of luck.

Ronald V. DeMars, MD (Retired) · Answer

If the surgeon finds the capsules thin and translucent, there is no need for capsulectomy, but if they are thick or calcified the capsules should be removed. If find the surgery is usually lessened if you have the surgeon deflate the implantts in the office and wait 6 weeks for the surgery as the capsules usually (but not always) shrink down ans the implants get smaller. Loss of sensation is a risk in every case of breast surgery.

Jon A. Perlman, MD (retired) · Answer

Each case and surgery is different but since it is necessary to encourage the old breast implant space to close off I usually recommend at least partial capsulectomy and placement of drains to compress the pocket.  Sometimes the capsule is too thin to be removable from a pragmatic sense and consequentially only small amounts are removed to encourage adhesion and a drain placed.  Capsules persist and can possibly cause distortion especially if they are thick or very elastic.  Allow your surgeon to use his/her best judgment at the time of the procedure.  I hope this is helpful.Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, California

Is a Capsulectomy necessary with Explantation of 19 year saline subglandular implants and Stage 2 capsular contraction? (photos)

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