If you leave the breast capsules in after explant what happens to it?

Hello,
And thank you for the question.
Following removal of breast implants also known as explant surgery, one option is to leave breast capsule (scar tissue) behind, especially if it appears soft without any issues or evidence of capsular contracture. Another option is to remove the capsule (partially or fully) knows as capsulectomy.
Sometimes, the scar tissue/capsule can be very adherent to the muscle and chest wall, and removing it may case more damage to the nearby structures. In those cases, the capsule remains in place.
Although some women report improvement or resolution of symptoms following removal of the implants and capsule, the cause of the symptoms and the degree to which they may be related to the implants/capsule are unclear at the current time. Research continues to be performed to better understand any potential association with breast implants and breast implant illness (BII).
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Explant surgeries to further discuss your options, specific techniques, concerns and expectations.
I hope this helps.
Best, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Hello @Justhavefaith, thank you for your question! In my opinion the ideal approach to remove the capsules, all of them (total capsulectomy) during the explantation procedure since it is not known what can be found in the tissue. Afterward, it would be necessary to carry out a preventive biopsy on each capsule. The removal of the capsules avoids any future inflammatory process. I linked a video about en bloc and total capsulectomy that will shed some more light. The most appropriate course of action is to consult one or several board certified plastic surgeons. This will allow you to get more information and options tailored specifically to your needs.

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).

Thank you for sharing your question. Without removal the breast capsule remains and largely does not change shape. Hope this helps.

Capsules, especially around saline implants, that are very thin may actually dissolve over time. I have seen this in reconstructive patients and in patients who wanted implants out and then chose to have implants back in at a later time. However, thick capsules tend to remain and appear not to change much. Again, I have also seen this in patients. However, the thick capsule might possibly change with a long enough period unless it is very thick. Calcified capsules remain as they are.

Although when an explant surgery is done I usually remove all tissue that belongs to the implant. That is including capsule. There are doctors that leave capsules and its also fine. Latest studies indicate that symptoms related to implants in BII are not related with removing or leaving capsules. It usually becomes scar tissue. Please continue doing your yearly follow up ultrasound.

Dear Justhavefaith,Thank you for your excellent question. It is more complex than it looks, and there are many controversies around this subject.There is no scientific evidence to support total capsule removal unless you have Baker grade IV capsular contracture, breast cancer, or ALCL. Patients who do not fall in those categories are concerned that the capsule may cause breast implant illness and ALCL (in the case of textured implants). The capsule may hold silicone residues, bacteria and be the source of inflammation, but to date, there is no evidence to confirm this.There are many factors to consider before deciding on capsule removal. Thin capsules may resorb. The decision of removing a capsule depends on each specific case. I would suggest that you discuss your concerns with your plastic surgeon.All the best