Volume loss after subfascial capsulectomy?

I had explantation of Allergan Natrelle round textured 365 cc subfascial because of late-onset seroma and pain last week. I insisted to have the capsules out as well (fear of ALCL). The PS told me that the capsule was so thin and soft he could only get out 2/3 of it (anterior part). 20 cc of seroma was drained and the same amount of capsule removed. My breast looks smaller than before now. Would my breast look different without capsulectomy? Do I still have to worry about ALCL in the future?

Doctor Answers 3


The capsule should have been removed with the implant to address the issue of ALCL.  The breast would not have looked much different.

San Antonio Plastic Surgeon
4.9 out of 5 stars 136 reviews

#Explant #BreastImplantRemoval - Volume loss after subfascial capsulectomy?

I'm sorry about the problems you're having but your case raises several important issues, some of what are unresolved at this time.  First, unless the capsule was thickened it probably did not contribute that much volume to your breast.  Even capsules that are tight (ie capsular contractures) are actually pretty thin once they're removed.  I am of course speculating but I'd guess that the capsule removal only contributed a small amount to the overall volume of your breast and, therefore, it's removal only a small amount (correspondingly). It's understandable that some of the capsule was left in a subfascial or subpectoral implant removal in the sense that that portion of the capsule is (often) densely adherent to the underlying tissues over the ribs and intercostal muscles.  Removing that can increase the risk of thinned tissue in that region, and even pneumothorax and/or injury to the pleural space (the area around the lungs).  On the other hand, relatively little is known about ALCL right now.  Total capsulectomy is recommended with that diagnosis, and is believed to be curative.  You should of course follow the advice of your own board-certified plastic surgeon but do not hesitate to seek additional opinions for confirmation or to get additional ideas.  I hope that this helps and good luck.  Dr. Alan Engler, Member of #RealSelf500

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Volume loss after subfascial capsulectomy?

Thank you for sharing your question and I am sorry to hear of your implant-related issues.  There are two reasons that implant removal and capsulectomy can leave you with a smaller appearance than before your augmentation.  The first is that a small amount of extra breast volume is obtained by the body's formation of an implant capsule around the implant which once removed will make your breasts appear smaller.  Secondly, implant placement can cause thinning of your natural breast tissue over time, which becomes more noticeable upon implant removal.  The overall risk of ALCL development is exceedingly rare, made less so with near complete removal of your capsules, but maintain normal mammogram testing.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 68 reviews

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