Subfascial implant removal- can the capsules be left in?

Hi, this is a great question. This depends on the reason for removing the implants. If you have breast implant illness or capsular contracture, the capsule should be removed. Otherwise, I would suggest leaving the capsule in place as this is a much less painful operation with lower risk of bleeding. You are absolutely correct that there is a risk of forming a fluid collection (known as a seroma) in the pocket if it does not re-adhere to the chest wall. For this reason, I typically will score the capsule to irritate the tissue and encourage it to heal. Best of luck!Alex Neusner, MDBeverly Hills, CA

Great, thoughtful questions. Here’s a detailed but straightforward answer for you.
Subfascial Implant Removal: Do the Capsules Have to Be Removed?
No, the capsules do not always need to be removed when subfascial implants are taken out, especially if:
• The capsule is thin, healthy, and not causing symptoms.
• There’s no evidence of capsular contracture, rupture, infection, or suspected BIA-ALCL (extremely rare).
In fact, leaving the capsule in place is very common and often perfectly safe.
When Capsule Removal (Capsulectomy) is Recommended
• If the capsule is thickened, painful, calcified, or contracted.
• If there are concerns about implant rupture, silicone leakage (for silicone implants), or suspected infection.
• If a patient has symptoms suggestive of breast implant illness (BII) and prefers a total capsulectomy.
• If the patient strongly prefers a complete capsulectomy for peace of mind.
When the Capsules Can Safely Be Left In
• If they are thin, soft, and asymptomatic.
• When implants were saline (like yours).
• If the patient has no breast implant illness symptoms and no medical reason for removal.
• Particularly during pregnancy or in complex health situations, surgeons may recommend leaving the capsule to minimize surgical risk.
Will the Fascia Re-adhere to the Muscle if Capsules Are Left In?
Yes, typically
• The fascia will gradually re-adhere to the muscle and the body will naturally remodel the space.
• The capsule itself will often shrink and flatten over time if left undisturbed, especially if there’s no ongoing stimulation (like an implant inside).
• Most people don’t feel lingering discomfort from the capsule once the implant is removed, particularly if the capsule was soft and not problematic to begin with.
Will There Be Discomfort if Left In?
• Usually not. Many patients feel immediate relief after implant removal, even when the capsules are left in.
• However, if the capsule is thick or you’re prone to scar tissue sensitivity, some residual tightness or minor discomfort can occur — but it’s rare.
• If any discomfort does develop later, the capsule can always be removed in a future surgery.