Subfascial implant removal- can the capsules be left in?

At surgery, the surgeon usually evaluates the capsules. If the capsules look calcified or abnormal in any way they can be removed. Routinely capsules are not removed.

Best Wishes,

Gary Horndeski, M.D.

This is an area where there’s a lot of confusion, so I’ll answer each part clearly.1) Do the capsules have to be removed in subfascial explant?No — total capsulectomy is not automatically required.In subfascial implant removal, the capsule can be:Completely removed (total capsulectomy)Partially removed (selective capsulectomy)Left in place (capsule preservation)The right choice depends on symptoms, capsule quality, and surgical goals, not on a blanket rule.2) When is it appropriate to leave the capsule?Leaving the capsule is generally reasonable when:There is no capsular contractureNo chronic pain or inflammationNo infection or rupture-related contaminationThe capsule is thin, soft, and non-problematicIn many asymptomatic patients, leaving the capsule avoids:Unnecessary traumaBleedingProlonged recoveryDisruption of chest wall structures3) Will the fascia re-adhere to the muscle if the capsule is left?Yes — in most cases, it will.After implant removal:The subfascial space collapsesThe body naturally heals by fibrosis and tissue adherenceOver time, the fascia re-adheres to the underlying muscle, even if portions of the capsule remainThis is especially true when:The capsule is thinThe implant has not been in place for decadesThere is no ongoing inflammatory stimulusThe body does not require full capsulectomy to re-establish normal anatomy.4) Will leaving the capsule cause long-term discomfort?Usually no, provided the capsule is healthy.Most patients with retained capsules:Do not experience chronic painDo not feel “something left behind”Do not have functional issuesDiscomfort is more likely if:The capsule is thickened or contractedThere is chronic inflammationThere is residual fluid or calcificationIn those cases, selective or total capsulectomy is appropriate.5) When should the capsule be removed?Capsulectomy is recommended if there is:Capsular contracture (Baker III–IV)Chronic pain clearly linked to the capsuleRuptured silicone implant with contaminationInfectionPatient-specific medical indication (rare systemic issues)Outside of these situations, routine total capsulectomy is not mandatory.

Dear 838383karina,

as long as you don't have capsular contracture, your capsules can stay in. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

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

Depending on the thickness of the capsule, it can be left in or removed, and it depends on the surgical technique used. A specific evaluation of your case is required.

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.

Capsules are scar tissue that form naturally around all implants. If your implants are ruptured or if the capsules are thickened or causing issues then the capsules should be removed along with the implants. If the capsules are thin and not causing issues the implants alone can be removed, leaving the capsules behind. I encourage you to begin by visiting with a board certified plastic surgeon near you for a consultation to see what is recommended for you.