I want to remove my implants and do a lift. My surgeon does not want to remove the capsules. Should I go elsewhere?

Question

I met with a surgeon about removing my 450 cc under the muscle, silicone implants and doing a lift. I’m not having any problems, just want a new look. He doesn’t want to remove the capsules, should I go elsewhere? I’m worried about seroma and other things I’ve read about when the capsules aren’t removed.

Gary M. Horndeski, MD · Answer

If your implants are retro-pectoral (under the muscle) that means the capsule is lying on top of your ribs. Performing a total capsulectomy on someone with retro-pectoral implants can cause damage to the blood and nerve supply and also pneumothorax. The capsules only need to be removed if there is infection or calcification. I agree with your surgeon on not removing the capsules.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Alan Gonzalez, MD, FACS · Answer

Hello @Elle2127 thank you for your question. In my opinion it is always necessary to adequately remove the capsule and reconstruct the tissue. After 21 years of experience and several breast implant removal surgeries I suggest taking out the whole capsule. After so many explants I can attest that when a patient comes for an explant and had has a change of prostheses without the removal of the first capsules, when I perform surgery I find 2 capsules: The ones left there from the first surgery and the capsules of the new prostheses. So every time we change prostheses we also remove the capsules because that way the mammary tissue can recuperate better and avoid a future inflammatory response from the body or an autoimmune syndrome like Asia Syndrome. Best wishes! Alan Gonzalez MD FACS

Finny George, MD · Answer

Hi, thank you for sharing your question. You can certainly have the capsule removed especially if you are concerned about long term issues. You may want to improve the safety profile of this plan by staging the surgeries into two stages. Implant removal with capsulectomy, then breast lift later.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your question.  There are different reasons for having the capsules removed versus leaving them behind and I would seek out multiple consultations to discuss what your goals and concerns are in order to get the best advice.

Daniel Barrett, MD · Answer

Dear Elle2127,
it is hard to tell for sure without an examination. Generally speaking, it is possible to remove only implants if the capsules are thin. In the case of thick capsules, removal of implants and capsules is recommended. 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

Connie Hiers, MD, FACS · Answer

Not all capsules, especially the thin ones, need to be removed. Your surgeon can use drains to help minimize the risk of seromas.

Camille Cash, MD · Answer

When removing breast implants the capsules should also be removed if there are issues such as thickening, rupture or calcification, otherwise it is an option to remove them or leave them behind.  It is important that you are comfortable and confident in your surgical plan.  I encourage you to discuss your concerns with your surgeon as well as the surgeon's rationale for not removing the capsules.  If you are not satisfied after this conversation then you may wish to get a second opinion.

I want to remove my implants and do a lift. My surgeon does not want to remove the capsules. Should I go elsewhere?

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