What is the risk of disrupting breast vasculature and pneumothorax with capsulectomy? (Photo)

Question

Over implants 26 yrs, explanting (no lift) because of baker 3 cc with up shift right side. One PS said he would remove both capsules, the other said only the anterior capsule on right because of risk of pneumothorax (will remove if that's what I want), no removal of capsule on left (unless I want) as it's not necessary so why risk disrupting the vasculature especially at my age (60, healthy, no meds). So frustrating, both PS ABPS.

Alejandro Nogueira, MD · Answer

If your implants have been in place 26 years (sorry if I misunderstood and this is your age) I disagree about the capsular contracture diagnosis, there is no cc beyond the 1st or 2th quarters postop, it is an early phenomenon and it does not happen at a later stage. Hardening of obsolete and aged implants is due to calcification (calcium carbonate) deposits made by your organism to destroy and insulate the implants; this is a natural and beneficial process.About the explantation, if this is your wish I think it is a respectable wish, but you should know that patients with cc or obsolete implants can receive new implants in the same procedure of explantation.Also you must know that total or subtotal capsulectomy is a MUST, an essential safety and health considering step, I don't see justifications not to carry out the capsulectomy. If a surgeon thinks he may produce pneumothorax performing capsulectomy he'd rather recycle himself a little.

Gary Lawton, MD, FACS · Answer

For
explant surgery, it is almost always best to remove the capsule in its
entirety.  This will allow the space to heal.  If you leave the
capsule in place, it does not heal.  Fluid can accumulate in the space.
 The situation that brings the patient to implant removal will have an
affect on the decision.  This is a surgery which requires discussion with
the plastic surgeon about the problem, the goals, and the technical concerns.
 The body does not re-absorb the capsule.

Alan M. Engler, MD, FACS (retired) · Answer

This is an insightful question concerning a rarely discussed but important possible compication of having a total capsulectomy done.If the implants were in the subglandular position, then doing a total capsulectomy is relatively straight-forward (and it is all relative) since virtually the entire capsule is well-protected from the chest wall (actually, the lower portion is less well protected).If, however, the implant were submuscular then the posterior (back) portion of the capsule is often densely adherent to the muscles overlying and involved the ribs.  It can actually be a very thin layer of tissue (scar tissue, muscle, connective tissue, etc) protecting the pleural space and while it may be unthinkable to the layman, the risk of pneumothorax (a "dropped lung") is somewhat increased when that portion of the capsule is removed.  While there are usually not significant and permanent complications from this there can be, and early detection and prompt intervention are critical.  With one version of a pneumothorax - a "tension" pneumothorax, the condition is life-threatening instantaneously.I would therefore recommend that the surgical plan include the option to leave the posterior capsule.  You don't seem to be having any problems with it (capsules can become proliferative and generate fluid; that may necessitate their complete removal) and so it should be okay to leave some of it there.Breast vasculature can also be impacted with a capsulectomy.  The thinner the tissues are overlying the capsule the greater the concern is for this.  If you (the patient) have relatively thick breast tissue overlying the capsule then it should be safer to remove the capsule; the less tissue there is the greater the concern.The safest approach is to leave the capsule in place.  It can be removed at another time if it becomes problematic, or portions can be removed if the surgeon feels it's indicated intraoperatively.I hope that this helps resolve this complicated issue, and good luck,Dr. Alan EnglerMember of RealSelf100

What is the risk of disrupting breast vasculature and pneumothorax with capsulectomy? (Photo)

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What is the risk of disrupting breast vasculature and pneumothorax with capsulectomy? (Photo)

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Everything you need to know about Breast Implant Removal

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