I've read it's not safe to leave the capsule behind after breast explant because of BII. What are your thoughts on this?

Thank you for your question. The recent increase in reports of BIA-ALCL (Breast implant associated anaplastic large cell lymphoma)  which is a rare kind of lymphoma that can develop in the scar tissue around the implant, has led to change the approach in the treatments of capsules. In the past there was no indication in removing a thin and normal capsule, where there has always been an indication in removing a thickened, calcified capsule. If the implants removed are textured, it is now considered preferable, when surgically possible, to perform a total capsulectomy (to remove the entire capsule) so that the risk of the onset of BIA-ALCL is nearly erased. If however the old implants are smooth and the capsules appear normal, there is no indication to remove it as the BIA-ALCL seems only related to textured implant. Hope it helps.All the bestAndrea MarandoPlastic and Cosmetic Surgeon, Manchester and London, UK

Hi, thanks for sharing your question. There are advantages and disadvantages in removing the entire capsule and each surgeon has his/her own preferences. Based on your physical exam and symptoms, you may require removal of all of the capsule. Consult with a board certified plastic surgeon to review your options. I hope this helps. Best of luck! 

Capsulectomy is only warranted/indicated in a few situations:
-Capsular contracture
-Ruptured silicone implants
-Suspicion of BIA-ALCL in the setting of a textured device (late fluid collection with ALK+ and CD30+ lymphocytes present)
A thin, soft (non-calcified) capsule in the setting of an intact silicone implant does not necessitate removal. Following explantation, it will simply shrink down. However, high grade firm/calcified capsules will remain so if not removed. In the absence of the implant this remain palpable and may be a source of discomfort.
As always,discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Verified Member
RealSelf Top 100
RealSelf Hall of Fame

Capsular tissue is nothing but collagen that is deposited by your body. There are certain instances where I would recommend having a prophylactic capsulectomy, but in most cases there is no need to go through the added trauma and surgical time of having a capsulectomy if there is no acute problem with it. Each case is unique, but if you have smooth round implants and do not have a rupture or capsular contracture then the only reason to remove the capsule would be for your piece of mind, however it is important to know that there is no medical reason to do this and there are significant risks that come with capsulectomy which are not present with a simple explant. The only way to know for sure is to book a consultation with a board certified plastic surgeon near you to discuss your specific case. Best of luck!  

A capsule is your body's reaction to a foreign body, it is like scar tissue.   It occurs around anything that is placed into the body tissues.  If it is thin and soft it is not normally removed.   If it is calcified or not smooth or is changing the shape of the breast, it is usually better to remove it.The surgery to remove a capsule can itself cause bleeding and change in breast shape and so it is best to do it only when absolutely indicated. Specifically to your question of BII and the safety of not removing the capsule, it is safe to leave the capsule, as it is part of you, not part of the implant.All the best to you,Dr. Nancy de Kleer

Hello and thank you for your question. I do a significant number of breast implant removal. As long as the capsule is thin and soft, it does not need to be removed. In the event of a ruptured gel implant, I do an en-bloc removal of the implant with a full removal of the capsule. I will also remove the capsule if it is thick and calcified. Removal of the capsule can be challenging and cause bleeding and other issues, so I would only remove it if it is absolutely necessary. I would seek consultation with a board-certified plastic surgeon
for a full evaluation and advice. Best,
Pejman Aflaki, M.D.                                            
Johns
Hopkins-trained double board-certified plastic surgeon

Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.  Removing a capsule unnecessarily could result in bleeding and slight tissue loss.

Removing the capsule is really individualized even in patients with signs and symptoms of BII.  The breast capsule is scar tissue that your body has formed when a foreign substance (breast implant) has been placed.  In fact a capsule is formed when any implant is placed in the body, such as total knee, hip prosthesis and so forth.  What is key here is that it part of what you body has formed and it is not foreign.  When an En Bloc capsulectomy is performed and all the capsule and implant is removed, your body will again form scar tissue to adhere the breast tissue back down to the chest wall.  This scar tissue is really no different than the capsule.  In certain cases it is best to remove the capsule.  It just depends on the situation and again on the issue at hand and what the patient presents with.Hope that helps.

Thank you for sharing your question.  As with any procedure, customization of what is to be performed requires an evaluation on a case by case basis.  Best to discuss in-person with your examination.

Dear Imaginative515495,
as long as you don't have capsular contracture or thick capsules, then there is no reason for capsule removal. If you are considering a surgery, I would suggest you to 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