During explant do I need to remove all the capsule?

Question

There seems to be a lot of mixed reviews regarding this topic. My saline, 550 cc, under the muscle implants haven't given me any issues. I was diagnosed with hypothyroid disease after implants and have had very bad memory loss, brain fog, hives, & fatigue etc BUT who is to say it's from the implants? Once I changed my diet to Vegan, and removed gluten I felt a lot better. I have interviewed many board certified PS and to do an en bloc and full capsule removal is expensive! Is it truly needed??

Joyce C. Chen, MD, MPH, FACS · Answer

Thanks so much for your question. If your capsule isn't causing any problems such as pain or distortion, removal of your capsule around the implant or a capsulectomy isn't necessary. However, in your case with your new symptoms only after placement of your implant, removing the capsule may help these symptoms improve further. Hope this helps...best of luck!

Joyce C. Chen, MD

Joyce C. Chen, MD

Stuart A. Linder, MD, FACS · Answer

The removal of capsule depends on the extent of pain you are having and the thickness of the scar tissue. Often a portion of the capsule will be removed from beneath the pectoralis muscle

Farbod Esmailian, MD · Answer

This is a very good question.  As you have realized you will get many answers on this topic.  There is significant variation and it depends a lot on what the surgeons sees and what the surgeon is dealing with. In general, if the capsule is very thin then it is unnecessary to attempt to remove all the capsule as it tends to be very difficult and very bloody if the implant was originally behind the muscle.  In certain cases as noted, removing the capsule would be a better option.  Some of those cases included in a case of capsules associated with ruptured silicone implants, calcified capsules, in a setting of infection, significantly diseased (thickened) capsules.  Having said that it some cases the thickened capsule maybe left behind if it is felt that removing it would case significant deformity or loss of volume or both.Hope that helps.

William Bruno, MD · Answer

If you don't have significant thickening of the breast implant capsule, then it does not necessarily need to be removed. Especially implants that are subpectoral since these capsules are more difficult to remove and are associated with more bleeding. Thin capsules can remain behind but your surgeon should shrink the pocket and place some sutures to prevent a seroma;  along with leaving a drain for a few days.Best wishes,Dr.Bruno

Thomas Fiala, MD, FACS, FRCSC · Answer

Remove the capsule if:1) it is diseased or abnormal2)  grossly calcified3)  associated with a ruptured silicone implantOtherwise, if the capsule is thin, wispy and normal looking, removal is optional.  Thin (normal) capsules may sometimes be difficult to remove "en bloc", as they tend to separate during the dissection.Recently, I have become aware of some websites promoting non-physician websites promoting en bloc capsulectomy for symptoms that may or may not be implant associated.  There is little scientific evidence to support this recommendation.

Camille Cash, MD · Answer

It is not always necessary to remove the entire capsule and sometimes it is not recommended.  If the capsule is very thin it may be safer to leave it, or at least part of it, behind in order to prevent damage to tissues in the attempt to remove it.  I encourage you to visit with your surgeon for an evaluation and to learn more about your options.  I've included a video I hope you find helpful.

Milind K. Ambe, MD · Answer

Thank you for your question.  As the other surgeons have stated, I do not think it is always necessary for the capsule to be completely removed.  If the capsule looks abnormal or unhealthy then that is a time to consider removing it.  Main thing is seek opinions from a Board certified plastic surgeon who performs a lot of explant surgeries. Best of luck to you

Benjamin J. Cousins, MD · Answer

Thank you for your question. When the implants are removed, there is a capsule or layer of scar tissue around the implant. This does not necessarily have to be removed, but should be if the capsule is irregular, painful, distorting the breast shape, is symptomatic or thickened. Removing very thin capsules may cause excessive bleeding and be associated with risks of injuring the chest wall muscles, ribs or other complications. After the implants are removed, any small capsule that is left will over time soften and dissolved/resorb and the breasts will settle into their post implant shape minus the skin stretch and original breast tissue and muscle shrinkage.Benjamin J. Cousins MD Board Certified Plastic Surgeon

Lisa Cassileth, MD, FACS · Answer

If capsules are TOTALLY normal, I don't remove them during explant. I use the capsule to strengthen the pec muscle repair, close down the open space, and lift up the breast. If they are ABNORMAL, as with cap con, then they have to be removed. Not en bloc though (=huge scar). I feel en bloc is oversold by specific surgeons, who could take out the capsule and implant separately through the initial augmentation incision cleanly if they would just learn how. Sorry to dis but I hate seeing those huge scars. Abnormal capsules should be tested for all biofilms, I'm surprised often by the presence of low grade bacteria in capsules on a patient who didn't look so bad pre-op. But the capsules is always weird when I get in there on those patients, or has a little fluid in it so you know...just check it. Finally, I have quite a few patients that have health issues and nothing apparently wrong with their capsules that request removal anyway "just in case". I usually comply although it makes the recovery a little bit harder, but it may be worth it for piece of mind.

Clayton L. Moliver, MD · Answer

As previously stated, if no significant issues are present, there is no need to remove the capsule. In my practice, I have performed removal of saline implants under local anesthesia(which, of course, lowers the cost). It really depends on the patient's comfort level and the condition of your breasts. You should consult with a Board Certified Plastic Surgeon, who can examine you and give you options specifically designed for the results you desire.