During explant do I need to remove all the capsule?

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??

Doctor Answers 12

Breast Implant and +/- capsule removal

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

Miami Beach Plastic Surgeon
5.0 out of 5 stars 8 reviews

Removing the capsule with implant removal

The short answer is that there is no medical reason to remove the scar tissue layer (capsule) around an implant unless it is demonstrably abnormal or distorting. It also adds to the cost, risk, and recovery of an explant procedure with no physical benefit. Additionally, a new scar tissue layer will form where the raw area of the old capsule was removed. It won't be called a capsule but it's still a scar tissue layer. 

I would add that there is actual evidence or medical science linking the silicone shell around a saline-filled implant with any disease process. Silicone rubber is used in a number of medical implant devices and there has never been any suggestion of diseases caused by this. This isn't the forum for it but there are a number of currently popular "diseases" that people worry about and treat that have no scientific basis. Even a classic quack disease like fibromyalgia is advertised on TV with an FDA approved treatment these days. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Do I need to have my breast capsules removed?

I give my patients the option of removing the #breast capsules or not. As you mentioned, it takes longer for this with more surgery and possibility of bleeding, pain. If you are replacing the #breast implants with other implants then it makes little sense to do a total #capsulectomy for #breast capsules regrow in as little as several days. If you are totally removing the #breast implants for health issues, then you may want to consider it. There is microscopic #silicone within the #breast capsules but even with a total #capsulectomy, there will still be some remaining.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

Capsulectony with Explant?

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

Capsule... To remove or not to remove?

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.

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

Removal of Capsule

Removal of the capsule depends on the condition of the capsule as well as pain involved.  Discuss this with your surgeon.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 reviews

Removal of saline implants

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.

Clayton L. Moliver, MD
Houston Plastic Surgeon
4.5 out of 5 stars 27 reviews

Removal of capsule

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 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 40 reviews

Complete Capsulectomy, Is it Necessary?

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.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 71 reviews

Breast implant/capsule removal

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,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 330 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.