Is it necessary to have the capsule removed with explant and why?

I've heard of implant illness and I'm planning to have my implants removed. Although I'm not sure if I've had "symptoms" I'm curious about having the capsule removed just in case. Why do some doctors feel it's important and others do not?

Doctor Answers 7

Breast implant removal - should the capsule be removed also?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question about your breast implant removal.
  • Here's the issue and my position - not every plastic surgeon will agree.
  • We know that the body forms a thin layer of tissue between any implant and the body.
  • This is a thin, soft lining. It is called the capsule. 
  • But if the lining becomes inflamed, it thickens and calcifies....all chronic inflammation does this.
  • This thickening makes the breast firm or hard and is called a capsular contracture.
  • We know that all chronic inflammation can give rise to cancer.
  • We also know that a very rare kind of cancer is known to be associated with certain breast implants.
  • So, for myself, unless the implants are known to be intact (not ruptured or leaking) and the breast is entirely soft, I remove the entire contracted capsule as well as the implants.
  • Years ago, I did not - but given the severely abnormal capsules I have seen and the fact that there is much we do not know in medicine, I am not comfortable leaving abnormal tissue in a woman's body.
  • It would help if we had a long-term study comparing women with capsules left in and taken out - 
  • But we don't - so for now, it's every surgeon's best judgement. That is mine.
Always see a Board Certified Plastic Surgeon.
Best wishes. Elizabeth Morgan MD PHD FACS

Enbloc removeal

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I strongly recommend the capsule to be removed.  The more explant enbloc procedures I do the more convinced I am that patients are presenting improvements in the way they feel.  There is still much to be cleared out about breast illness and the involvement or not of the breast implant and its capsule, but until we can give a precise cause to this problem and specially noticing how patients refer to improve after this procedure, I think removing both is the way to go.

Victor Urzola, MD
Costa Rica Plastic Surgeon

Is it necessary to have the capsule removed with explant and why?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your excellent question.  Depending on the character of the capsule I will remove it completely when thickened, hardened/calcified, or if it shows some irregularity. This allows for examination by a pathologist as needed. At times some capsule is left behind if there is concern for overlying skin viability or if it does not come off of your chest wall as the risks (bleeding, rib injury, muscle injury) outweigh the benefits. Hope that this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

You might also like...


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
If you have hard implants it usually means a thick capsule has formed around the implants and removing it is indicated, specially if you are having new implants replaced; otherwise the new implants will harden again.  It is not so necessary if the implants are not being replaced.  Best wishes, Dr. T.  

Is it necessary to have the capsule removed with explant and why?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I am not aware of any illness caused by implants. If you have your implants removed- it is always necessary to remove a capsule in its entirety. One of the risks following implant removal is fluid accumulation in the pocket. This can be reduced by partial capsule removal.

Is it necessary to have the capsule removed with explant and why?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for the question.  
Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en block removal of breast implants is a good procedure.
On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.
Recently I have become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy is always necessary and undergo unnecessary surgery associated with additional morbidity and unnecessary expenses.
I hope this, and the attached link, helps. Best wishes.

Implant illness?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is no such thing as "implant illness".  Having the capsule removed is sometimes done at the same time as implant exchange/removal.  

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.