Can I do a capsulectomy with local/twilight anesthesia? And what's the risk of not removing my capsule?

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contractureis seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  Without knowing your issues andwithout an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you.  It would be difficult to do a full capsulectomy without general anesthesia. Hope that this helps! Best wishes!

If your capsules are thickened or causing issues they are typically removed at the time of explant. If they are not causing issues you can elect to have them removed or leave them behind. The surgery to remove them is more involved than simple implant removal and therefore it is recommended that it be performed under general anesthesia.

Thank you for your comments. Be sure to see a Board Certified Plastic Surgeon who can examine you and discuss with you more twilight anesthesia vs general anesthesia. With implant removal, the
capsule does not necessarily have to be removed, but it should be if the capsule is irregular, painful, distorting the
breast shape, is symptomatic or thickened. This may be a "game
time" decision for your PS. Removing very thin capsules may cause
excessive bleeding and be associated with other risks of injuring the chest
wall muscles, ribs or other complications.

Best wishes,

Benjamin J. Cousins MD

Thank you for the question. Given your concerns regarding "health issues" and the presence of breast implants, you will likely  be better off undergoing  capsulectomy surgery.  In my practice, this is best done under general anesthesia supervised by a board-certified plastic surgeon.  Having said that, I have done this procedure under "twilight" anesthesia again expertly administered by a board-certified anesthesiologist.Generally speaking, anxiety prior to surgery is very normal; its complete elimination is usually not possible. Assuming you have chosen your plastic surgeon carefully, other important "variables" such as anesthesia provider and surgery facility will be selected based on everyone's first priority: safety. This careful selection should give you some peace of mind that you will be safe around the time of surgery. Discuss your specific areas of concerns with your plastic surgeon who will be in the best position to help you calm your nerves.  





I ask my patients to try to be as calm as possible prior to surgery; this “calmness" tends to translate to a smoother postoperative course. You may be able to alleviate some pre operative anxiety with music, exercise, meditation, a glass of wine (if ok with your surgeon),   and positive/objective focus on the long term outcome/benefits etc. prior to your procedure.



Generally, patients find that they did “get worked up for nothing” after their recovery is completed.



I hope this, and the attached link, helps.   Best wishes.

In general it is much better to remove the implant and the capsule at the same time. If you are having health issues, better to remove the capsule, enblock removal, There is some risk of accumulating fluid in the capsule if the capsule is not removed.Enblock removal of the implant and the capsule can be done with local and sedation. an intercostal block type of supplemental anesthesia would be helpful also for pain control after the surgery.

In general it is much better to remove the implant and the capsule at the same time.  I would not do this surgery under local anesthesia as it is uncomfortable for the patient.  If the capsule is difficult to remove, it is much easier to do the surgery without having to worry about the patient having any pain or being uncomfortable.  Request an anesthesia consult prior to surgery to discuss your health issues and fears.