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

Hello I have 9 years old silicone implants over the muscle, I'm planning in doing a explant surgery, can I do a capsulectomy with local anesthesia/ and or Twilight anesthesia since I'm super scare and nervous of general anesthesia. Also what's the risks of not removing the capsule if I'm doing this explant because I'm having some health issues and most likely is because my silicone implants are affecting me! My capsule is not hard, thank you!!

Doctor Answers 5

Implant removal +/- capsulectomy

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

Miami Beach Plastic Surgeon
5.0 out of 5 stars 10 reviews

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Can I do a capsulectomy with local/twilight anesthesia?

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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

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

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.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

Breast Implant Explant En block

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.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 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.