Removal of saline implants under local...still confused. Any suggestions?

I am grateful to the doctors who answered my last question about removal of saline implants under local and leaving the capsule . However, there was no consensus as to what to do. Some said that the peer review literature says scar capsule must be removed. Some said the scar capsule is just scar tissue and leaving it typically causes no problems, and yet others said it might be okay, if drains are used. So I am asking again, hoping to clear up my confusion. Thank you.

Doctor Answers 7

E implants under local...still confused. Any suggestions?

Thank you for reposting your question. It is difficult to answer your question without examining you. It essential to find out if there is any grade III or gradi IV capsular contracture and if so I would recommend for capsulectomy. It is best to discuss this with your board certified plastic surgeon. Good luck.

Removal of saline implants under local...still confused. Any suggestions?

Thanks for reposting your question. So this is really simple. I did not see the original question but no where do I see you saying that you have a capsular contracture. You are saying that you want to know if your saline implants can be removed under local. The answer is yes. If you do NOT have a capsular contracture that causes you problems there is no reason to remove the capsule. That is very clear in the literature. Drains are totally up to the surgeon. I use them in many cases because patients for a seroma or fluid collection during that first week. Others would argue that when a saline implant ruptures it deflates and re-absorbs and no drain is ever used. So the drain part is up to the surgeon. I hope this helps. It seems like a very simple answer to me if you are giving me all the information here. 

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 45 reviews

Removal of saline implants under local...still confused. Any suggestions?

For a patient with a saline implant and soft breast capsules, assuming no other issues, the implant can be safely removed under local anesthesia, without removing the capsule, and not placing a drain. The is no medical evidence that capsule removal or a drain are needed. 

For silicone gel implants or when a firm capsule is present, then it may be appropriate. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 65 reviews

Removal of saline implants under local...still confused. Any suggestions?

You are never going to get every doctor to agree on anything so it is fruitless to try. I can tell you in over 30 years of a very active practice in breast surgery, I have not found it necessary to remove a capsule around a saline breast implant if it was thin and soft. So the answer depends totally on the quality of your specific capsule and since none of us has examined you, none of us can answer your question as it pertains specifically to you. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Probably won't find a consensus; this is not unusual in the plastic surgery field.

Thank you for the question. Don't be surprised if you receive a variety of differing responses again.
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 you to additional risks, such as bleeding and minimal size loss. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity).
Recently I have become more aware of the fact that there are (thank goodness only a few) 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.

Removal

Your best answers will be given after you are seen by a plastic surgeon and have your breasts examined. If the scar tissue is very thin, the capsules can be left in place and the implant just removed. If you have any issues with your capsules, it is best to have them removed as well.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Removal of saline implants under local...still confused

Not sure about your previous post, but there appears to be a consensus here. Unless there is an extenuating circumstance, the capsule can stay and no drains are necessary. I do this routinely.

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.