Yes - in fact, sometimes you have to.
In general, it's "better" to remove the entire capsule if it has become symptomatic. But there are many times when implants are removed without removing any of the capsule, and it heals well. In that case even though are two smooth surfaces of the capsule in place, they adhere to each other and occlude the space. If they are thin the result may even be more aesthetic, as it leaves a little more volume (the capsules) in place.
On the other hand, if capsules are thickened, producing seroma fluid, etc., then removing them may be advisable. This makes the procedure more involved and has higher risks of bleeding and thinned tissue. At the back (on the ribs), if the capsule is adherent then trying to remove it can cause not only excess bleeding but, in rare conditions, the pleural cavities (spaces around the lungs) may be entered. There are many possible sequelae to that occurring.
Therefore, even when total capsule removal in planned it is often prudent to leave some of the posterior shell in place. Even that does not guarantee a problem-free recovery and result, as persistent capsule can continue to generate fluid etc., and ultimately mandate removal. But if a secondary procedure has to be done at that point, at least you know that a prudent approach was taken.
I hope that this helps and good luck,
Dr. Alan Engler
Member of #RealSelf100
Hello! It is definitely ok and routine to leave part of the capsule on the chest wall to avoid damage to the chest area. This will not create a problem. The surgery is not as barbaric as it might seem. All that is done is removal of the implants as well as the scar tissue around them, and then the incision is closed. You will probably feel better after the surgery is done.
Sometimes the entire capsule can not be removed because of its tight adherence to the chest wall, or when the tissues are very thin. Drains are sometimes used.
Ruptured silicone breast implant needs to be removed enblock to minimize the contamination of the breast with silicone. This requires expertise, and experience. The incision is in the inframammary line, slightly larger than the original scar for breast augmentation. the use of Harmonic Scalpel will minimize the removal of breast tissue. (Expensive tool)
If the implant is under the muscle, it is more technically challenging to remove the capsule off the chest wall (Possible pneumothorax).
No body can give you guarantees , decisions are made in surgery based on findings. (Imaging is not always accurate). Then decision on what is needed to do after removal. muscle repair, re-implant, type of implant size, position
In my practice many hours of discussions and decisions to be made.
When there are ruptured silicone gel implants most surgeons will attempt to remove as much capsule as possible. You try to remove the capsule intact with the ruptured implant contained inside. This helps prevent spillage of silicone into the surrounding tissues. If the implants are under the muscle the back side of the capsule may be too adherent to the underlying ribs and complete capsulectomy may be difficult . This does not present a problem for the patient. Generally, I use a drain whenever a capsulectomy is performed to avoid fluid collections.
Depending on how thick the capsule is, it can sometimes be difficult to remove all of the capsule without causing excessive damage in the process which can require drains and can even injure the chest wall (the part of the capsule that is on the chest was is known as the posterior portion of the capsule). There should not be a problem with leaving the posterior part of the capsule if it cannot easily and safely be removed and as long as the front and side parts of the capsule are removed (anterior and medial/lateral portions) you should have no problems. Best of luck with your surgery!
I perform many breast revision surgeries. I try and remove most if not all of the capsule. If the capsule is very thin I try not to remove it but usually it is thick and needs to be removed if I am doing a remove and replacement with new implants. It is safe to try and not remove the capsule if it is stuck to the rib cage. Can cause bleeding and pain.
I use drains most of the time when removing and exchanging and doing a removal of the capsule. Best to get as much of the capsule out as possible.
Best to find a Board Certified Plastic Surgeon to do the procedure.
Andrew Cohen, MD
Capsulectomoes are not always necessary. Sometimes they can be left in, removed in part or removed totally. Trust your surgeon to make the best judgement during the surgery.
If the capsule is thin or very attached to the chest wall it is perfectly okay to leave it in place, It likely will adhere well and obliterate any space of the past implant. My Best, Dr C