I have smooth implants, no rupture but I have BII symptoms, is a partial capsulectomy ok or should I get a total capsulectomy?

Unfortunately, you have not provided photographs, told us the size of your implants or your bra size.  However, if the implants are retro-pectoral, often times it is possible to do only partial capsulectomy because part of the capsule is attached to the ribs and is very difficult to remove without complications.  If the implants are in front of the muscle it is easier to do a capsulectomy.  However, a capsulectomy can injury the blood supply and nerve supply to the nipple-areola complex.  Also, after explant alone, many women are dissatisfied with the hanging skin, empty appearance and require a lift.  The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.  Removing a capsule unnecessarily could result in bleeding and slight tissue loss. Consult with a board certified PS via email, Skype, or in-person if possible.

Dear 92404,
generally speaking, if there are thick capsules around implants, then removal of implants and capsules is the best choice. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If you're experiencing symptoms of Breast Implant Illness (BII) and considering surgical intervention, such as a capsulectomy, it's crucial to discuss your options thoroughly with a skilled healthcare provider, preferably a board-certified plastic surgeon experienced in managing BII cases. Here are some considerations to keep in mind:
1. Partial Capsulectomy: A partial capsulectomy involves removing only a portion of the scar tissue capsule surrounding the breast implant while leaving some of the capsule intact. This procedure aims to alleviate symptoms associated with BII while preserving some of the natural tissue support around the breast. It may be appropriate in cases where the capsule is thin, the symptoms are mild, or there are concerns about preserving breast shape and symmetry.
2. Total Capsulectomy: A total capsulectomy involves removing the entire scar tissue capsule along with the breast implant. This procedure provides complete removal of any potentially problematic scar tissue and foreign material, which may be beneficial for individuals experiencing more severe symptoms or those who prefer a more comprehensive approach.
Factors to consider when deciding between partial and total capsulectomy include:
• Severity of Symptoms: The severity and persistence of your BII symptoms can influence the decision on the extent of capsulectomy. If your symptoms are severe and significantly impacting your quality of life, a total capsulectomy may be recommended to ensure complete removal of any potential triggers.
• Implant Type and Condition: Smooth implants, like the ones you mentioned, may have a lower risk of capsular contracture compared to textured implants. However, if you're experiencing symptoms despite having smooth implants, it's essential to evaluate the condition of the capsule and the potential role it may play in your symptoms.
• Cosmetic Considerations: Your aesthetic goals and concerns about breast shape and symmetry may also influence the choice between partial and total capsulectomy. Your plastic surgeon can discuss the potential impact of each option on your breast appearance and help you make an informed decision.
Ultimately, the choice between partial and total capsulectomy should be based on a comprehensive evaluation of your individual circumstances, including your symptoms, implant type, capsule condition, and personal preferences. It's essential to have a thorough discussion with your healthcare provider to understand the risks, benefits, and expected outcomes of each approach before making a decision.

If you truly have BII, then you need a complete capsulectomy to remove any foreign material and capsules from breast implants.

Typically if you have rupture, thickened capsules, or have issues you should have the capsules removed at the time of the explantation.  If you are having no issues and the capsules are thin it is your option to have them removed or leave them behind.  As you are having symptoms you may consider having the capsules totally removed for peace of mind.  I encourage you to discuss your concerns with your surgeon.

With smooth, intact implants, the issue of capsulectomy with BII symptoms has no clear answer.  In my practice, I make that determination at the time of surgery.  If the capsule is extremely thin and membranous, there is no benefit in its removal.  If, on the other hand, it is thick, fibrous, or calcified, then a complete capsulectomy should be performed.  The removal of the posterior capsule, (which usually distinguishes partial vs. complete) is sometimes easily done and sometimes is very adherent and can increase the complication rate postoperatively with a higher bleeding risk.

Hope this helps.

Dr. Ali Mosharrafa