Should the Capsule Be Removed with the Implants?

If someone wants to permanently remove their saline breast implants, does the capsule need to be removed as well? If the capsule stays in, what happens to it? Will it move to other parts of the body or does it dissolve eventually? I've heard conflicting information about it. I heard from some that it is risky to remove it and it will dissolve over time. On the other hand, I read other stories about women who get sicker from leaving it in. Which is correct, to remove the capsule or leave it in after removing the implant permanently?

Doctor Answers 13

Managment of the capsule with breast implant removal (explantation)

Breast implants can certainly be removed(explantation) under local anesthesia.

In regards to the capsule:

  1.  There is some controversy among surgeons if this should be removed and this is difficult to perform under local.
  2. Over the muscle capsules are easier to remove than under the muscle capsules
  3.  With saline implants in which there is minimal capsule, i have left in place.
  4. With saline implants that have a severe, thickened or infected capsule, I will attempt to remove all or significant portions of the capsule
  5. In instances incwhich there may be concern about pathology such as Atypcial Lymphoma, I will remove signficant portions of the capsule
  6. With intact silicone implants of relatively short term duration (,<5 years) I will leave these in place
  7. Wtih silicone implants of long term duration with thickened capsules I will attempt removal of the capsules
  8. In ruptured intracapsular silicone implants, I will attempt en bloc resection.
  9. In ruptured extracapsular silicone implants, I will attempt en bloc resection in combination with involved tissues.

Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Partial removal of capsule or total removal

It is a normal process to form a capsule around breast implants.  Most surgeons will remove a portion or totally remove the capsule at the time of implant exchange if it is thickened or calcified.  Total capsule removal can be a messy operation with prolonged drainage.  I try to avoid this if possible reserving total capsulectomy for cases where other options do not exist.  Implants can be placed in a different position with a fresh pocket created allowing the surgeon to avoid some capsule removal.  Choose a surgeon that performs this frequently.  I always say look for some gray hair, but not too much.

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon
4.6 out of 5 stars 82 reviews

Treatment of the capsule in explantation

The considerations for removing implants are to streamline a woman's life (ie eliminate the maintenance concerns) and optimize the appearance of her breasts. Assuming that your nipples are at or above the inframammary fold (where the breast meets the chest wall) and your skin brassiere is elastic, there is a chance that your eventual result will be acceptable, even if somewhat deflated.

My approach is as follows: a) for low grade capsules (Baker I & 2); capsulotomy, drain placement, antibiotics, compression and limited activity for 4 weeks; b) for high grade capsules (Baker 3&4) open dome capsulectomy (subtotal release), drains, antibiotics, compresssion and limited activity for 4 weeks. My rationale is to ensure that the prior space collapses down consistently.

Good luck

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Capsulectomy with implant removal?

If the capsule is symptomatic (thickened, firm or calcified) it is in your best interest to have the capsule removed to avoid problems such as firmness and irregularity  of the breasts postoperatively. These problems may confuse self breast exam (for cancer detection). Furthermore, calcification in the capsule may confuse mammography use for breast cancer screening. Of course, it is important during this process of removal of the capsule to avoid excision of normal breast or subcutaneous tissues.

If the capsule is soft and asymptomatic then excision is unnecessary.

Best wishes.

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

Everyone is right!

Capsules left in can be nothing or they can fill with fluid and create a bulge.

Ideally, some or all of the capsule should be removed and then the pocket sutured closed. I prefer to lift the breast tissue at the same time, by suture the anterior pocket a little highr than befor removal.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Capsule Removal Not Always Necessary

In the vast majority of explantation cases, it’s not necessary to remove the capsule that surrounds the breast implant.When these capsules are left alone, they collapse upon themselves and the implant pocket is eventually obliterated.In addition, capsule removal may be associated with secondary complications such as bleeding.For this reason, removal of breast capsules is not undertaken without specific indications.

When patient’s have ruptured silicone implants, calcified capsules, or thickened capsules with breast distortion, capsulectomy is usually indicated.Under these circumstances, failure to remove the capsule will result in a persistent deformity.

In someone who’s not having problems with capsule formation, simple removal of implants without capsulectomy is probably reasonable. Under these circumstances, it’s important to discuss this issue with your plastic surgeon.Your surgeon should be able to formulate an appropriate treatment plan.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Should the capsule be removed with the implants?

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 capule 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 contracture is 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 and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies 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. Hope that this helps!  Best wishes!

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

Capsule of implants

Most capsules that are soft around the implants do not need to be removed.  They will often just resorb over time.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Do breast Implant Capsules need to be Excised?

No, most breast implant capsules do not need to be excised following breast implant removal because they will be absorbed by your body.

If your are doing having a breast implant exchange, particularly if a larger implant is being placed, and the same pocket is being used then sometimes a cutting of  the breast implant capsule  to release it might be done.

Fredrick A. Valauri, MD
New York Plastic Surgeon

Capsulectomy during breast implant removal

It is possible to completely remove the capsule during breast implant removal. If you are having difficulty or thickness with the capsule this technique may be recommended. However if the capsule is soft and is not affecting adjacent structures, the capsule may be left in place.

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 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.