Is it true that removing thin capsules could cause damage?

Question

Breast implant removal with muscle repair but without taking out the capsules, I have a 3 years old implants under the muscles and my surgeon said my capsules are very thin and I would do more damage trying to get it out than leaving it alone since it’s thin. How true is this?

Tom J. Pousti, MD · Answer

There's definitely some truth in what your plastic surgeon has told you.  Removal of any type of capsule, thin or thickened, can potentially  lead to "damage" of surrounding tissues.

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 bloc removal of breast implants is a good procedure.

***On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.

The good news:  breast implant removal surgery is a very well-tolerated procedure with minimal discomfort,  compared to first-time breast augmentation surgery. Patience is definitely indicated after removal of breast implants; it will take many months for the skin to “bounce back” and for you to see the final appearance of the breasts.

I hope this helps. Best wishes for uneventful surgery and an outcome that you will be very pleased with.

Kenneth Hughes, MD · Answer

Concur with your PS's advice. If areas of the capsule are difficult or dangerous to remove, the risks of removing thin, pliable capsules outweigh leaving the capsule.  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.Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Camille Cash, MD · Answer

There is a risk of damaging surrounding tissues when the capsules are removed, but it can be done if desired.  Typically if the capsules are thickened or the implant is ruptured, then removing the capsules is recommended.  If they are thin it is an option to leave them behind when the implants are removed.

Eric Wright, MD · Answer

Yes, removal of the capsule has a higher risk of injury than leaving the capsules.  Thin capsules can be completely removed but it more challenging, especially for implants below the muscle.  You would need to discuss the reasons why you are removing your implants and what symptoms you are experiencing.  Dr. Eric J. Wright

Farbod Esmailian, MD · Answer

If the capsule is very thin it is unnecessary to remove the capsule.  If there is thickening of the capusle, if there is rupture of silicone implants, or any other medical issue at hand, then removing the capsule en bloc would be the preferred approach.For a simple explant where the patient doesn't want implants anymore and the breast is very soft and very thing capsule, then just removal of the implant is sufficient.Trying to remove capsules can lead to issues such as bleeding, sensation loss, contour irregularity in a thin patient and others.Hope that helps.

Daniel Barrett, MD · Answer

Dear huynhmylove,
most plastic surgeons don't remove capsules at the same time as implants, unless there is a thick capsule or capsular contracture. 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

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