Remaining Scar Tissue After Capsulectomy?

Question

What happens to any remaining scar tissue after a complete capsulectomy? Does it eliminate itself from the body if it is stuck to ribs, or does it stay?  I am interested in breast implant removal en-bloc and am concerned if all the scar tissue can't be removed.

Lewis Albert Andres, MD · Answer

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 capsule 
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 an en bloc fashion) 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!

Jed H. Horowitz, MD, FACS · Answer

Good day! For your guidance, the removal of the capsule will enable the surgeon to remove as much silicone as reasonable without creating significant deformity. However, this operation may require a larger incision and longer surgery and recovery time. General anesthesia is usually necessary and subsequently all of the costs associated with this operation will be higher. Do not hesitate to ask your doctor if this is the right route for you and discuss realistic goals and expectations. Best of luck! #RealSelf100

Richard J. Bruneteau, MD · Answer

Every effort is made to
remove the entire capsule when plastic surgeons perform total
capsulectomies.Unfortunately, small
amounts of capsule are occasionally left behind.In addition, capsule removal may be associated
with secondary complications such as bleeding and rarely, perforation of the
chest wall.For this reason, remnants of
the capsule may be left behind on the chest wall surface.Under these circumstances, it may not be safe
to remove the capsule from the anterior chest wall.When capsule remnants are left behind they form scar
tissue which eventually remodels and softens.This doesn’t generally create long term problems for patients and wounds
tend to heal without difficulty, even when small amounts of capsule are left
behind.If you’re considering
capsulectomy surgery, it’s important to discuss these issues in detail with
your plastic surgeon.Your surgeon
should be able to discuss this in detail and alleviate any anxiety that you may
have.

Larry S. Nichter, MD, MS, FACS · Answer

Complete capsulectomy for all practical purposes means removal of all internal scar tissue. Your body as a part of natural part of healing under ideal circumstances will make a new thin and supple capsule rather than a thick stiff one that was removed.

Otto Joseph Placik, MD · Answer

Scar tissue tends to dissipate over time through a process called scar maturation. It will generally be thin and soften as long as most of the foreign body is removed.

Raffy Karamanoukian, MD, FACS · Answer

There are two surgeries available, a partial or complete capsulectomy; to remove capsule and scar after augmentation. It is usually not necessary to remove the entire contents of the capsule, as the anterior portion predominately contributes to asymmetry and distortion.

Kevin Brenner, MD, FACS · Answer

When it comes to capsulectomy (removal of breast capsules), there is no universal agreement. In general, if a surgeon is able to remove the entire breast capsule, then it should be done. This is usually done more easily for implants that are placed in the subglandular position. For implants placed in the submuscular position, removal of the the capsule underneath the implant can be tricky. For some patients with this situation, it is safer to leave the posterior capsule in place. This usually does not cause a problem, unless the capsule appears to be diseased for some reason.

Farbod Esmailian, MD · Answer

It really depends on the situation at hand whether the scar tissue around the implant is removed completely. In general, where there is suspicion of ruptured silicone and/or a thickened scar then it usually is all removed competely. If the scar tissue is thin and the implant is a saline implant, then most commonly it is left alone to adhere to each other and heal over time.

	Hope that helps.

Steven Wallach, MD · Answer

The goal is to take as much of the capsule out if it is scarred in. Sometimes the entiere capsule can not and often this softens and disappears.

Robert M. Freund, MD · Answer

Once the implant is removed, the capsule is staring the surgeon in the face. it may be tough going, but all capsule should be removed if the will is there.

Remaining Scar Tissue After Capsulectomy?

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