Implant removal - do I need to have the capsule removed at the same time?

Dear Sheenyrube,
it is hard to tell for sure without an examination. Generally speaking, if your capsules are thin there is no need for their removal. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hi @Sheenyrube, thanks for your question. To prevent long-term inflammation, it is also important to perform a capsulectomy to remove the entire capsule, because this inflammatory tissue is not reabsorbed by the body. From my experience, I recommend performing the Explantation with a breast tissue reconstruction technique, in my case my BRALAN technique without implants, to avoid future inconveniences. If you are considering a breast explantation, consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes!

Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Hello, thank you for your question. When it comes to explanting a breast implant, especially in cases involving infection or complications like fluid accumulation, the decision to remove the capsule (the fibrous tissue that forms around the implant) is important for several reasons. It can prevent future complications, a better healing environment, and clearer assessment. Please review the attached video that discusses your question in detail. While capsule removal during explantation in generally advisable to achieve the best long-term outcomes, the final decision should be made collaboratively with your surgeon based on your unique circumstances. Ensure that all of your concerns and goals are addressed in your consultation, so you can proceed with confidence toward your next steps.

If you have an infected implant and infected capsule then it may be in the best interest to remove the capsule. I recommend you wait 6 months before doing a repeat implantation.

Best Wishes,

Gary Horndeski, M.D.

When considering implant removal, whether or not to have the capsule (the scar tissue that naturally forms around breast implants) removed at the same time depends on several factors. Here’s an overview to help you understand your options:
Reasons to Remove the Capsule:
1. If the capsule is hardened, painful, or distorts the breast shape, removing it (capsulectomy) may be recommended to improve comfort and aesthetics.
2. In cases of suspected Breast Implant Illness (BII) or rare conditions like Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), complete removal of the implant and capsule is often advised.
3. If you plan to replace the implant or achieve a flat chest with natural contours, removing the capsule can help ensure optimal results.
4. If the implant is ruptured or there’s an infection, the capsule may also be removed to prevent further complications.
Reasons to Leave the Capsule:
1. If the capsule is soft, thin, and not causing symptoms, your surgeon might suggest leaving it, especially if removing it could increase surgical risks.
2. Leaving the capsule can reduce surgery time, cost, and recovery duration, as capsule removal is typically more complex.
Types of Capsule Removal:
1. Total Capsulectomy: The entire capsule is removed.
2. En Bloc Capsulectomy: The implant and capsule are removed together as a single unit, typically done when there are health concerns or ruptures.
3. Partial Capsulectomy: Only parts of the capsule are removed, often when it’s adhered to sensitive tissues like the chest wall.
Consulting with a board-certified plastic surgeon is essential to evaluate your specific situation and determine the best approach for your implant removal and capsule management.

You may want to consider having the capsule removed along with the implant unless it is too thin and would cause further complications. You will want to wait until the infection has completely healed before considering augmenting again. Your surgeon will help guide you through this.

The capsule has not fully formed. Your surgeon can decide once he/she looks inside to see if what has formed may need to be removed. Usually, this early in the healing process, the capsule does not need to be removed.

As a general statement, infected implants need to be removed.
There have been instances documented where infected implants have been salvaged with controlling the infection, but these instances are rare and most of the time failure to remove the implant in a timely manner makes the situation worse by allowing bacteria to grow causing tissue destruction, and Increased Inflammation with the development of capsular contraction.
The fact that you have ongoing leakage from your implant tells me that you still have bacterial contamination.
Most likely the reason that you’re not showing a clinical infection is because your body has the ability to drain the contaminated fluid.
The indication for a capsulectomy is if the capsule is thickened.
at this point you may be in the early stages of contraction and the capsule may thicken further if it hasn’t already.
It’s obviously desirable to avoid removing the implant if possible, but waiting sometimes set the patient back because of continued exposure to bacterial contamination. Because the chance of successfully salvage an implant that’s infected is so low. I usually always recommend removing them , when there’s evidence of an infection.
The inflammation from the infection and combination with removing the implant can cause severe scar tissue formation leading the breast to become highly disfigured after removal of the implant.
This may severely limit the ability to have a quality augmentation in the future.
There’s no right or wrong answer or easy solution to your problem.
Working with the right provider is the most important variable
Recognize that your chance of having a long-term quality outcome without further complications is relatively low.
I wish I could be more optimistic, but my experience has taught me that these situations can be difficult to manage and once a patient has had a significant problem with breast documentation the chance of quality long-term outcome goes down significantly.
It may be possible to re-augment in the future with a reasonably good outcome, but it’s also possible that you may face further complications.
Make sure you’re working with a plastic surgeon who has enough experience to have managed the situations in the past.
Best,
Mats Hagstrom MD