Thin capsule removal - breast implant illness. Can total capsule removal be done on thin capsules?

Question

Mentor textured 300cc breast augmentation over the muscle in Jan 2023.Experiencing BII aswell as both implants bottomed out. My surgeon never dealt with BII before. Said capsule will be thin and not be able to remove it all. Can total capsule removal be done on thin capsules ? If breast implants bottomed out does that mean they have fallen out of the capsule? Do textured implants leave flecks or traces which lead to ALCL ? Want removal done properly as illness affecting my life.

Shaher W. Khan, MD · Answer

Please watch the video regarding thin capsule removal. A bottoming out implant does not mean that it has fallen out of the capsule. The capsule engulfs the implant. Over time, due to multiple factors including age, weight, and gravity; implants may bottom out. Having textured implants does increase the risk for BIA-ALCL; however, if the capsule and implant are not removed as one, entire system it can result in the risk still being there. It is important to ensure you have multiple consults to ensure your surgeon will remove the entire implant and capsule to alleviate your symptoms of BII.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Ashley Thorburn, MD · Answer

Total capsule removal, also known as en bloc capsulectomy, involves removing both the breast implant and the surrounding scar tissue capsule as a single unit. This technique is sometimes recommended, particularly in cases of implant rupture, severe capsular contracture, or concerns about breast implant illness (BII).Whether total capsule removal can be done on thin capsules depends on various factors, including the thickness and adherence of the capsule, the condition of the surrounding tissue, and the surgical approach. In some cases, even if the capsule is thin, it may still be possible to remove it entirely.However, it's essential to note that performing en bloc capsulectomy on thin capsules can be challenging, and there may be an increased risk of leaving residual capsule tissue behind. In such cases, the plastic surgeon may need to use meticulous surgical techniques and possibly additional tools such as electrocautery or a surgical laser to ensure complete capsule removal.Additionally, the decision to perform total capsule removal should be made in consultation with a board-certified plastic surgeon who is experienced in breast implant removal and revision surgery. They can assess your individual situation, discuss the risks and benefits of total capsule removal, and recommend the most appropriate surgical approach based on your specific needs and concerns.If you are considering total capsule removal due to concerns about breast implant illness, it's essential to have an open and thorough discussion with your plastic surgeon about your symptoms, concerns, and treatment goals. They can help you make an informed decision about the best course of action for your situation.

Connie Hiers, MD, FACS · Answer

If your implants have bottomed out, but they are still inside the capsules. The capsules can still usually be removed. Sometimes, however, the most posterior aspect of the capsule must be left for safety to the chest wall. We do not want to injure the wall and see lungs and heart.  The whole implant is still inside the capsule so it can be removed. Implants do not flake. Do remember, not all women improve with implant removal.  BII is complicated and other factors, like harmful ingredients in foods, air, water, dyes, tattoos, cosmetics, and cleaning products may still be to blame for many health issues.

Camille Cash, MD · Answer

The capsule that surrounds a breast implant is scar tissue that your body naturally creates as a barrier.  If the capsule is thin, it is more challenging to remove.  You can elect to have the implants removed as soon as you wish, especially considering you feel they are impacting your health.  I've included a video on breast implants and BII that I hope you find helpful.

Mats Hagstrom, MD (license on probation) · Answer

Doing a complete capsulectomy, including the under surface is more difficult when the capsule is thin and flimsy. The indication for a complete capsulectomy is also decreased with less capsule formation. If you believe your implants are making you sick, then you’ll probably not feel better until you have your implants removed. Likewise, if you feel the capsules are contributing to your overall state of health, then you’ll probably continue to believe that the capsules are in someway pathologic know it is just your own tissue. Implants after having been removed should have no residual implant material left behind. While on a more theoretical level, there’s certainly chances of microscopic particles, having separated from the implant. In reality, I would take the assumption that explantation removes all implant material.
In today’s day and age, there are lots of people that had all kinds of vague symptoms of just not feeling well. This is now become common place to the point where the psychiatric community can no longer handle the patient loads. 
While I don’t believe in the implant sickness, I do believe that for those who have the concept seeded in their brain it is probably very real.
In reality, the rest of your life will not be changed if your capsule has segments left behind, but I’m going to guess that you’ll feel better being told that the complete capsule has been removed. For that reason alone, it is probably worthwhile to insist I’m having a complete capsulectomy for at least to the best of the surgeons ability. Removing the entire capsule could be viewed as unnecessary lengthy surgery. A lot of it is simply tedious detail meticulous work that requires time.
In the end, you simply have to have faith in your provider. There’s certainly nothing wrong with getting second opinions for the procedure. Sometimes second opinions can help confirm certain ideas or concepts, but can also confuse patients if they’re given contradictory information. In the end, finding the best plastic surgeon, and having faith in their skill, experience and talent is probably the best that you can do. I recommend patient try to avoid making their own assessments or making their own diagnoses. As a physician myself, the temptation is very real, but I as a patient make a solid effort to not get involved too much with my own health issues and let my doctors Make good decisions for what’s in my best interest.
I think the idea of having textured implants removed is a solid decision plan. I’m guessing you’re not interested in converting to smooth implants. If you feel like your plastic surgeon is the right provider then follow their recommendations.Good luck,
Mats Hagstrom MD

Thin capsule removal - breast implant illness. Can total capsule removal be done on thin capsules?

Answers (6)

More Breast Implant Removal Questions

35 year old mom of three and have 425cc under the muscle. Will I need a lift? (photo)

Capsule Biopsy under local anesthesia?

Implant removal while breastfeeding?

I am removing my Allergan Biocell textured implants, should I remove my capsules as well?

Breast implant illness & explanting Mentor Siltex, 350ccs - what would be the most important questions to ask?

Breast implant removal options? 385cc Sientra

WE SEND PRETTY
EMAILS