Extreme pain from capsular contracture. My surgeon says if I have an explant he will leave the capsules in place.Any suggestion?

I'm afraid if the capsule remains I may not have full relieve my pain. How do I respectfully ask my surgeon to remove the capsule even though his standard of care is to keep them in place. I'm also concerned he may not be well experienced in removing capsules since he usually doesn't.

Doctor Answers 11

Extreme pain from capsular contracture. My surgeon says if I have an explant he will leave the capsules in place.Any suggestion?

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I almost always go after the capsule when I remove implants, especially if the capsule is thick and tight.   It is true that in some cases, total capsulectomy is either not possible or it can be risky but in most cases, most if not all of the capsule can be safely excised.  Leaving the capsule behind can result in fluid build-up (a seroma), a firm and tender wad of scar tissue and it can look very strange on a mammogram.  I have seen all three of these issues.  In most cases of capsular contracture, patients feel a lot better after surgery.  There are some cases, however, where pain can persist.  I really hate to second guess other plastic surgeons, but I think you should get a second opinion.

Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Should the capsule be removed?

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Dear Happyplus3,

In my practice I generally recommend removing the implants and the capsule. However, in my aesthetic fellowship some of the surgeons I worked with left the capsules in place. The pain related to capsular contracture is generally related to the implant resisting the capsule tissue rather than the capsule itself. The reason I generally recommend removal is that most of the capsules I have taken out that cause pain are quite hard and can be felt beneath the breast tissue if left in place. Additionally, if you are considering having implants in the future it is best to remove the capsules and give you a fresh start. There is nothing wrong with letting your surgeon know that you would prefer to have the capsular tissue removed- he or she will then have the opportunity to discuss in more detail with you why they have recommended this treatment plan. Ultimately, it is important that you are on the same page with your surgeon. You may find that you agree with his or her reasoning once you have a better explanation, or you may choose to get a second opinion. Best wishes, Dr. Meghan Nadeau, Seattle, WA

Meghan Nadeau, MD
Seattle Plastic Surgeon

Capsulectomy and explant

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You did not mention how long you have had your implants. This actually makes a difference since the longer you have the implants and the contracture the thicker the capsule can get and the more calcification can form  over time   If your issues are relatively recent than just taking out the implant should not be a problem. If you have had your implants for many years and have had a hard  breast for a long time then a capsulectomy would also be indicated . Discuss your concerns with your plastic surgeon. If he still does not want to remove the capsule then you should seek another  opinion 

Andrew Kaczynski, MD (retired)
Sacramento Plastic Surgeon

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Seek a Second Opinion

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In many cases the capsule is removed with explant surgery especially when the patient is experiencing pain.  Consider a second opinion prior to your surgery.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Capsulectomy is the Treatment for Painful Capsular Contractures #breastaugmentation

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  • Patients who develop a capsular contracture after breast augmentation are best treated by undergoing a capsulectomy. A capsulectomy removes the thickened capsule that has developed around the implant. 
  • You may want to consider getting a second opinion from a board certified plastic surgeon (ASPS). 

Extreme pain from capsular contracture. My surgeon says if I have an explant he will leave the capsules in place.Any suggestion?

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For patient with painful grade 4 capsular contractures, I recommend removal of the implants and capsulectomy. If you are not comfortable with your plastic surgeon's recommendations, you could always seek a second opinion with surgeons in your local area. Thank you for sharing your question and concerns. Best wishes. Dr. Gregory Park, San Diego Plastic Surgeon.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 177 reviews

Extreme pain from capsular contracture.

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I'm sorry to hear you are so uncomfortable. Not all capsules require capsulectomy and it is important for the surgeon to understand when it is necessary and when it is not. But if a patient wants the capsule out, understanding the increased cost and risk, I see no reason why your surgeon would say no assuming you are healthy enough for the surgery. It can be a difficult and tedious operation so make sure your surgeon is comfortable with that, otherwise it is OK to see a different surgeon. BUT, and this is a big but, the discomfort will almost certainly be gone after the implant is removed with or without a capsulectomy. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Extreme pain from capsular contracture. My surgeon says if I have an explant he will leave the capsules in place.

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Thank you for your question. With a capsular contracture (grade IV) the capsule is typically removed. However, every case is different and there are situations where you may elect to leave some, or part, of the capsule. It's important to have a thorough discussion with your plastic surgeon about your concerns regarding leaving the capsule in place. They should be able to explain to their thought process regarding when to remove, or when to leave, the breast capsule.

Breast implant and capsule removal

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Thank you for asking about your breast implant and capsule removal.

  • Usually the pain of a capsular contracture is from pressure on the implant.
  • So removing the implant may relieve the pain.
  • that said, there are many causes of pain - and surgery won't predictable remove all pain
  • Removing a thick capsule is usually done these days - because of reports of significant abnormalities in them.
  • Ask your surgeon if he will remove it for you - there willl be an extra charge.
  • If you have doubts about his competence, you can go elsewhere but an experienced plastic surgeon should be able to do this without difficulty

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Breast Implant Explant

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With grade 4 capsular contracture and pain, the implant and the total capsule should be removed. There are no guarantees that the pain will disappear.

Samir Shureih, MD
Baltimore Plastic Surgeon

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.