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

Thank you for your question. If there is a significant amount of scarred and contracted capsule, then I usually recommend to patients that we take it out at the time of explant. Your surgeon may other reasons for wanting to leave it in and you would need to discuss those with him. If you think the capsule needs to be removed, then discuss that with him and go over the risks and benefits of leaving it in or removing it. If you still cannot come to an agreement about what you want, then you might need a second opinion.Best of luck!

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

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). 

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.

Typically if the capsules are thickened or are causing issues they are removed along with the implants. I encourage you to discuss your concerns with your surgeon. If you are uncomfortable with the response there is no harm in seeking a second opinion.

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

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.

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.

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 

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.