Capsule removal or not? Concerned about long term issues with scar tissue.

Question

I‘ve had smooth gel implants since 11/2015 (over the muscle). Recently I started to notice a tightening and firmness in my right breast (only). My surgeon who placed them had me get an MRI. The images confirmed there is NO rupture, but I do have capsular contracture. I’ve decided to explant. My surgeon said there was no need for a capsulectomy and to remove the implant only. I’m torn. I don’t think I have any BII issues. I’m concerned about long term issues with the scar tissue. Recommendations?

Alan Gonzalez, MD, FACS · Answer

Hello @kimberniki, thank you for your question. I believe that every time an explant is performed, the capsule must be removed. Complete capsulectomy. Whether it is en bloc does not matter as long as the whole capsule is removed and the tissue is sent for pathology after taking the capsule out. This will prevent future inflammatory responses from the body because capsules do not get reabsorbed. A capsule will always form around a prosthesis because it surrounds it and isolates it, since the prosthesis is a foreign tissue. To shed more light, I share a video. 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)

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

Shaher W. Khan, MD · Answer

Hello, thank you for your question. It is great that you got an MRI and I am happy to hear you have no rupture. My recommendation is to fill out the breast implant illness questionnaire to assess the symptoms you may have that breast implants cause. I would also recommend to have both the capsule and any inflammation removed that surround the implant. I recommend to ensure you complete extensive research on a surgeon that is willing to remove the entire implant and capsule to ensure you have the best quality of life post explant. The capsule has been noted to have silica particles that will continue to trigger an inflammatory response.

Richard Baxter, MD · Answer

With implants in front of the muscle it is probably safer to leave the capsules in, unless there is a very specific reason to remove them.

Camille Cash, MD · Answer

Typically if the capsules are thickened they should be removed.  When there is contracture this indicates that the capsule has tightened around the implant.  Often the capsule and implant can be removed as one unit.  This is called En Bloc.  If you are concerned about long term issues you can elect to have the capsules removed along with the implants.  I encourage you to discuss your concerns with your surgeon.

Capsule removal or not? Concerned about long term issues with scar tissue.

Answers (10)

Answer: OK to leave the capsule with implant removal

Answer: OK to leave the capsule with implant removal

Answer: Capsules

Answer: Capsules

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Everything you need to know about Breast Implant Removal

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Capsule removal or not? Concerned about long term issues with scar tissue.

Answers (10)

Answer: OK to leave the capsule with implant removal

Answer: OK to leave the capsule with implant removal

Answer: Capsules

Answer: Capsules

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Recommended reading

Everything you need to know about Breast Implant Removal

Our mission is to create a world where every investment in modern beauty is Worth It.