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

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.

Adam Bauermeister, MD · Answer

Hi, it appears that you have a breast capsular contracture. This is more common when the implant is placed in a subglandular position (above the muscle). You have multiple options in treatment depending on the severity of the capsular contracture. You can remove the capsule, alter the capsule by cutting it in several places, use absorbable scaffolds, and or change the implant pocket position to a submuscular position. Explant surgery is also a reasonable option if you no longer want your implants. I typically remove the capsule when I perform an explant surgery in order to reduce the risk of a seroma (fluid collection) following surgery, however it is not mandatory and may be associated with an elevated surgical risk in individuals with very little breast tissue (can effect skin and nipple blood supply). I would need to perform an exam and get further history for a more accurate recommendation.

Daniel Barrett, MD · Answer

Dear kimberniki,
it is hard to tell for sure without an examination. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Shana Kalaria, MD · Answer

If there are no concerns for BII or no implant rupture, there is no need to remove the capsules. Over time they will scar down and heal. You should also discuss whether a lift is necessary with your implant removal as this is frequently the case. Please visit with a board-certified plastic surgeon. Good luck!

Connie Hiers, MD, FACS · Answer

Unless the capsule is very thin, I would suggest removing it a well, because it may have some thick areas of scar tissue.

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.

Erik Hoy, MD · Answer

While treatment of a ruptured implant may entail removal of the implant alone (saline rupture, for example), patients with capsular contracture benefit from capsulectomy, or removal of the scar capsule around the implant.  There are several reasons for this such as removal of unnecessary or restricting scar tissue, removing tissues which can be contaminated with silicone or bacteria, or for better release/shape/healing after implant removal.  All good topics to review with your plastic surgeon to find the best answer for you and your care.  Best wishes, Dr Hoy

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

Answers (10)

More Breast Implant Removal Questions

Right breast is smaller and a weird shape post explant - do I need a revision? (photos)

Capsule was stuck & only part of it removed - does this happen sometimes?

Am I eligible to have my breast implants removed?

Textured Breast Implant Removal - Should I consider a capsulectomy?

Should I just remove implants & lift rather than get new implants at the same time?

Interested in breast implant removal, from 32D to AA. What are my options? Will I need a lift? (photos)

WE SEND PRETTY
EMAILS