Explant of silicone subglandular smooth mentor implants, how much capsule to remove?

Hi @afawnf, thank you for your question. All explantations must be accompanied by a total capsulectomy, because the capsules can cause future inflammatory processes if left in the body. From the hundreds of breast implant removals I have performed I can attest that the capsules are not reabsorbed by the body. To shed more light on this, I have included a video and link to one of my articles, best wishes!

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science" Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

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Thank you for your question. I have attached a detailed video that explains your question. In my professional opinion, I recommend to ensure that the entire capsule is removed to ensure that you have an optimal chance at recovery.

There is no reason to remove any capsule unless there is a valid reason to do so (such as capsular contracture). I would recommend seeing a board-certified (American Board of Plastic Surgery); ideally, a surgeon with also a history of proper aesthetic breast surgery training.

Dear afawnf,
it is hard to tell for sure without an examination. Generally speaking, if your capsules are thin then only implants can be removed. 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

As you suggested, this can be an individualized answer. With a soft, pliable capsule, there is no reason to remove any of it. If the capsule is thick and calcified, I would usually remove all of it, if possible. No reason to retain a mass of thickened, calcified tissue that might be palpable.
Other than that, there is no reason to be concerned about leaving the capsule. It would be a good idea to suture the front and back together to hold the overlying in breast in place and decrease the chance of getting a fluid collection or seroma.

Thank you for this important question. In reality, the answer is up to you to choose because there is no definitive right or wrong answer. Here are some points to consider:
1) There is no good data out there to show that (outside of severe cap con or BIA-ALCL), removal of the capsule is necessary.
2) Removal of the capsule does expose the patient to increase surgical time, discomfort, and risk (especially with SM implants).
3) There is reasonably good data out there to show that self-reported patient symptom improvement after surgery was irrelevant of type of capsulectomy performed. In other words, the studies that have been done did not show that people who had a total capsulectomy did any better than those who had no capsulectomy or partial capsulectomy in terms of the symptoms they were experiencing before or after surgery.
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Routinely when I do explant, I do not remove the capsule unless there is indication such as calcification or infection. I am not familiar with any studies that show adverse reactions to leaving the capsule behind if the capsules are normal.

Best Wishes,

Gary Horndeski, M.D.

Excellent question! At this point, the research shows that if the capsule looks nice and thin and normal, there is no reason to have to remove it. There is some thought that there could be a "biofilm" which means some bacteria, but no real evidence that this makes any long term difference as far as complications. Leaving healthy capsule tends to be the safer procedure.

If the capsule is thin, it can be left in place, especially if it is on the back side of the implant. on the back side of the implant, there is risk of injuring the chest cavity and even entering into the space of your lungs or heart. That would not be good, and you would be sent emergently to the hospital for a chest tube.

An exam is the best way to determine how much, if any of the capsule needs to be removed. If the capsules are thickened or causing issues they should be removed along with the implants. I encourage you to visit with us in our Houston office to learn more.