Capsulotomy or Capsulectomy? What is best for severe capsular contracture?

For explant surgery, it is almost always best to remove
the capsule in its entirety. This will allow the space to heal. If
you leave the capsule in place, it does not heal. Fluid can accumulate in
the space. The situation that brings the patient to implant removal will
have an affect on the decision. This is a surgery which requires
discussion with the plastic surgeon about the problem, the goals, and the
technical concerns. The body does not re-absorb the capsule.
Revision surgery requires drains because the fluid is going to be
generated when you operate on the scar capsule. If you provide a
mechanism for the fluid to be removed (i.e. drains), the risks are lower.
If the fluid accumulates because there were no drains, it will most certainly
cause problems in the future.

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

Effective treatment of the capsule frequently involves completely removal of the capsule (#capsulectomy), and occasional incisions in the capsule may be somewhat helpful (#capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.

Thank you for your question.  Most authorities would recommend removal of as much capsule as is safely  possible .  You would also want information regarding the consequences of removal of the implants and capsule during your assessment.   You may need to consider a breast lift afterwards.  I would recommend starting with a face to face consult with a Board
Certified Plastic Surgeon who has experience in breast surgery.   Good luck. 

If you have severe capsular contracture and are symptomatic it is best to have your capsules and implants removed. With severe capsular contracture the breast may feel hard, look misshapen, or even hurt. I've included a video on this that I hope you find helpful.

Hi,

Thanks for posting your question. I am happy to try and help you. It is
important to remember that a board certified plastic surgeon will be your best
resource when it comes to an accurate assessment of your situation, and
concerns.

Having said that, people get confused trying to use medical terms they do not
understand. You are better off not trying to use these terms and learn what the
doctor is actually telling you.

Simply put: any word with 'ectomy' at the end of the word means to
remove, so tonsilectomy, appendectomy, mastectomy all mean to remove the
organ. So these would be to remove the tonsils, appendix and breast,
respectively.

Any word with 'otomy' at the end of the word means to open or make a
hole in. So in terms of a breast implant capsule, a capsulotomy simply
means they are going to cut a hole in the capsule to pull the implant out.
There is no removal, just open. Obviously, if you want the implant removed,
exchanged, pocket surgery, etc they all start with the 'otomy'. Thats it. So a capsulotomy under local anesthesia or light sedation is absolutely fine.

For breast implant removals, as long the capsule is thin, soft and without
calcium deposits, it is fine to leave them in. The body will reabsorb the thin
layer over time. This is of no consequence and is entirely safe. Now if the capsules are thick then you may require their removal. This should be done under anesthesia for your comfort.

I hope all goes well with your surgery.


Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

In general, a total capsulectomy is the the most effective treatment for a severe capsular contracture.  However, there are caveats to that.For one, if the implants are below the muscle, then an anterior capsulectomy may be the most prudent procedure.  Removing the posterior portion of the capsule may get too close to the ribs and even the pleural cavities (around the lungs).  Also, for women with very little breast tissue, it may be riskier to remove the capsule than just to incise (cut into) it; that's termed a capsulotomy.  That may work if you reinsert implants; if you merely score the capsule and remove the implants the capsule may reform.Ultimately, you'll need to discuss this with a board-certified plastic surgeon who can examine you in person.  If your skin is very then, then just removing the implants and seeing how you heal may be the safest approach, even if it makes a second procedure more likely.  That's part of what you'll have to go over with your surgeon.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf100