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

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