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.