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

Question

I have baker grade IV capsular contracture which is extremely uncomfortable and painful. I was wanting dr's opinion on which procedure is best and also I am getting my implants removed and not replaced..... Thank you! Kind regards Jess

Gary Lawton, MD, FACS · Answer

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.

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

Jed H. Horowitz, MD, FACS · Answer

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.

David J. Wages, MD · Answer

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.

Michael J. Brown, MD · Answer

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

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

Answers (6)

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

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

Answer: Breast implant removal capsule management

Answer: Breast implant removal capsule management

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Everything you need to know about Breast Implant Removal

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

Answers (6)

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

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

Answer: Breast implant removal capsule management

Answer: Breast implant removal capsule management

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Recommended reading

Everything you need to know about Breast Implant Removal

Our mission is to create a world where every investment in modern beauty is Worth It.