Should I consider having my capsules removed?

Thank you for your question. In most cases, removal of the implant capsule is unnecessary. BIA-ALCL is a very rate form of lymphoma , particularly if you’ve had only smooth breast implants. Removal of the capsule (capsulectomy) can be associated with complications, including bleeding. The risk of surgery most likely outweighs the benefit but I would recommend you discuss your concerns with your plastic surgeon. I hope this helps.

Anytime you remove your breast implants, the capsule must be removed as well in it's entirety. The proper method is 100% total capsulectomy or also known as en bloc. Breast implants are associated with different cancers and gel bleed. The capsule holds these toxins therefore they need to be removed as well. If you have had your implants removed already, you would then need a residual capsulectomy to remove those capsules.

If you are developing symptoms such as fluid collection, redness, or pain, you should see physician. Textured implants have been associated with breast implant related cancer. The BSCC consensus statement points out that it is currently unknown whether the removal of breast implants with or without a capsulectomy will prevent the future development of a breast implant-associated cancer. It also says there is a rare subset of patients who have still developed breast implant-associated cancer after capsulectomy.

If there is capsular contracture, I recommend capsulectomies to remove them. BIA-ALCL is a very rare periprosthetic malignancy that requires capsulectomies en bloc. Capsular contracture is NOT a malignancy. It is just excessive scar contracture of the capsule related to low grade bacterial biofilm contamination of the implant in the pocket.

Hi mc931119, thank you for this great question. BI-ALCL has only been found in patients with textured breast implants and the overall risk for patients with textured breast implants is approximately 1 in 30,000. Therefore I do not recommend undergoing capsule removal for the purposes of preventing BI-ALCL . If you had textured implants and you were to develop swelling in one breast I would have it evaluated.

As for fat transfer, this is a great procedure I commonly perform in patients at the time of their explant surgery. If you choose to have a delayed fat transfer the capsules do not need to be removed.

Hello @mc931119, thank you for your question. Yes, removing the capsules is key. I believe that every time an explant is performed, the capsule must be removed. Complete capsulectomy. Whether it is en bloc does not matter as long as the whole capsule is removed and the tissue is sent for pathology after taking the capsule out. This will prevent future inflammatory responses from the body because capsules do not get reabsorbed. Here is a video that sheds more light on the topic. Best wishes!

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

Dear mc931119,
as long as your capsules are thin and you don't have capsular contracture, you should be fine with just implant removal. In case of capsular contracture or thick capsules, it is best to remove implants and capsules in order to prevent possible complications.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

There is probably no medical reason to remove the capsules. Her surgeon had and opportunity to visualize the capsules, and assuming everything was normal, including of fluid around the implants, there is more risk of complications with taking the capsules out, versus leaving them in.

Since the implants have been removed, you may or may not have capsules. I have seen some thin capsules dissolve over time once the saline implants were removed. Also, it may be difficult now to go back and find your capsules. No one is recommending removing thin capsules, especially with smooth implants, just because they are present.

If you were not having issues with your capsules it is typically fine to leave them behind. I encourage you to discuss your concerns with your surgeon as she/he has had the benefit of examining you as well as actually performing the surgery. As you mentioned that you are considering fat transfer, you may want to take into account that fat that is transferred to the breasts runs the risk of developing calcifications which may interfere with testing such as mammography.