Does the Capsule Have to Be Removed when Removing Breast Implants?

Hello! Thank you for your question!  It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

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

Breast Capsule Removal (Capsulectomy) Guidelines and Explanation
The guidelines I recommend for my patients are pretty straight forward. If the capsule is very thick, calcified or otherwise distorts the breast or is calcified it needs to be removed. The same for any ruptured silicone implants as it gives you the opportunity to remove traces of free silicone.

The purpose of the Capsulectomy is to  Remove Abnormal Internal Scar Tissue. Without doing so it will remain. A Complete capsulectomy for all practical purposes means removal of all internal scar tissue. Your body as a part of natural part of healing under ideal circumstances will make a new thin and supple capsule  when the new implant is placed rather than a thick stiff one that was removed.

Breast Capsule Removal (Capsulectomy) Guidelines
The guidelines I recommend for my patients are pretty straight forward. If the capsule is very think and distorts the breast or is calcified it needs to be removed. The same for any ruptured silicone implants as it gives you the opportunity to remove traces of free silicone. On the other hand, if there is no rupture of a silicone implant, or a saline implant (ruptured or not) and the capsule has normal thinness I leave it alone. These guidelines have served me well over the past few decades.

Thank you for your question.

As you know the capsule is the scar tissue shell that the body creates around the outside of the breast implant.  When the breast implant is removed the scar tissue can be left behind or it can be removed.

In my own practice I generally removed the scar tissue only if it is thick or has held a leaking silicone implant.  If the capsule is soft I find there is generally no need to remove it.  In a woman with a very thin breast leaving the capsule minimizes surgery and leaves a better blood supply to the overlying breast tissue if one day you require a breast lift.

I would recommend you let your board certified plastic surgeon use his or her own judgment about whether removal of the capsule is necessary.

Best wishes.

If the capsule is removed it increases the risk of bleeding.  If a silicone gel implant has ruptured then removal of the capsule would be recommended otherwise I would leave it alone unless it was calcified.  If there is distortion of the breast after implant removal may also be a reason to remove the capsule.  The capsule probably never fully gets resorbed and refinements will be there for a long time.  This would not cause a health risk.