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

Question

My ps said he does not remove the capsules since they contain tissue when removing implants. Is this harmful? He also said that since I had a lift a few years ago then a revision i can be at risk for losing my nipple if i needed a lift down the road after the removal.....im so sick just thinking about this and do know what to do!

Lewis Albert Andres, MD · Answer

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!

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Larry S. Nichter, MD, MS, FACS · Answer

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.

Adam Tattelbaum, MD · Answer

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.

Camille Cash, MD · Answer

If you have a ruptured implant or are having issues with your capsules such as contracture, thickening, or pain then it may be recommended to have your capsules removed along with your implants.  If you are not having issues and the capsules are thin it is an option to have them removed or leave them behind.  If they are very thin it can make surgery more challenging if they are removed.

Jeffrey Zwiren, MD · Answer

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.

Moneer Jaibaji, MD · Answer

Your plastic surgeon raise valid points. It would be hard for us in this forum to answer your questions without proper examination of the breast. What grade of capsular contracture you have, how thin is your breast tissue, what type of lift you need and what size implants. Also, what type of lift you had in the past. All these questions and more need to be answred before an accurate answer to your question is given.

Steven Wallach, MD · Answer

I remove capsules if they have formed a capsular contracture.  If the patient is having an exchange I will adjust the capsule for the implant.

Tom J. Pousti, MD · Answer

Thank you for the question.

	When breast implants,  or any other foreign body,  is inserted into the human body,  the body forms a lining around it.  This lining is referred to as the &ldquo;capsule&rdquo;.   This capsule is normally very thin and soft;  however, it can become  thick and hardened in a process called encapsulation or capsular  contracture.

	In the process of breast implant removal,  assuming the breast implant capsules are soft and asymptomatic,  there is no reason to remove them (capsulectomy). Removal of breast  implant capsular  tissue increases  the risks of surgery (for example bleeding).
	 
	I hope this helps.

Daniel P. Markmann, MD · Answer

To remove or not remove a breast implant capsule is a decision made on an individual case by case basis.  Sometimes it needs to be removed, others, it doesn't.  If you are removing your implants an not replacing them, and your capsules are soft, they don't need to be removed. If they are firm, I would likely remove them.   If your implants feel hard (capsular contracture) and you are planing on replacing them with new implants, the capsule should be removed. 
	Your statement that your PS doesn't remove capsules because they contain "tissue".  I believe he means because they contain "blood vessels" and removing them can impinge on the blood supply to your skin or nipples if your breast tissue is very thin.  This is true if you have very little tissue between your capsule and your skin. 
	I would recommend a second opinion.

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