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

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 so sick just thinking about this and do know what to do!

Doctor Answers 8

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!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast Implant Removal and Capsules?

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 “capsule”.   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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Capsule does not always have to be removed

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.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Reasons for Capsule Removal When Removing Breast Implants

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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

? Capsulectomy

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. 

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Capsule removal with implants

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Do you have to remove the capsule if you remove the breast implant.

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.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 105 reviews

Should your Breast Implant Capsule be Removed With Your Implants....?

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.

Daniel P. Markmann, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 114 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.