How to Tell if the Capsules Are Thin and Soft?

Question

I have had silicone implants under the muscle for 4 years, no major problems except slightly palpable, and I can feel a small knuckle near my cleavage. My surgeon suggested an implant removal surgery under local anesthesia, and leaving the capsules behind. How would you be able to tell if the capsules are thin and soft before surgery? What happens during the surgery if you find out then the implants were leaking? The local asnesthesia wouldn't be enough if the capsules need to be removed.

Kenneth Hughes, MD · Answer

Removing implants under local anesthesia is appropriate only in the simplest case of pure removal. Capsular contracture is fairly easy to assess in a physical exam. I always have an anesthesiologist available if a more extensive procedure is needed. If there happens to be a rupture this may not be the easiest thing to detect in a silicone implant, and a portion of the capsule may need to be removed. Kenneth Hughes, MD Los Angeles, CA

Tom J. Pousti, MD · Answer

Generally speaking, if the breasts  feel soft upon direct examination, it is most likely that the  capsule surrounding the breast implants are soft and thin. Abnormally thickened breast implant capsule will, in other words, lead to a firmer breast implant ( and breast) feel upon direct examination.

	 In my practice, if I feel that capsulectomy will be necessary/beneficial, surgery is performed under sedation or general anesthesia.

	 Best wishes.

Connie Hiers, MD, FACS · Answer

Women who have little breast tissue may be able to feel their implants, especially the saline implants. If you are thin, and the implant is pushing through the tissue creating a "knuckle", a couple of things could be done. Fat (your fat) could be added to the area to give more fullness and held "hide" the implant. The surgeon could also place a dermal graft--bottom side of skin taken either from you (like a small tummy tuck incision) or from a cadaver. This dermal graft will give more support for the implant and help correct the "knuckle". Simply removing the capsule, but leaving the implant, may make this worse. If your breasts are soft and move naturally, usually the capsules are thin. It is the body's normal response to make a capsule around an implant. The implant and capsules may be removed with local anesthesia, but I would recommend having at least sedation with the procedure. General anesthesia works well also for the removal. The risk of 4 year old implants being ruptured is low. These new gel implants are very cohesive (like jello), and don't leak nor spread like the old (like honey) gel implants. I would suggest that you ask your plastic surgeon specific questions about your breasts. Each breast is different, and during the consultation can the issues be specifically addressed.

How to Tell if the Capsules Are Thin and Soft?

Answers (3)