Is the pocket under the muscle closed up surgically during implant removal? & Is it necessary to remove the capsule? (photo)

I have lateral displacement and bottoming out of my 550 cc saline implants. I want to know if the pocket is general closed up surgically after implant removal? A surgeon I consulted with felt it was best to do this and remove the capsule to prevent the breast tissue I have naturally (about a full C/ small D cup) from falling into my armpit after implant removal. My breasts are still super soft. No contracture. I don't know which approach to take? I keep hearing conflicting opinions. Please help!

Doctor Answers 4

Is the pocket under the muscle closed up surgically during implant removal? & Is it necessary to remove the capsule?

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Thank you for the good question and pictures. You have done a nice job demonstrating your concerns.

If you choose to have the breast implants removed permanently, you may also wish to consider capsulorraphy, the use of sutures to repair the lateral breast fold areas on the side(s) where the breast implants have displaced laterally. This maneuver, in my opinion, will help improve your breasts' position when the breasts implants have been removed.

Generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, there is no indication to have them removed. On the contrary, capsulectomy can expose you to additional risks, such as bleeding and minimal size loss.

Having said that, I often remove a small segment of capsule tissue when removing breast implants with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.

You will find that you will be receiving multiple different answers to your question;  ultimately, careful selection of your plastic surgeon will be one of the keys to success in your case.

I hope this, and the attached link ( dedicated to breast implant removal concerns), helps.


Closing the implant pocket surgically after removal of implants

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This appears to be a good example of what happens when too big an implant (with too many cc's) is placed behind a breast that is not big enough to accommodate it and the result is less than ideal, requiring revision. 

In general, with no abnormalities such as contracture going on, the capsule is just a scar tissue layer and if the pillow of the implant is removed the two sides of the capsule will just collapse on each other and seal off the space where the implant was. The risks of fluid collection is minimal and even if it occurs can be easily dealt with when there is no implant present. So one answer to your question is that simple implant removal should not require doing anything to the capsule (which adds to the surgery, the risks, and will still heal with a scar tissue layer). 

The resulting look depends on how much the breast was distorted by putting too big an implant behind it. If the implant fit properly and the pillow of the implant was simply removed then one would expect the breast to look like it did before the implant was put in. But if the breast tissues were distorted or the breast has changed for whatever reason since the implants were put in, then it won't look like it did before the implants. 

One simple but counterintuitive answer to implants that are in a stretched pocket and bottom out or fall laterally when supine and leave an empty medial chest, is to replace the implants with implants that are wider (and therefore bigger) as long as the capsule is not altered. Unfortunately, it's not predictable to put narrower (smaller) implants in as the empty capsule will not close down reliably around a smaller implant and artificial capsules like Strattice are complex and expensive. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Treating augmented breasts that move to far to the side

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It appears as though you have several issues bothering you.  If you want the implants removed completely, you will have very deflated appearing breasts.  If you want to keep the implants and just move them in more to prevent them from moving laterally, then you might need to have Strattice placed and the pocket tightened laterally to prevent this from happening.  Either way, I can give you a better idea of how to address your concerns after an examination.  Thank you for your question!

Dr. Schreiber

Baltimore Plastic Surgeon

Dr. Kayser

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There is no absolute conscensus on this matter. However, the implant has occupied a space which is totally surrounded by a scar tissue envelope or capsule. Simply removing the implants will possibly allow the scar cavity to fill up with serous fluid that may prevent the breast from re-attaching to the unlying tissues; this would allow unnessary motion, including lateralization of the breasts or volume differences because of the possible fluid variations. I have seen these spaces over a long period of time in both cosmetic and reconstructive patients and while some surgeons believe that this scar is not that significant, I believe that removing the capsule allows a new raw surface to promote adhesion of the breast and possibly a better long term result. I hope this helps and have a wonderful day! Dr. Kayser

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.