Is it necessary to remove capsule when doing explant? What are the pros and cons of leaving it?

Thank you for your question, and it is clear that you have done your homework!  In general, the capsules formed around breast implants do not need to be removed when explanting.  Unless the capsule has created issues from scar contracture, has thickened, or looks/feels abnormal, it can often be left in place.  This allows for a much faster operation, with less anesthesia time, and less risk of bleeding or overlying skin issues.  Because the capsule is created after the implant is placed, it does add additional volume to the breast, and the reason you have noticed that breasts appear smaller if the capsules are removed.  I do use drains in patients, in order to avoid fluid collections from developing.  As far as results, there are reasons that some may look better than others, and this can be the result of how the capsule is treated, but also if ancillary procedures such as breast lifts are done at the time of explantation, as well as consideration as to the amount of breast tissue relative to implant size.  The greater the stretch placed on a patient's skin with implants, the greater the skin excess when the implants are removed, and the greater likelihood of breast irregularities or poor cosmetic results.  Hope this helps!

Thank you for your inquiry!Technically, a capsulectomy is to be performed after explantation. However, the decision is made on a case by case base.Additionally, a capsulectomy is not performed as a "free standing" procedure following the explantation. A reconstruction is almost always needed to make sure none of what you mentioned above happens.I hope this helps.Ali Sajjadian, MD FACS

Thank you for your question. The capsule is removed if it is thick and causing a contracture.  If it is thin and soft then there is not need to remove. Make an appt. with a Board Certified Plastic Surgeon to further answer any questions ypu may have. Best Wishes.

yourself.  Removing the capsule (excluding ruptured silicone gel or calcified contracture) causes more discomfort, more scarring (not less), a larger surgical area, and more complications (risk of bleeding, fluid, infection...all because of a more extensive procedure).  All for no reason.  There is no benefit or so little that the risk far outweighs any potential benefit.

In my experience it greatly depends on the thickness of the native breast tissue and how hard the capsule is. A reasonable result can usually be obtain even in very thin tissue with a hard capsule by careful dissection and a conservative lift. If the tissue is thicker above the implant then a much More perky look can be achieved. In short... The capsule should be removed if it hard or painful, otherwise if it soft it can be invited and a lift preformed at the time of explanation. Good luck! Hope that helps!

In my experience is better to do a "Capsulectomy" (complete removal of the capsule) because of these factors :1st. Is a fibroblast cell that can  reorganize,2nd. Capsule may contain foreign objects like  textile and powder talc of the surgical gloves,3rd. Some times  it can also contain some kind of low activity micro organisms, and 4rd. Recently the discovery of the "Giant Cell Lymphoma" is another motive to remove it.

If the capsule is soft and all you want is the implant removed, the capsule does not have to be removed. Best of luck.

Thank you for your question and you have obviously done your research well.  If you remove the capsule you will remove some tissue along with the capsule.  If the implant is sub glandular you will be removing breast tissue.  If the implant is sub-pectoral you would be right on the pectorals muscle and the ribs of the chest wall to remove the capsule.  These things will add to the deformity associated with implant removal.  If the capsule is normal (not thickened or calcified) studies have shown that they will completely disappear about 90% of the time if left alone.So the answer to your question about removal of the capsule is frequently an intra operative decision that needs to be made.  The capsule does not need to be removed, but if abnormal at least a partial capsule removal is indicated. I would suggest discussing this with your Board Certified Plastic Surgeon and let him or her know your wishes so the capsule can be treated in an appropriate way consistent with your wishes.Thanks again for the question.

Thank you for the question. You have made some insightful observations after looking at photographs.In many areas of plastic surgery, including breast implant removal surgery, you will find many different (often strong) opinions as to the best way to handle a specific situation. In my practice, generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, I do NOT remove them. On the contrary (unless indicated), capsulectomy can expose patients to additional risks, such as bleeding, breast size loss and/or irregularities... Your plastic surgeon, based on your physical examination, will be able to inform you whether the breast implant capsule is thickened or abnormal.
Having said that, I often remove a small segment of capsule tissue when removing breast implants ( even when not encapsulated) with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also. Hopefully, you have chosen your plastic surgeon carefully; do not hesitate to address your questions/concerns directly to him/her and ask about the rationale behind any decisions that you question. You may find the attached link, dedicated to breast implant removal surgery concerns, helpful to you as you learn more. Best wishes.

the capsule does not need to be removed. however, if it is a thick capsule then you could get fluid accumulation in your old implant pocket. you could also have a capsulotomy, which would not remove breast tissue and cause some healing and closure of the pocket. the end result of removing your implant is related to your starting breast tissue volume (or how big your breasts were), and also the size of the implant and the length of time it was in place (putting pressure on your breast tissue).