Capsules too thin for en bloc explant or full capsulectomy - How would you manager the intracapsular rupture of a 29yo implant?

Thank you for sharing your excellent question.  In most cases the capsule can be removed successfully, especially in cases of rupture.  Otherwise the ruptured implant and its contents are removed, the capsule scored with electrocautery and the pocket washed out copiously.  Hope this helps.

The capsule is rarely too thin to remove, it just requires a different conversation because the procedure may be more involved and sacrifice more normal tissue. If the rupture is intracapsular the capsule can simply be opened and the implant and all its contents suctioned out before it spills into the normal tissue. The capsulectomy can then be completed as it normally would be. I would suggest having an in-person consultation by a local breast implant revision expert to be properly assessed. Hope that helps! 

Dear catfficionado,
In case of implant rupture, plastic surgeon will try to remove implant en-block together with the surrounding capsule. However, there are some cases in which en-block capsulectomy is not possible so we try to remove the implant, as much as possible capsule and free silicone. In most cases, a combination of suction and lavage are used. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

In general if the capsules are very thin, then you do not need to remove them.  Thickened capsuled that are calcified and sharp often need removal.  Your surgeon will decide at the time of surgery whether the capsules should be removed or not.  However, just removing the implants and capsules may not solve your problem.  Women are often dissatisfied with the hanging skin envelope and empty appearance.  The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

In most cases the capsule can be removed enbloc when there is ruptured silicone implant.  An enbloc is done to help remove every bit of silicone material in a way that makes it easier and less messy.In rare cases where the capsule is so thin that it is impossible to remove or unnecessary to remove (rare case) then the implant material can be evacuated, special cleaner can be used to help clean up all the silicone gel material.I would recommend you see a board certified plastic surgeon to discuss your options.Hope that helps.

In the setting of rupture (silicone) or an abnormal capsule will require capsulectomy which will be somewhat more complicated. The capsular tissue must be peeled out either to minimize spillage of silicone.Depending on the plane of augmentation (over vs under) this can be more difficult (submuscular being more difficult to remove). Ultimately, capsulectomy comes with greater post operative pain, recovery and risks (bleeding, fluid collection etc.).
With regards to your specific question, a thinner capsule is technically more challenging to remove (but not impossible). As with any procedure involving removal of a ruptured silicone device and a capsule, residual capsule and silicone are often the rule rather than the exception. Regardless the approach is the same.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

Thank you for your question!Yes en bloc capsulectomy is preferred but if not possible a combinaison of capsulectomy, debridement, succion and lavage can be acceptable to remove as much as possible the free silicone.Best Wishes
Dr Genevieve FCaron, Board Certified Plastic Surgeon
Montreal, Canada

As much as possible, the capsules can be removed, and then the area is thoroughly washed with suction to help remove any free silicone.

Typically the capsules can be removed along with the ruptured implant if they are thickened.  If they are too thin to be removed as one great care is taken to remove the implant and any free silicone.  As much of the capsule as possible will be removed as well.  I encourage you to discuss your concerns with your surgeon so that you are comfortable with the procedure and your options.

In most cases where the implant is ruptured, the capsule is thickened. Thickened capsule with ruptured implant can often be treated with total en bloc capsulectomy as you indicate. If this is not the case, the whole capsule or almost all of it can still be removed at the time of surgery. The most important point of this operation is that any silicone gel fragments or remnants of implants are completely removed. If there is a small remnant of thin capsule, your body will most likely resolve that on its own.