What type of surgery is required to remove 23 year old textured saline implants that may have capsular contracture on one side?

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. I have always favored a complete capsulectomy vía en bloc method.  Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today  A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure.  
If significant capsule formation is seen intraoperatively, a full capsule 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 is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. 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).  
But, I completely believe in removal of the entire capsule, en bloc, for several reasons - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo.  These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space.   Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast, and suturing the muscle back to where it started from. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast.  Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time.  Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra.  Cost will vary amongst surgeons. Discuss with a surgeon who is knowledgeable, skilled, and experienced with this technique. Hope that this helps!  Best wishes!

Unfortunately, you have not provided photographs or told us your bra size.  However, the technique I recommend is explantation 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.

En bloc refers to removing the capsule and the implant in one piece.  Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted. The FDA reports that Breast Implant Associated—Anaplastic Large Cell Lymphoma (BIA-ALCL)may develop in 1 in between 3,817 to 30,000 women with TEXTURED breast implants.  As of this date the risk appears to be very small.

A sample of the fluid around the implant can be screened for lymphoma.  Fluid collecting around breast implants does not mean you have developed the disease.  Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Great question!  You would need an implant removal and removal of the entire breast capsule - many surgeons do this en-bloc which means it all gets removed at the same time. That way the entire capsule and implant is removed.  You may need to have new implants placed depending on your goals.  Make sure you see a board certified plastic surgeon for details of the procedure.Best of luck and hope this information helps!

- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

To obtain best answers- it will require in person exam/consultation. Depending on the findings of physical exam- a capsulectomy, and possible lift may be needed. I suggest that you consult with an experienced Board Certified PS

Thank you for sharing your excellent question and I am sorry to hear of your capsular contracture.  The procedure required is an saline breast implant removal with capsulectomy.  The capsulectomy refers to the removal of the capsular contracture tissue.  Depending on your desired outcome you may also need a breast lift to remove any excess skin that has developed over 23 years.  Hope this helps.

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) The definitive treatment for capsular contracture includes (at a minimum) implant removal/exchange and total capsulectomy. If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!
Matthew A. DelMauro, M.D.

Thanks for your question! You'll want to have your implants removed and as much of the capsule removed as possible. Capsular growth occurs differently for different people so one approach is not necessarily universal. Replacement of the implants with a smooth alternative can be done at the same time to maintain the aesthetics or you'll have other options such as a reshape or simply leaving what is, is. Best of luck! 

To address your concerns you will want to have the implants and capsules removed.  This can either be done en bloc, which refers to removing the implant and scar capsule as one unit, or separately.  I recommend visiting a board certified plastic surgeon near you for a consultation.  After an exam and discussion of your concerns, you can decide together the best approach for you.

With your history of 23 year old textured implants, I would recommend implant removal with en-bloc capsulectomy.  This entails the removal of the implant and all of the capsule together.  Consult with a board certified plastic surgeon in your area.  Bet wishes.