Explant - when to remove capsules?

For explant surgery, it is almost always best to remove
the capsule in its entirety. This will allow the space to heal. If
you leave the capsule in place, it does not heal. Fluid can accumulate in
the space. The situation that brings the patient to implant removal will
have an affect on the decision. This is a surgery which requires
discussion with the plastic surgeon about the problem, the goals, and the
technical concerns. The body does not re-absorb the capsule.
Revision surgery requires drains because the fluid is going to be
generated when you operate on the scar capsule. If you provide a
mechanism for the fluid to be removed (i.e. drains), the risks are lower.
If the fluid accumulates because there were no drains, it will most certainly
cause problems in the future.

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for the question.  

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.