Explant - when to remove capsules?

Question

I am considering explantation in the very near future. I hear capusles may be left in, or explanted too. What is either dependent on? Thank you.

Gary Lawton, MD, FACS · Answer

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.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Kurtis Martin, MD · Answer

If the capsule is clean, with no silicone or calcification, then it can be left in place. If infected, thick, or calcified it should be removed.

Jaime Caloca, Jr., MD · Answer

Hello. Removing a capsule when Breast implant change is considered, depends mainly on symptoms and grade of contracture if any. If you have hardness and experience pain, then this may be the reason to remove some or all of the capsule. Your medical history will help your surgeon determine if capsule is removed during surgery. Also, during your operation, the surgeon will be able to evaluate the actual condition of the capsule and decide if you will benefit from removal. Before surgery an MRI or a CAT scan can help your doctor determine the thickness of the capsule and if it is calcified.

Michele A. Shermak, MD · Answer

Many of my patients come in requesting implant removal. As they get older, they feel augmentation is no longer ideal for their body image. I enjoy working with these patients. If the implants are intact and the scar tissue around the implant - the capsule - is soft, then there is no need to remove the capsule, particularly if you undergo another breast shaping procedure at the time of implant removal, like a lift. If your implant is under the muscle and the capsule is firm or thickened, it is difficult to remove all of the capsule under the implant, which is on the ribcage.If the implant is worn through and ruptured resulting in a contracted breast, then at least a partial capsule removal should occur.Best of luck!

Camille Cash, MD · Answer

When removing implants the decision has to also be made whether or not to remove the capsules.  When a silicone implant has ruptured or if the capsules are thickened or causing issues it is recommended to have them removed.  If they are thin and not causing issues then it is an option to remove them or leave them behind.  Your surgeon can help you determine what is best for you.

Michael J. Brown, MD · Answer

Hi,

Thanks for posting your question. I am happy to try and help you. It is
important to remember that a board certified plastic surgeon will be your best
resource when it comes to an accurate assessment of your situation, and
concerns.

For breast implant removals, as long the capsule is thin, soft and without
calcium deposits, it is fine to leave them in. The body will reabsorb the thin
layer over time. This is of no consequence and is entirely safe. If the capsule is thick, it should be removed.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

Tom J. Pousti, MD · Answer

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.

Steven Wallach, MD · Answer

Sometimes the capsule is removed and sometimes it is not. It really depends upon many factors. Best of luck.

Connie Hiers, MD, FACS · Answer

Capsules should be removed if they contained thick, hard, or calcified scar tissue, or are around the old gel implants which may be leaking. Otherwise, if the capsule is soft and thin, there is less risk with keeping the capsule, and may be helpful with internal lifting techniques. Your surgeon can help guide you to what you may expect. However, once he/she actually looks and sees what you have in surgery, the final decision about your capsule can be made.