Implant removal 4 months post tuberous BA. Do I need a complete capsulectomy?

Question

I am looking to have breast implant removal, only 4 months post BA. I never felt comfortable with implants, but felt this was my only option due to my tuberous nature. I am experiencing headaches, fatigue, anxiety, and extreme tingling in hands and feet. I know breast implant illness is controversial, but my surgeon only wants to perform partial capsulectomy. My symptoms are not severe but I’m worried they could Drastically worsen over time if some of the capsule left in. Could symptoms worsen?

Finny George, MD · Answer

Hi, thank you for your question. 
In the absence of definitive findings within the breast pocket or capsule that are concerning, a total capsule Tony may not be needed. With that said, I typically perform  a total capsulectomy in the setting of implant removal. It would be helpful for you to consult with multiple board certified plastic surgeons before making your final decision.
I hope this helps. Best of luck!

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

Kenneth Hughes, MD · Answer

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.  If the capsule is left behind, the body will break down and remodel the scar tissue on its own.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your worsening symptoms.  After four months the capsule present will be minimal and can likely be cauterized rather than removed if desired.  Hope this helps.

Daniel Barrett, MD · Answer

Dear Witty5949,
As long as you don't have capsular contracture or thick capsules, you can get only implant removal. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
Breast implant capsules may contain particles of silicone and we therefore recommend removal of any capsular material that we can find at surgery followed by copious irrigation. However, at only 4 months post augmentation, there probably isn't much capsule to remove. Breast implant illness is a controversial topic. There is no guarantee of success with explantation.  You may consider evaluation by an immunologist who may provide more insight. One can not be sure of the cause of your symptoms (cause / effect vs. coincidence?). 
Continue followup with your plastic surgeon.
Best wishes...

Kamran Khoobehi, MD · Answer

Your implants are new and there will be minimal capsule formation. The removal of the capsule will thin your tissue and cause more issues.

Connie Hiers, MD, FACS · Answer

Since your implants are only 4 months old, your capsules are probably still very thin and not fully mature. Sometimes more damage can be done in trying to remove very thin capsules than just leaving them. However, if you have any signs of an infection or thick capsules, it is best to remove the capsules.

Camille Cash, MD · Answer

I'm sorry to hear of the issues you are experiencing.  In the case of implant rupture or if the capsules are thickened then it is recommended that the capsules be removed at the time of explant.  If the capsules are thin and no implant rupture is evident then it is optional to leave the capsules behind.  The capsule is scar tissue that the body forms as a natural process around the implant.

David E. Berman, MD (retired) · Answer

there is no evidence that breast implants or the capsule are causing the endless number of complaints that some women feel they are causing. of course, only you should decide, if you want them out. it is important to understand that the word, "capsule" is really nothing more than scar tissue which forms around any foreign body - whether it is a sliver in your foot, a hip replacement or a breast implant. Sometimes that capsule is very thick, resembling a thick grapefruit peel, in which case, it is quite easy to remove in its entirely. However, much of the time (and i very strongly think this will be your case, since your implant is new and not very hard), the capsule is much more like a thin peel on a peach,. if you try and remove it (rather than just remove the implants), you will get no benefit,  but will no doubt cause a lot of bleeding as the surgeon tries and detach it from the surrounding muscle (above) and the tissue over your ribs (on the bottom). my strong advice is that you should leave the decision on how much, if any, of the capsule your surgeon should remove, to decide at the time of surgery. there is zero reason to think that the breast capsule is causing ANY of your systemic symptoms.david berman md

Implant removal 4 months post tuberous BA. Do I need a complete capsulectomy?

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