Comprehensive Guide to Breast Capsulectomy: What You Need to Know

Breast Capsulectomy, often referred to simply as capsulectomy, is a surgical procedure used to treat complications related to breast implants. It’s primarily performed when there is excessive scar tissue formation, also known as a capsule, around an implant. The goal of the surgery is to remove this tissue to relieve discomfort, restore the natural shape of the breasts and prevent further health issues. This procedure is an essential part of post-breast augmentation care for many patients and can dramatically improve both physical health and aesthetic results.

In this guide, we’ll explore everything you need to know about capsulectomy — from why it might be needed, to the steps involved, potential risks and recovery process.

What is Breast Capsulectomy?

Breast Capsulectomy involves the removal of the fibrous tissue capsule that forms around a breast implant after it is placed in the body. This capsule is a natural response by the body to the implant, acting as a protective barrier. In most cases, the capsule remains soft and unnoticeable. However, in some individuals, the capsule can harden and contract, leading to capsular contracture. When this happens, the capsule can cause pain, distortion in the shape of the breast and other complications that may require surgical intervention.

The procedure can be performed for various reasons, including:

Capsular contracture: The scar tissue around the implant tightens and hardens, causing pain, distortion of the breast shape and implant displacement. This often necessitates breast implant removal surgery to alleviate symptoms and restore breast appearance.

Implant rupture: A rupture in the implant can cause leakage of silicone or saline and may trigger the need for capsulectomy. Patients may also consider breast implant replacement if they wish to replace their implants after removal.

Infection or other complications: In cases where infection or other health issues develop around the implant, a capsulectomy may be required to remove the scar tissue and restore breast health.

Why Consider Capsulectomy?

There are several reasons why someone might consider undergoing capsulectomy, whether for cosmetic or health-related purposes. Some common motivations for choosing this procedure include:

1. Capsular Contracture

The most common reason for capsulectomy is capsular contracture, where the capsule around the implant becomes thickened and tight. This leads to a change in the breast shape and can cause discomfort or even pain. In severe cases, it can make the breast feel hard to the touch, giving it an unnatural appearance. The severity of capsular contracture can be classified in stages, from mild (Stage I) to severe (Stage IV), with Stage IV often requiring surgery. Plastic surgeons play a crucial role in diagnosing and treating capsular contracture, ensuring that patients receive the appropriate care and management for this condition.

• Symptoms of Capsular Contracture:
• A visibly hard or tight breast
• Pain or tenderness around the implant area
• A distortion or uneven appearance of the breast

In some cases, capsular contracture can occur even if the implants are new. It may happen due to an infection, bleeding or simply the body’s natural response to the foreign object.

2. Implant Rupture or Leakage

If an implant ruptures, whether due to trauma, aging or other factors, the body may form a capsule to contain the contents of the implant. While a rupture may be asymptomatic at first, it can lead to complications over time. A capsulectomy can remove both the implant and the surrounding capsule to prevent further health problems. After the removal of a ruptured implant, a new implant can be inserted into the pocket to address issues like capsular contracture or to change the shape or size of the breasts.

Signs of Implant Rupture:

• Sudden deflation or change in breast shape
• Change in texture or feeling of the breast
• Soft or squishy feeling (in the case of saline implants)
• Hardness or lumps (in the case of silicone implants)

3. Infection or Inflammation

Infections or other complications can occur around the implant site, leading to the formation of an overly thick capsule. This may necessitate capsulectomy to remove the capsule and any infected tissue. In some cases, implant removal surgery may also be required to fully address the infection or inflammation. Failure to remove infected tissue could lead to chronic health issues, so the procedure is crucial in these cases.

Symptoms of Infection:

• Redness, warmth or swelling in the breast
• Fever or chills
• Pain in the breast area that worsens over time

4. Breast Implant Illness (BII)

Breast Implant Illness (BII) refers to a collection of symptoms that some women experience after breast augmentation surgery. Symptoms may include fatigue, muscle aches, headaches and autoimmune reactions. Though it is a controversial diagnosis and not all medical professionals agree on its validity, some patients find that removing the implants and the surrounding capsule tissue can alleviate these symptoms. A capsulectomy in these cases might be pursued to improve the patient’s overall health.

Symptoms of BII:

• Chronic fatigue
• Joint pain or stiffness
• Cognitive issues (brain fog)
• Autoimmune responses such as rashes or hair loss

Understanding the procedure and risks of breast surgery is crucial. Breast surgery, including the placement and removal of implants, carries potential complications and requires careful consideration of the recovery process and the risks involved.

Types of Capsulectomy

There are several techniques for capsulectomy, each depending on the severity of the complication and the patient’s health needs. Surgeons performing these procedures often have specialised training and experience in reconstructive surgery, which is crucial for restoring both the physical appearance and the confidence of patients who have undergone mastectomy or other breast surgeries.

1. Total Capsulectomy

This is the most comprehensive form of the procedure and involves the complete removal of the capsule surrounding the implant. This approach is often necessary for severe cases of capsular contracture or when the implant has ruptured. It is also recommended in cases of breast implant illness, as removing the entire capsule tissue is believed to improve overall health.

2. Partial Capsulectomy

In some cases, a partial capsulectomy is performed when only a part of the capsule is problematic. This technique involves removing the affected area of the capsule while leaving the healthy tissue intact. Partial capsulectomy is often sufficient for mild to moderate capsular contracture.

3. En Bloc Capsulectomy

In the en bloc technique, both the implant and the capsule are removed in one piece. This method is typically performed in cases of implant rupture or to reduce the risk of contamination, such as when dealing with breast implant illness. En bloc capsulectomy offers the advantage of removing both the implant and the surrounding tissue while minimising the spread of silicone or other implant material into the body.

Breast Implant Removal and Capsulectomy Procedure Overview

Step-by-Step Process of Capsulectomy:

1. Anaesthesia: The patient is placed under general anaesthesia to ensure comfort and avoid pain during the procedure.
2. Incision: An incision is made, typically in the same location as the original breast augmentation incision. Common sites include:

• Inframammary fold (beneath the breast)
• Periareolar (around the areola)
• Transaxillary (under the arm)

3. Removal of Capsule: The surgeon carefully dissects the tissue around the implant and removes the capsule. Depending on the severity of the complication, the surgeon may remove the capsule in pieces or as a single unit.

4. Implant Removal or Replacement: If the implant is damaged, it will be removed. If the patient wishes to replace the implant, a new one may be inserted.

5. Suturing: The incision is carefully closed with stitches, and the breasts are supported with bandages or a surgical bra to assist in healing.

Recovery After Capsulectomy

Immediate Recovery:

• Pain Management: Post-operative discomfort is common, and patients are typically prescribed pain medication for the first few days.
• Swelling and Bruising: Expect some swelling and bruising around the breasts. This usually resolves within a few weeks.
• Drainage: If the procedure is extensive, the surgeon may place drains to remove excess fluid from the surgical site. These will be removed during follow-up visits.

Long-Term Recovery:

• Rest: Resting during the first few days after surgery is essential for proper healing.
• Physical Restrictions: Patients are advised to avoid strenuous activity, lifting heavy objects or exercising for about 4 to 6 weeks.
• Follow-Up Care: Regular follow-up appointments with the surgeon are necessary to monitor the healing process and ensure no complications arise.

Risks and Complications of Capsulectomy

Like any surgery, capsulectomy carries certain risks. Some of the potential complications include:

• Infection: As with any surgical procedure, there is a risk of infection. It’s important to follow post-operative care instructions to reduce the likelihood of this.
• Scarring: Although the surgeon will aim to minimise scarring, some degree of scarring is inevitable.
• Hematoma: A collection of blood can form beneath the skin, requiring drainage.
• Changes in Sensation: Some patients experience changes in sensation in the breast or nipple area, which could be temporary or permanent.

Aftercare and Follow-up

After undergoing capsulectomy, patients must follow specific aftercare guidelines to ensure the best possible outcome. Here are a few key points to consider during recovery:

• Wearing Supportive Garments: Following the surgery, patients may be required to wear a surgical bra or compression garments to support the breasts and reduce swelling.
• Avoiding Pressure: Patients should avoid any pressure on the chest area, including sleeping on their stomach or side, for the first few weeks after surgery.
• Monitoring for Complications: It’s important to be aware of the signs of infection, such as increased redness, pain or discharge at the incision site. If any of these symptoms occur, immediate medical attention is necessary.

Conclusion: Is Capsulectomy Right for You?

Capsulectomy can be an essential procedure for those dealing with complications from breast implants. Whether it’s addressing capsular contracture, implant rupture or breast implant illness, this surgery can help restore both comfort and aesthetics. While the procedure carries some risks, it is generally considered safe when performed by an experienced surgeon.

If you’re experiencing symptoms of capsular contracture or other implant-related issues, it’s important to consult with a qualified plastic surgeon. They can assess your situation and recommend whether capsulectomy is the right course of action to restore both your health and appearance.

For more information about capsulectomy or to book a free phone consultation with a board-certified plastic surgeon, click here.

Posted In: Body Treatments Blogs

Written By: Dr Azhar Aslam