What Is A Capsulectomy? Explaining A Vital Element Of Breast Implant Removal
Many breast augmentation and reconstruction patients have been alerted to a potential problem via recent news stories and increased understanding of life with implants—a problem known as breast implant illness—prompting them to consider breast implant removal. Philadelphia’s Dr. Brian Buinewicz, a triple board-certified plastic surgeon who rarely performs augmentation procedures anymore, is known nationally for his passion in educating patients on breast implant illness and his work on breast implant removal, including a procedure known as capsulectomy.
First, some definitions:
Breast Implant Illness
“Breast implant illness is a collection of signs and symptoms that are still being investigated in the medical community, but appear to stem from an overactive immune response to the insertion of implants,” Dr. Buinewicz says.
Roughly five to seven years after the augmentation procedure, some patients begin to notice problems associated with increased inflammation and a spread to other organs and systems throughout the body. Signs include—but certainly aren’t limited to—localized or systemic pain, fatigue and brain fog, migraines, depression and other mood issues, bloating, reflux, vision changes, acne, hair loss, rashes, and more.
A specific cancer known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), while rare, is also a possible complication linked to textured implants. This, too, is under study, with the best current understanding attributing the problem to a likely mix of implants with a textured surface, growth of bacteria on that surface, an inflammatory response that grows over time, and genetic factors.
Breast Implant Removal and Capsulectomy
With breast implants as a possible cause of breast implant illness and the association of textured implants with BIA-ALCL, implant removal and a total capsulectomy are considered a reasonable treatment for patients seeking relief and a healthier future. The procedure, known informally as “explant” surgery, involves a plastic surgeon making incisions (often in the same locations used for the initial augmentation) and removing the devices, as well as the capsule in its entirety, then closing the incisions.
Some patients choose breast implant removal and capsulectomy for cosmetic reasons. For example, their priorities and their bodies may have changed in the years since they first got their implants, and they now want either smaller or larger sizes. Others want to remove large and heavy implants that are pulling down on their breasts, causing them to stretch and sag and cause symptoms such as back and shoulder pain. Inserting new implants is a possibility, but many patients choose to leave their breasts natural after the explant procedure.
After an implant is inserted, the body creates a wall of scar tissue, or capsule, around it as a protective response, building a barrier to the rest of the body out of collagen, blood vessels, and other tissue. This scar tissue can sometimes later tighten, leading to a problem known as capsular contracture, which can cause discomfort and squeeze the implant out of shape. When this happens, an operation is necessary to correct this problem. A total capsulectomy—as capsule removal is called—involves the careful dissection and excision of all of the scar tissue.
Current best practices for treating patients with BIA-ALCL call for removal of the implant and total capsulectomy, preferably “en bloc,” which means the capsule is not torn or violated when removed. If a patient has bilateral implants, removing the implant and capsule may be considered also at the same time. For patients in the early stages of the disease, this approach can result in high five-year survival rates.
Dr. Buinewicz says, “Later-stage BIA-ALCL, which involves cancer that has spread to other systems or organs, may require subsequent treatments with chemotherapy or radiation, and survival rates are much lower”
Once the textured implants and capsules are removed, patients may opt to have new, smooth implants inserted in order to maintain their desired silhouette, proceed with a breast lift or mastopexy to improve the appearance of their natural breast, or they may refrain from other procedures..
In all cases, Dr. Buinewicz considers the capsulectomy a vital part of the explantation process. Considering that the capsule is chronic scar tissue that has formed as a response to a foreign body, capsule-related complications are best addressed via its complete removal. Of course, the first step should also be a consultation with a board-certified plastic surgeon—and especially one that has particular experience in breast implant removal and capsulectomies.
For more information about breast implant removal, breast implant illness, capsulectomy, and other procedures, contact Buinewicz Plastic Surgery. Send a message online to arrange a conversation or consultation.