Breast Implant Removal Usually Should Include Capsulectomy, Surgeon Advises

December 18, 1998

Although thousands of women have breast implants removed each year, there is little information on whether to remove the scar tissue that forms around them. Therefore the journal Plastic and Reconstructive Surgery asked V. Leroy Young, M.D., to make recommendations in its September 1998 issue.

Young, a professor of plastic and reconstructive surgery at Washington University School of Medicine in St. Louis, drew upon his experience of removing more than 300 implants during the past eight years. He also reviewed the medical literature, though few papers came to light.

The body reacts to implants by walling them off in a sac of scar tissue called a capsule, which sometimes becomes as hard as an eggshell. "Most of the time, we recommend that the capsule should come out as well, though there are certain circumstances where it does not need to be removed or only a portion can be removed," Young says.

Young adds that capsule removal is a neglected topic. "I think it just got overlooked," he says. "Therefore many plastic surgeons don't know whether to remove capsules when they remove implants."

When capsules should be removed
About 1 million American women have breast implants, most of which are filled with silicone gel. The usual reasons for removing or replacing them are implant rupture or contraction of the capsule, which can shrink over time, making the breast round and hard. Less common reasons are infection of the breast, fear of autoimmune reactions to silicone or the desire to change to another size of implant.

As well as taking out the implant, the surgeon may cut away the capsule, leaving only breast tissue. This procedure, capsulectomy, requires a larger incision and adds about $1,000 to the total cost. Young says capsulectomy should accompany implant removal when:

• The implant won't be replaced -- capsules left in place may appear as abnormal masses on mammograms.
  
• The new implant will occupy a different position with respect to the chest wall muscle. In this case, leaving the capsule in place might create fluid-filled cavities that could become infected.
  
• The implant will be replaced by a larger implant.
  
• The capsule has contracted, and another implant will be put in. The breast will be much softer after reimplantation if the capsule is removed.
  
• The capsule is very thick or calcified. About 30 percent of implants calcify after 10 or more years.
  
• The implant has ruptured, especially if it was filled with silicone gel.
  
• The new implant has a textured surface -- such implants need to be in contact with normal tissue for the texture to exert its effect.
  
• The area around the capsule is infected.
  
• A tumor has developed in or next to the capsule.

Some women also may want to request a capsulectomy to improve silicone removal, Young says, though he notes that 20 epidemiological studies have failed to link health problems to silicone implants. A report issued Dec. 1, 1998, by a federal court-appointed panel also found no connection between silicone breast implants and disease.

Capsulectomy is not a good idea, Young adds, when the capsule is flimsy, the implant is touching the skin or silicone has migrated into the armpit, where there are major nerves and blood vessels. In these cases, capsule removal might damage healthy tissues. "The bottom line," Young says, "is that the benefit of removing the capsule should be greater than the risk."Note: For more information, refer to: Young VL, "Guidelines and Indications for Breast Implant Capsulectomy," Plastic & Reconstructive Surgery 102(3), 884-891, September 1998.



Washington University in St. Louis

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