Capsulectomy

Capsulectomy

“Capsulectomy” is a procedure term that is often used in association with particular adverse issues directly related to breast implants. While breast hardening caused by capsular contracture has traditionally been the focal issue connected to capsulectomy, the term has more recently been used in relation to various other breast implant problems that have gained considerable attention across the internet—particularly on social media.

In an effort to better help you understand what a capsulectomy is, when it may be appropriate and what techniques are available as well as separate facts from hysteria, we have provided the informative sections below. If you have any questions or if you are experiencing breast implant-related issues and wish to find out if this treatment may be right for you, please contact us today to schedule a consultation with breast specialist Steven H. Turkeltaub.

What Is a Capsulectomy?

A capsulectomy is a procedure involving the surgical removal of the scar tissue that naturally develops around breast implants following a breast augmentation or in implant-based breast reconstruction. Referred to as a capsule, this scar tissue forms regardless of the type (silicone or saline), shape (round or teardrop), surface style (smooth or textured) or size of the implants. In actuality, the formation of a scar capsule is not solely limited to breast implants—it occurs when any “foreign” material is placed in the body, including pacemakers, orthopedic devices and other types of medical implants.

Under normal circumstances, the capsule that envelops breast implants is soft, thin and flexible and does not have any effect on the look, feel or movement of the implants themselves. In some instances, however, the scar tissue hardens and tightens around an implant—an issue known as capsular contracture—causing the affected breast(s) to feel overly firm, appear deformed and, in severe cases, become painful. The thickness of the capsule may also increase considerably, thereby exacerbating the problem(s).

In the vast majority of cases, capsular contracture can be effectively treated by performing a capsulectomy—the surgical removal of the capsule.* The procedure can usually be combined with implant exchange for women who wish to have new breast implants placed, or it can be performed as part of an explantation for those who no longer desire to have breast implants. In addition, a breast lift or a breast reduction can often be performed simultaneously depending on the patient’s desires and other considerations.

*When radiation has been utilized as part of breast cancer therapy, the treatment of capsular contracture is not always as straightforward.

When Is a Capsulectomy Indicated?

Most commonly, a capsulectomy is indicated for the treatment of capsular contracture, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII)—each of which is explained below.

Capsular Contracture

As described in the previous section, capsular contracture is an undesirable hardening and constriction of the scar tissue (capsule) that surrounds a breast implant. Depending on the severity, this can cause aesthetic breast deformities, an excessively firm breast feel and sometimes even pain.

For a number of different reasons, the occurrence of capsular contracture was far greater in the past than it is presently. It is also widely documented that the rate of development is higher when implants are placed in front of the chest wall muscle (submammary position) versus behind the muscle (submuscular position) as well as when a periareolar incision is used as opposed to an inframammary incision.

At least 95 percent of the capsulectomies that plastic surgeons perform are to treat capsular contracture.

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL, is an extremely rare form of non-Hodgkin’s lymphoma that develops in the scar capsule surrounding certain types of implants. All data collected up to this time suggests BIA-ALCL is exclusively linked to implants with a textured surface—most notably Allergan’s Biocell® textured implants which were removed from the market in July of 2019. As of February 2020, the American Society of Plastic Surgeons (ASPS) reports that there have only been 307 suspected/confirmed cases in the United States.

In all cases of BIA-ALCL, a total capsulectomy is the prescribed surgical treatment.

Breast Implant Illness (BII)

Breast implant illness, often shortened to BII, is a term used in reference to a non-specific array of systemic issues that some women believe are attributed to their breast implants. Symptoms reported include chest discomfort, headaches, sensitivities to light, anxiety, chronic fatigue and a variety of other concerns.

With the aid of aggressive social media and internet marketing efforts, many self-proclaimed experts have strongly advocated for the surgical treatment of BII via en bloc capsulectomies (see the following section). Despite the fact that there is currently no scientific evidence to support this advice, the widespread reach of this claim has caused many patients who believe they are experiencing BII to demand this particular procedure be performed.

In truth, when a capsulectomy is the prescribed treatment for unfavorable responses to breast implants, the en bloc technique is not always the exclusive and/or most appropriate option for a number of reasons. It is also important to note that a capsulectomy might not even be necessary to resolve certain issues which is why seeking the expertise of a board-certified plastic surgeon like Dr. Turkeltaub who has extensive experience in breast revision and explantation is critical in the event that BII is suspected.

What Are the Different Capsulectomy Techniques?

There are three capsulectomy techniques: partial capsulectomy, total capsulectomy and en bloc capsulectomy. Each of these methods is described below.

Partial Capsulectomy

A partial capsulectomy involves the excision of some but not all of the scar capsule surrounding a breast implant. This technique is often appropriate when it is either unnecessary to remove the entire capsule or when the risks of doing so far outweigh the potential advantages. For example, there are often instances in which sections of the capsule can be left on the chest wall and/or left on the deep surface of the skin where the tissue may be quite thin.

Total Capsulectomy

A total capsulectomy is the surgical removal of the entire capsule enveloping the breast implant. For this procedure, the capsule is most commonly excised in sections as opposed to being removed in one piece for numerous reasons including the physical nature of the capsule, the degree of technical difficulty and patient safety.

En Bloc Capsulectomy

An en bloc capsulectomy involves the complete removal of the capsule as an intact unit with the breast implant contained inside. While there may be certain situations in which this technique is preferred, an en bloc capsulectomy is not advisable or even possible for everyone. For instance, it is impossible to perform this approach for patients who have extremely soft, thin capsules.

Fortunately—and despite claims made on the internet and social media by self-touted experts—there is presently no scientific evidence to suggest that the en bloc method is significantly superior to the traditional total capsulectomy procedure. As a result, a generic total capsulectomy can usually be performed when the en bloc approach is not appropriate.

Which Capsulectomy Method Is Right for Me?

If you are in need of a capsulectomy and wish to find out which technique is right for you, please contact our practice today to schedule a consultation. Dr. Turkeltaub will be happy to provide more information and help you determine the safest, most effective surgical approach based on your unique needs and desires.

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