Breast augmentation is one of the most popular cosmetic surgeries in the U.S. In 2020, nearly 200,000 people had breast implant surgery. But getting breast implants isn’t always a simple process. Many people need additional surgery to revise, remove, or replace the original implants.
One of the reasons that you might need a follow-up surgery after getting breast implants is to fix capsular contracture. Scar tissue around your implant can become so tight that it causes problems with the look or feel of your breasts. To fix the issue, your doctor may suggest an operation called a capsulectomy.
What Causes a Capsule?
When you have an implant placed in your breast, your body begins to build scar tissue around it, forming a covering called a capsule. The scar tissue is a natural response to a foreign object inside your body. The capsule is usually not noticeable, and it can help hold the implant in place. The scar tissue is usually soft and flexible.
In some cases, the scar tissue that forms the capsule gets thick and tight, squeezing around the implant and potentially distorting the shape. This is called capsule contracture. If this happens to you, you might notice that one or both breasts look misshapen. Your breasts may be hard to the touch. Some people feel pain or discomfort from capsular contracture.
The only way to relieve capsular contracture is with surgery.
Types of Capsule Removal Operations
There are several types of capsule removal surgeries. Your doctor will talk to you about your goals for the surgery. They will choose which type of operation to do based on that.
Partial capsulectomy (capsulotomy). A partial capsulectomy — sometimes called a capsulotomy — is an operation to loosen the scar tissue around your implant. You may choose this option if you have capsular contracture that causes you discomfort or affects the appearance of your breasts. In this operation, your doctor removes a portion of the capsule tissue. Removing a section of the tight scar tissue can release the tension around your implant to soften the implant and improve the appearance of your breast. You may or may not want to replace your implant at the same time as your capsulotomy.
Total capsulectomy. In a total capsulectomy, your doctor removes all of the capsule tissue, taking it out in pieces. Your doctor may also remove the implant and replace it with a new one, if that is what you want. Your doctor may suggest a different type of implant for the replacement. They might also recommend a different placement for the new implant. These steps may reduce your risk of having capsular contracture again later.
En bloc capsulectomy. In an en bloc capsulectomy, your doctor will remove the implant with the capsule tissue still around it. The goal is to remove everything in a single piece. This method is usually chosen when there are complications with your implants. If your doctor suspects that there is a risk of the implant rupturing, or if you have a breast implant-related illness, en bloc capsulectomy might be safer than other methods. You and your doctor can decide whether replacing the implant is appropriate based on your health.
Breast implants are not intended to last a lifetime. Most experts recommend replacing implants every 10 to 15 years. Breast implant replacement surgery may require a capsulectomy in order to make your new implants look the way you prefer. Your doctor will let you know if you need a capsulectomy as part of breast implant revision.
In rare cases, your doctor will recommend a capsulectomy and implant removal because of breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. This is a type of cancer that develops in the scar tissue of the capsule. While very rare — only about 300 cases have been reported in the U.S. — this is a serious condition. You will need to have your implants and all the capsule tissue removed.
Implant removal and capsulectomy might be necessary if you have breast implant illness and want to remove the implants. Some people feel generally unwell after getting implants and experience symptoms such as chest discomfort, headaches, sensitivities to light, or chronic fatigue. If you suspect you have breast implant illness, your doctor can help you decide the best course of treatment.
If you have breast implants and are worried about capsular contracture or other implant-related illness, speak to your doctor. They will be able to help you decide if you need additional surgery on your breasts.