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Capsulectomy with or without Implant Replacement

Introduction

Capsulectomy with/without breast implant exchange is a surgical procedure performed to remove silicone implants and either replace them or do a breast lift procedure. Patients may have had silicone implants either as a cosmetic procedure or as part of a breast reconstructive procedure.

The placement of a foreign material in the human body results in the formation of a capsule. A capsule is like a pillowcase protecting our bodies and immune system from the foreign material. Over time the pillow case my become hard, loose shape, break or cause anatomical distortion leading to an unattractive cosmetic result. It may also cause chronic pain due to the formation of a capsular contracture.

Unfortunately is not always an easy process to remove the “pillowcase” or capsule. The capsule may be hard due to the formation of calcifications in the wall of the pillowcase or part of the capsule may grow into your normal breast and chest wall tissue. It may be difficult to remove the capsule associated with an extensive silicone leak into the soft tissue of the breast, chest and armpit.

If the capsule is soft and pristine it is not mandatory to remove the entire capsule, part of the capsule may be removed as deemed necessary. There are cases where you absolutely have to remove the capsule especially in cases where we find a hard calcified capsule. If the capsule is a soft smooth film it may remain as it is a normal part of the body.

In patients whom have had a previous breast augmentations and have developed a capsular contracture, it is advisable to remove the implant and capsule and place the implant in a new position. If the previous implant was below the breast tissue you may now place it behind the muscle and vice versa. It is important to remember that once you have had one capsular contracture the chance for a subsequent capsular contracture is about 80% this may be due to a sensitization of the immune system.

During removal of the capsule there will be removal of some of the normal breast tissue in conjunction with the implant and capsule. Thus the volume of native breast tissue will be reduced. In some cases the capsule may be tightly adherent to the chest wall and ribs raising the possibility of creating a puncture of the lung called a pneumothorax for which a chest drain will be required. The removal of associated breast tissue around the implant and capsule is less of a problem in previously augmented patients, the volume may be compensated for by a larger implant. In patient having had silicone prosthesis for previous reconstructive purposes the lost tissue may be problematic. In reconstructive cases it is appropriate to delay reoperations as much as tolerable so as not to thin the overlying tissues unnecessarily.

The duration of the procedure is unpredictable. It is impossible to predict how tightly the capsule will be adherent to the native breast and chest wall tissue or the ease with which it may be removed. The amount and extend of silicone leakage further complicates the procedure. Post-operative bleeding is not uncommon and requires the use of drains which will have to remain for 7-10 days.

If the breasts are not the same size or shape before surgery, it is unlikely that they will be symmetrical afterwards. Patients undergoing Capsulectomy surgery with breast implant exchange must consider the possibility of future revisionary surgery.

nately at a considerable cost.

The procedure is done under a general anesthesia in theatre. I would suggest that you remain in hospital for one night however the procedure may be done as a day case. The procedure takes anything from 60 to 120 minutes depending on the difficulty of removing the implant, capsule and silicone leak. You will have 2 drains which remains for a few days. I will see you once a week until all the wounds are healed, that may take anywhere from 3 to 8 weeks.

A Capsulectomy  may be a painful procedure especially if the muscle is raised in anyway. I would recommend that you take it easy for 2 weeks. You will have to visit a hairdresser to help with styling your hair. No physical exercise is allowed until all the wounds are healed. Sweating is not permitted on the surgical scars. You may drive after 2 weeks and return to full physical activity after 3 months. Your body will guide you as to when the best time is to resume full exercise. Do not do anything that is painful or uncomfortable. The massaging and moving of the implants are no longer necessary.

Should you develop a complication you would have to return to theatre which will require additional theatre and hospital fees.

Some other possible complications:

Local Complications

-Haematoma formation (Bleeding)

-Seroma formation

-Delayed wound healing

-Infections

-Sensory changes in the nipples and breasts

-Pneumothorax requiring a chest drain

Systemic Complications

-Fluid and electrolyte abnormalities

-Deep vein thrombosis

-Pulmonary Embolism

Cosmetic Complications

-Malposition and displacement of the implant

-Implant rupture and leakage of the implant

-Asymmetries of the breasts (pre-existing asymmetries may be aggravated)

-Capsular Contracture (hardening of the tissues around the implant)

-Visibility of the implant around the edge

In Conclusion

A Capsulectomy with or without implant exchange is a risky undertaking. Mostly one the basis of previous surgery but also on the basis of unknown factures. It is impossible to predict the extend of silicone leakage and easy of which it may be removed. It is also impossible to predict the ease of removal of the capsule and associated silicone prostheses. I would recommend that the procedure only be performed if absolutely necessary.

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