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Charles A. Messa, III, MD, FACS

“Capsule-What?” Understanding Capsulectomy and When You May Need One After Breast Augmentation

Posted September 08, 2022 in Breast Revision Surgery

3 Minute Read: 

Capsulectomy is a technique performed during breast implant removal or breast revision surgery to remove the fibrous scar tissue that forms around the implants. 

While you may never have heard the term, it’s far more common than you might think.

A woman with bandaged breasts.

In fact, it is almost always used in cases of severe capsular contracture, a condition that can develop after breast augmentation surgery and should be discussed during your breast augmentation consultation.

What Is Capsular Contracture?

After receiving breast implants, a scar tissue capsule will form around the implants. This is a normal part of the healing process and is beneficial in keeping the breast implants from shifting out of place.

Occasionally, the capsule hardens and tightens around the implant, leading to cosmetic issues and painful breasts. 

Capsular contracture is so common that one in six breast implant recipients experience some degree of the condition, though not every case requires capsulectomy.

The severity of this condition is determined by the following grading system:

  • Grade 1: The patient is asymptomatic, and the augmented breasts look and feel soft and natural.
  • Grade 2: Breasts appear normal but feel unusually firm.
  • Grade 3: Cosmetic changes have developed, often appearing rounder with the nipples may be distorted and the breasts feel harder. 
  • Grade 4: Breasts are very hard and misshapen. At this stage, women usually experience significant breast pain.

Capsular contracture grades 1 and 2 don’t require surgery, while grades 3 and 4 are typically treated with a capsulectomy or a capsulotomy to relieve pain and restore the breasts’ natural feel and appearance.

Most cases of capsular contracture occur within the two years after breast augmentation; however, capsular contractures can develop several years following breast implant surgery. When this happens, it is commonly caused by a rupture in one or both of the implants.

Besides Capsular Contracture, What Other Reasons Require a Capsulectomy?

Capsulectomy is also the treatment of choice for these conditions: 

What Happens During a Capsulectomy?

General anesthesia is administered before your surgery, and a breathing tube may be placed to keep your airway clear during surgery.

Incisions are made in the creases of your breasts for the scar tissue, and the implant removal process proceeds. There are three types of capsulectomy: Complete capsulectomy, partial capsulectomy, and en bloc capsulectomy.

Complete or partial or capsulectomy and implant removal: An incision is made in the fibrous capsule, and the implant is removed. The capsule is then completely or partially removed in large sections.

En bloc capsulectomy: During surgery, the entire capsule is separated from the surrounding breast tissue with the breast implant still inside. Then the entire capsule containing the implant is removed as one unit.

Both implants are typically replaced after the capsulectomy is completed. A biological surgical mesh called an acellular dermal matrix (ADM) might be placed in the breast pocket to reduce the chances of capsular contracture from occurring or reoccurring.

Drains are placed — if needed — and the incisions are closed with sutures or a strong medical adhesive.

This surgery usually takes two to three hours.

What Is a Capsulotomy?

In some milder cases of capsular contracture, a capsulotomy may be recommended. This procedure involves removing part of the capsule or opening it up to allow additional space for the breast implant. Implants may be removed, re-inserted, or replaced with new implants during a capsulotomy.

Your Weston, FL Capsulectomy and Breast Revision Expert

At Weston Cosmetic Surgery Center, Dr. Charles Messa, a well-respected, board-certified plastic surgeon, regularly performs breast implant removal surgery, breast revisions, and capsulectomy for patients in Weston, Florida, and all surrounding areas. 

Call us at (954) 659-7760 or (877) 250-8117 to schedule your cosmetic breast surgery consultation, or scroll down to contact us online.

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2823 Executive Park Dr, Weston, FL 33331