When breast implants are removed and what a capsulectomy is

Around every implant the body forms a thin layer of scar tissue, the capsule. This is a normal reaction. The decision to remove or replace implants is made on the basis of check-ups and findings, not only the number of years since surgery. The most common reasons are:

• hardening of the capsule (capsular contracture), when the breast becomes firm, changes shape or hurts,
• implant rupture, which with silicone implants often causes no symptoms and is found by ultrasound or MRI,
• implant displacement or visible rippling under the skin,
• wanting a different size or shape,
• a personal decision to no longer have implants.

Very rarely, most often with textured implants, a specific type of lymphoma associated with breast implants has been described. It usually appears years after surgery as new swelling or a lump in the breast. Any new swelling, pain, lump or change in breast shape should be shown to a doctor.

Capsular contracture is a condition in which the scar capsule around the implant thickens and tightens. The breast may then feel firmer, change shape or position and, with more pronounced contracture, hurt. It can occur at any time, most often in the first years after surgery, on one or both sides.

With milder changes the surgeon sometimes suggests monitoring. When contracture causes symptoms or changes the appearance of the breast, surgery is usually considered: removal or replacement of the implant, with partial or complete removal of the capsule.

A capsulectomy is surgical removal of the scar capsule around the implant. The capsule can be removed completely or partially, as the surgeon decides based on the findings at the examination and during surgery. The removed tissue is sent for histopathology if needed.

The plastic and aesthetic surgery price list of Maja Hospital has separate items: unilateral and bilateral silicone implant removal, and unilateral and bilateral capsulectomy. The surgeon explains at the examination what is needed in your case.

At the examination the plastic surgeon asks when and where the implants were placed, what the symptoms are and what you want: removal only, replacement or a change of size. Bring documents from the earlier operation if you have them, especially details of the type and size of the implants.

The doctor may request a breast ultrasound or MRI to check the condition of the implants and surrounding tissue. Prices for breast ultrasound and breast MRI are in the radiology price list of Maja Hospital and in the table on this page.

After implant removal the breast is smaller, and the skin, especially if it was stretched, may be looser than before the implants. How the breast will look depends on the size of the implants, the quality of the skin and breast tissue and how long the implants were in place.

That is why the surgeon sometimes also suggests a breast lift, in the same or a later procedure, or placing a new implant. Discuss the expected appearance before you decide.

The procedure is usually done under general anaesthetic, and the surgeon and the anaesthetist decide on the type of anaesthetic. Recovery depends on the extent of the procedure: after implant removal alone it is usually shorter than after a capsulectomy or replacement. In general:

• swelling, tenderness and bruising are expected in the first days,
• the surgeon advises a recovery bra and sometimes drains, which are removed at a check-up,
• lifting and strenuous effort are avoided until the surgeon allows them,
• at the check-up the surgeon examines the wounds and assesses recovery.

Contact the surgeon without delay if you develop a fever, severe pain, rapidly increasing swelling, redness or pus in the wound.