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Open Capsulectomy/Capsulotomy*

Open Capsulectomy with Breast Implant Replacement Using Saline Filled Implants

Capsulectomy is a surgical operation performed to treat scarring which occurs around breast implants or to revise the shape of the pocket where the implant is placed.  This usually involves surgical cutting and removal or cutting of scar tissue that forms around a breast implant and usually the placement of a new breast implant.

It is normal for scar tissue to form internally around a breast implant.  In some patients this scar tissue may tighten and make the breast round, firm, and possibly painful.  Excessive firmness of the breasts can occur soon after the original surgery or years later.  The causes of capsular contracture are not fully understood. The incidence of symptomatic capsular contracture can be expected to increase over time.  Capsular contracture may occur on one side, both sides or not at all.  Calcification can occur within the scar tissue that surrounds breast implants.  Treatment for capsular contracture may require surgery, removal of the capsule layer, implant replacement, or implant removal.  Patients may elect to increase or decrease the size of their breast implants.

Individuals with old, damaged or broken implants (either saline or silicone gel-filled) may consider capsulectomy surgery and breast implant exchange as a way to maintain the long-term results from their original surgery, whether for cosmetic or reconstructive purposes.  You may be advised by your surgeon to consider replacing your breast implants with new ones, irrespective of how long you have had them.  In some situations, you may be advised to consider new breast implants with a textured outer surface or to consider a different type of implants.  Patients undergoing capsulectomy surgery and breast implant exchange must consider the possibility of future revisionary surgery.  Breast implants do not have an indefinite lifespan and will probably require surgery for removal and/or replacement.

Depending on the extent of the scarring problem, it may be necessary to place the implant in a different location, partially underneath the pectoralis muscle on the chest, alternatively in front of the pectoralis muscle if the original placement was behind the muscle, either completely or partially, known as a “dual plane”.  Incisions for the capsulectomy procedure may be placed in different locations than those used for the original surgery.  If the breasts are not the same size or shape before surgery, it is unlikely that they will be completely symmetrical afterward.  Conditions that involve sagging of the breast or diminished skin tone (stretch marks) may require additional surgical procedures (breast lift/mastopexy) to reposition the nipple and areola upward and to remove loose skin.  Additional procedures to internally tighten or reshape the implant pocket may be needed to reposition implants.

Patients who consider secondary surgery to revise or maintain their results from breast implant surgery must consider that additional surgery may not correct or improve their results.

SALINE-FILLED BREAST IMPLANTS

Saline-filled breast implant devices have been approved by the United States Food and Drug Administration (FDA) for use in breast augmentation and reconstruction.  Saline-filled breast implants can be used for revision of procedures in patients who have formerly undergone breast augmentation or reconstruction with silicone gel or saline-filled breast implants.

Breast implant surgery is contraindicated in women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or individuals who are currently pregnant or nursing or who have open wounds anywhere on their body.  Individuals with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and a poor surgical outcome.  According to the FDA, a woman should be at least 18 years of age for cosmetic breast augmentation.

Breast implants are manufactured in a variety of shapes, sizes, and with either smooth or textured surfaces.  The method of implant selection and size, along with surgical approach for inserting and positioning breast implants, will depend on your preferences, your anatomy and your surgeon’s recommendation.  The shape and size of the breasts prior to surgery will influence both the recommended treatment and the final results.  Some degree of breast asymmetry is normal and may occur after breast surgery in any patient.  If the breasts are not the same size or shape before surgery, it is unlikely that they will be completely symmetrical afterward.

Patients undergoing surgery that involves breast implants must consider the following:

  • Breast augmentation or reconstruction with saline-filled implants may not be a one-time surgery.
  • Breast implants of any type are not considered lifetime devices. They cannot be expected to last forever.  You will likely require future surgery for implant replacement or removal.
  • Changes that occur to the breasts following augmentation or reconstruction with implants are not reversible. There may be an unacceptable appearance to the breast if you later choose to have breast implants removed.
  • Large volume primary augmentation, reconstruction or revision with larger sized implants (350 cc) may increase the risk of complications such as implant extrusion, hematoma, infection, palpable implant folds, and visible skin wrinkling requiring surgical intervention to correct these complications. The correction of these complications may leave additional scars and other permanent changes.

*Disclaimer: Plastic & Cosmetic Surgery Results Can Vary Significantly Between Patients. In terms of results and expectations, there are numerous variables with every patient, each surgery and every recovery and healing period. For more information click to read our full Disclaimer