Name of the Procedure:

Peri-implant Capsulectomy, Breast, Complete
Common Names: Total Capsulectomy, Removal of Breast Implant Capsule

Summary

A peri-implant capsulectomy involves the complete removal of the scar tissue capsule that forms around a breast implant along with any intracapsular contents, such as the implant itself or any leaked silicone.

Purpose

This procedure addresses complications or issues with breast implants such as capsular contracture, implant rupture, or chronic pain. The goal is to alleviate symptoms, remove problematic tissue, and, if necessary, prepare the area for a new implant or different reconstructive surgery.

Indications

• Capsular contracture (hardened scar tissue causing discomfort or aesthetic issues)
• Implant rupture or leakage
• Chronic breast pain
• Infection or inflammation
• Desire to remove breast implants
• Suspected breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Preparation

• Follow preoperative fasting instructions, usually no food or drink for 8 hours before surgery.
• Adjust any medications as advised by your healthcare provider, including stopping blood thinners.
• Undergo preoperative diagnostic tests such as mammograms, ultrasounds, or MRIs.

Procedure Description

1. Anesthesia: Administered general anesthesia to ensure the patient is asleep and pain-free.
2. Incision: A precise incision is made, typically in the inframammary fold (under the breast), around the areola, or along the previous surgical scar.
3. Capsulectomy: The surgeon carefully removes the entire capsule of scar tissue surrounding the implant along with the implant itself and any leaked materials within the capsule.
4. Closure: The surgical area is cleaned, and the incision is closed with sutures.
5. Drainage: Small drainage tubes may be placed temporarily to prevent fluid accumulation.

Duration

The procedure typically takes 1.5 to 3 hours, depending on the complexity of the case.

Setting

Performed in a hospital or outpatient surgical center under sterile conditions.

Personnel

• Plastic surgeon or surgical oncologist
• Surgical nurse
• Anesthesiologist
• Surgical assistant(s)

Risks and Complications

• Infection
• Bleeding
• Scarring
• Asymmetry or changes in breast shape
• Anesthesia-related risks
• Hematoma (blood collection under the skin)
• Seroma (fluid collection)
• Pain or discomfort
• Unsatisfactory cosmetic results

Benefits

• Relief from symptoms associated with capsular contracture or implant complications.
• Improved breast appearance and symmetry.
• Reduced risk of further complications related to the breast implants.
• Quick relief from chronic pain or discomfort.

Recovery

• Follow post-operative care instructions including wound care and activity restrictions.
• Wear a supportive bra as advised.
• Avoid vigorous activities and heavy lifting for 4 to 8 weeks.
• Attend follow-up appointments to monitor healing.
• Full recovery typically takes 6 to 8 weeks, but patients can usually return to light activities after 1 to 2 weeks.

Alternatives

• Non-surgical management of symptoms (e.g., medications, physical therapy).
• Partial capsulectomy or capulotomy (only removing part of the capsule).
• No removal, only adjusting the existing implants.
• Autologous reconstruction (using the patient's own tissue for breast reconstruction).

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any discomfort. Post-operatively, patients might experience soreness, swelling, and bruising. Pain is typically managed with prescribed medications. Full results and resolution of symptoms can be seen after complete healing, generally within a few months.