Capsulectomy at Leicester Hospital

What is a capsulectomy?

A capsulectomy is an operation to take away the capsule, a layer of fibrous tissue your body naturally grows around a breast implant. It's usually carried out alongside removing the implant itself, to ease symptoms this tissue can cause or to deal with other implant-related concerns.

What conditions does a capsulectomy treat?

A capsulectomy may be recommended for:

• capsular contracture, where the capsule tightens and hardens around the implant, causing pain, discomfort or a change in breast shape
• a ruptured or leaking implant
• unusual changes within the capsule itself, for example it becoming thicker, developing calcium deposits, or other irregularities
• breast implant illness (BII), a term for symptoms such as fatigue and chronic pain that some people link to their implants
• concerns about breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare cancer that can develop in the scar tissue, particularly linked to textured implants.

What are the benefits of a capsulectomy?

Removing the capsule can ease pain and tightness in the chest, and correct any distortion or unevenness in breast shape that comes from this fibrous tissue squeezing the implant.

For some, it also brings peace of mind about their long-term health, particularly where there are worries about implant rupture or BIA-ALCL.

There's no firm evidence that removing the capsule prevents complications in every case, so whether it's the right choice is something to work through with your surgeon, based on your own circumstances.

Are there different types of capsulectomy?

There are several recognised approaches, and your surgeon will choose based on why the capsule needs to come out:

• en bloc capsulectomy: the implant and the entire capsule are taken out together as one piece, without cutting into the capsule
• total intact capsulectomy: the whole capsule comes out as one piece, but without that extra margin of tissue; used for capsular contracture or a ruptured implant when there's no suspicion of cancer
• total capsulectomy: the whole capsule is removed, but not necessarily as a single piece
• partial capsulectomy: only part of the capsule is taken away, with some tissue left in place; considered when this is thought to be safe, often for milder contracture or minor issues.

Removing the whole capsule isn't always possible or safe, particularly where it has become attached to the ribs or chest wall. In these cases, your surgeon might suggest a capsulotomy instead, where the capsule is opened or released rather than taken away.

What happens before a capsulectomy?

Your surgeon will discuss your symptoms, medical history and goals with you, including whether you'd like your implants replaced or removed without replacement, and whether you'd also like a breast lift to address any looseness left behind. Where there's any question over a rupture or a rarer concern such as BIA-ALCL, you may also need imaging or blood tests beforehand.

• Stop smoking or vaping ahead of surgery, since this can affect how well you heal
• Arrange for someone to take you home afterwards, as you will not be able to drive yourself.

What happens during a capsulectomy?

1. You're given a general anaesthetic for the procedure.
2. Your surgeon reopens a cut, usually along your original implant scar, which may run a little longer than last time, given there's now the capsule to remove alongside the implant.
3. Depending on the technique used, the implant and capsule may be removed together as one piece, or the implant may be taken out first, followed by the capsule separately.
4. If you're having new implants fitted, these are put in at this stage, and a breast lift may be carried out at the same time if this was agreed beforehand.
5. A small drainage tube may be placed under the skin to remove excess fluid.
6. The cut is closed with stitches and covered with a dressing.

The procedure usually takes between 1 and 3 hours, though an en bloc capsulectomy, or one combined with other surgery, can take longer.

What does recovery look like?

You'll be watched over in a recovery area for a short while before going home the same day, with someone else driving you. Any drainage tube fitted is usually taken out after 3 to 5 days.

You can expect some pain, swelling and bruising for the first few days, managed with the painkillers you're given. Keeping your head and back raised while sleeping can help reduce swelling, and it's best to avoid sleeping on your front for a few months.

• A well-fitted, supportive bra worn afterwards helps keep swelling down and adds comfort
• Avoid strenuous activity and heavy lifting for around a month
• Attend your follow-up appointments so your surgeon can check on your healing.

Initial recovery generally takes 1 to 3 weeks, after which most people return to normal activities, although scarring often stays most noticeable for the first 1 to 3 months before it starts to fade.

What are the risks and complications?

Possible risks of a capsulectomy include:

• bleeding
• infection
• changes in breast sensation
• scarring
• complications linked to the specific technique used, particularly where the capsule is attached to the ribs or chest wall.

There's currently no definitive evidence that removing the capsule prevents future breast implant-related cancers in every case, and this uncertainty is worth discussing with your surgeon before deciding whether to go ahead.