Capsulectomy for Breast Implants: A Clear, Calm Guide

If you have breast implants, you will also have a thin layer of scar tissue around each implant called a “capsule.” A capsulectomy for breast implants is surgery to remove some or all of that capsule. This article explains when it’s considered, the limits and risks, and what to expect.

What is the capsule and why does it form?

The capsule is your body’s normal response to a medical implant. In many people it stays soft and unnoticed. In others, it may thicken or tighten (capsular contracture), contribute to pain or shape change, or—rarely—harbour a problem that needs treatment. “Enbloc” is a cancer-surgery term for removing a tumour and surrounding tissue; outside of confirmed malignancy, using “enbloc” for routine capsulectomy is misleading.

When is capsulectomy for breast implants recommended?

Clear indications include a confirmed capsular malignancy (for example, BIA-ALCL), significant capsular contracture, or removal of a ruptured silicone gel implant. For people troubled by systemic symptoms sometimes called “breast implant illness,” studies show many improve after implant removal, and improvement does not depend on taking out the entire capsule in most cases. Decisions should be individualised after a full medical review.

Regarding BIA-ALCL, it remains uncommon. Typical warning signs are a new, painless swelling from fluid around the implant years after surgery, a new lump, or severe contracture. There is no screening test; if you notice these changes, seek prompt assessment. Routine removal of symptom-free implants to “prevent” BIA-ALCL isn’t advised because surgical risks can outweigh potential benefit

Risks and limits—why I don’t promise “total” every time

Safety comes first. In submuscular reconstructions or augmentations, the very thin posterior capsule can be stuck to the ribs and chest wall. Trying to peel all of this off risks bleeding, rib injury, and—rarely—pneumothorax (air leak causing lung collapse). For that reason, I do not promise a complete capsulectomy in every case. My approach is to remove as much capsule as is safely possible and clinically indicated. UK guidance also cautions that total capsulectomy is a complex operation with potentially serious complications, so it’s reserved for clear indications or when benefits outweigh risks.

What happens at surgery—and the alternatives

Surgery is under general anaesthetic. Depending on your goals and findings, options include:

• Partial capsulectomy (remove the problematic portion only)

• Total capsulectomy (entire capsule where safely achievable)

• Capsulotomy (release without removing tissue)

• Implant exchange, implant removal alone, or removal with lift (mastopexy)

• Autologous fat transfer to restore contour without a new implant (case-by-case)

If you are seeking surgery for systemic symptoms, current evidence suggests that symptom relief can occur after implant removal even when only part—or none—of the capsule is removed. This helps us tailor a safer, less invasive plan when appropriate.

Most people go home the same day. Expect swelling, a drain in some cases, and activity restrictions for a few weeks. Scars depend on your prior incisions and what needed to be done. If an implant is not replaced, the breast will look smaller and may sit differently; a lift or fat grafting can sometimes improve shape, either at the same time or later.

It’s important to be honest: surgery can help symptoms linked to contracture, rupture, and some systemic complaints, but results vary and no surgeon can guarantee complete relief. Shared decision-making is key.

In summary: Capsulectomy is helpful when clearly indicated. I won’t promise a full removal if it endangers your ribs or lungs; instead, I’ll remove what is safe and necessary to achieve your goals. If you notice rapid swelling, a new lump, or major shape change years after implantation, arrange a prompt review.

Our practice focuses on individualised planning, balancing benefits against risks, and giving you realistic choices.

FAQs

Do I need my capsules removed if I’m symptom-free?

Usually not. Routine removal to “prevent” problems isn’t recommended given surgical risks.

Is capsulectomy necessary for symptom relief?

Not typically. Many patients improve after implant removal regardless of whether part or all of the capsule is removed.

What are the main risks?

Bleeding, infection, delayed healing, contour changes, and—when the posterior capsule sticks to the ribs—rare lung injury (pneumothorax).

What symptoms of BIA-ALCL should prompt review?

New, rapid breast swelling from fluid, a new lump, or severe contracture years after surgery. Seek assessment promptly.

Further reading

• Aesthetic Surgery Journal (2022–2023). ASERF “Systemic Symptoms in Women” series (parts 1–4): symptom change after explantation and biospecimen analyses.

• Aesthetic Plastic Surgery (2023). Joint Patient Safety Advisory—Breast Implant Removal and Capsulectomy.

• British Journal of Haematology / EJSO / JPRAS (2020). UK guidelines for diagnosis and management of BIA-ALCL.