Capsulectomy

Probably more than 10% of women who have silicone implants will develop capsules. Capsulectomy can be carried out if the capsule causes unacceptable distortion of the breast or if the capsule is painful.

Yes. There are many reasons a person changes surgeons, which I discuss in the Frequently Asked Questions regarding Consultation.

This is a good question. The reasons for any muscle changing in function if it is not used for any reason, injured, the nerves been damaged or the muscle length and therefore its tension has changed. Initially the muscle is damaged because we have to incise it partially to get the implant under it. This is why sub-muscular implants are more painful postoperatively than implants placed directly under the breast. Also initially because it is stretched the muscle will function slightly differently, but nature is forgiving because the muscle will learn to behave as normal after a period of recovery. I have not detected any long term functional problems with the muscle (called the pectoralis major muscle). However, if you were a professional swimmer, tennis player, athlete (such as a javelin thrower, gymnast) I would not recommend any sub muscular implants to be inserted. For “normal people” in the long term, I do not think that there should be any impediment to sporting activities and every day life. Long term the muscle, I believe, fully recovers. If the implant is removed the muscle will function as before but I suspect that there will be a relatively short period of full functionally recovery as the muscle gets used to the decreased length and tension after the implants have been removed.

This is a complex and important question. There is no indication for regular MRIs in my opinion to check the state of the implants. An MRI should be carried out only if there is clinical suspicion that there is something wrong with the implant. For example a volume change, a change in shape or the presence of pain, may indicate rupture (implant failure) or capsule formation. I also believe if the patient is anxious , or feels she is experiencing odd symptoms or the implants has been in a very long time; then a scan should be done. A simple ultrasound is probably as good as an MRI in the right hands for detecting implant rupture. If an implant is damaged then they should be removed with the option to replace them with a different implant, perhaps consider fat filling. What is a long time? This is not really known but after 10 years it maybe prudent to have an ultrasound. This is an arbitrary figure based upon the fact that nothing man-made lasts for ever and the cause of implant failure is multifactorial. Unfortunately, sometimes I am sure that an implant maybe damaged and ruptured but not detected clinically. This is because the natural capsule that forms around the implant keeps the implant in shape and in position. This logically begs the question of whether it is dangerous to have a ruptured implant in your body with internal extrusion of silicone. The opinion of the majority of medical practitioners and available research of statistical data (known as meta analysis), indicates that it is not dangerous. There is no evidence that silicone is harmful to the human body although of course, if the silicone used in implants is of low-industrial grade (such as in the PIP implants), then I believe that they can cause side effects and abnormal internal inflammatory responses. In my practice with Nagor, Allergan and Mentor implants I have not seen ruptured implants causing serious systemic problems. For some PIP cases, I have seen bad abnormal capsule formation and lymph node involvement and also historically in patients who have had implants that ruptured many years ago with old generation implants.The patient has to listened to and examined carefully should there be some change in. The other reason for scans and investigations would be for diseases that may affect your breast in the future. This is a separate issue and must be treated on their own clinical merits. The implants would not affect the efficacy or the way diseases of the breast itself can be investigated. There is no evidence that you are more at risk or there is less chance of diagnosing breast disease because of silicone implants. There is certainly no evidence that they cause cancer.

Any emergencies will be covered free of charge, however long term surgery is not free. For example, if a hard capsule forms around the implant after several years, the cost of the implant will be covered (as this is under warranty) but not the cost of the surgery. The rate of capsule formation is about 10%. If the patient wants bigger implants or the implants removed then there will be a cost in the region of £2900 to £4900 dependant upon the surgery required/requested.

En bloc means the implant and capsule are removed together as one unit, usually for ruptured implants or special concerns. Standard or total capsulectomy removes all the capsule, but not necessarily in one piece.

Yes, many patients choose to have replacement implants in the same procedure, but it’s not required.

If you have pain, firmness, visible changes, or concerns about your implants, a consultation will help you decide if capsulectomy is right for you.

Not always. It depends on your symptoms, the condition of your capsule, and your wishes. Hiroshi will advise what’s best for you.

When performed by an experienced surgeon in a CQC-registered facility, capsulectomy is very safe. Risks are rare and carefully managed.

Incisions are usually placed where your previous scars are, or under the breast, and are designed to be discreet.

If rupture is confirmed, Hiroshi will safely remove both the implant and any leaked material, usually with a total or en bloc capsulectomy.