Capsulectomy

The surgery is performed through the same incisions created for the breast augmentation surgery. The capsule surrounding the implant is removed and a new implant is normally inserted into the pocket. Some patients may choose an alternative option such as no implant, fat grafting or a mastopexy. The skin incision is then closed.

The procedure takes approximately one hour to perform and is most performed under a general anaesthetic (you will be fully unconscious). You are likely to stay in hospital for one night, although, on occasions, you may be able to go home the same day as your surgery.

You will feel stiff and sore for a few days. Expect the most discomfort to be within the first 72 hours. Usually only simple pain killers are all that is required.

Having surgery should be a very positive experience. Decisions about this surgery should never be rushed.

Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss them.

These risks can be divided into the risks specific to the surgery and the risks of anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

• Unintended intraoperative awareness, which is very rare
• Dizziness and nausea
• Sore throat
• Damage to teeth or mouth
• Nerve injury due to body positioning
• Allergic reaction or anaphylaxis
• Malignant hyperthermia, which is a rare life-threatening condition

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars:  These are hidden in the crease under the breast, using the existing scar from the original breast implant insertion. They normally settle remarkably well, so that the scars are barely perceptible. However, some patients heal with thick, thin or stretched scars, which can be noticeable.

Bruising and swelling: A degree of swelling and bruising is normal, and this may take approximately 2 weeks to settle.

Haematoma: This is clotted blood that collects in the breast. It occurs in between 1% to 4% of women who undergo a capsulectomy and removal of implant. It tends to occur within 4 to 6 hours post-surgery.

Any increase in swelling or pain should be reported immediately for assessment. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.

Infection: The risk of infection is inherent with any surgical procedure, albeit very uncommon in elective breast procedures. Antibiotics are administered during surgery and for 7 days after surgery to minimise the risks. Less than 1% of patients develop an infection post-operatively and rarely require any intervention, apart from further antibiotic treatment.

Numbness, reduced sensation or oversensitivity:  A reduction in nipple sensation may occur, which may improve to some degree with time. However, this may never completely return to normal. Occasionally patients feel that nipples become more sensitive.

Wound healing problems: These are rare but can happen. These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to more significant issues that may require scar revision. Fortunately, this is very rare.

Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Asymmetry: Each breast is slightly different and will continue to be following surgery; remember, “they are sisters and not twins”. However, if you have noticeable asymmetry before your surgery then this will be corrected as part of the surgery and will be discussed with you.

Fat necrosis: Sometimes areas of fat within the breast scar form hard lumps called fat necrosis. Usually, no specific treatment is required, and the problem settles down over a 12-month period.

Implant rippling or wrinkling: A capsulectomy removes a thin layer of scar tissue and should not alter the volume of your breast significantly.

In patients with capsular contracture, the implant is squeezed tightly, which removes any wrinkles or ripples in the implant shell.

When the capsule is removed, and a new implant put in the pocket, it will feel much softer. In very slim patients, or those who have very little breast tissue, the implant can be more visible revealing these wrinkles or ripples. This can be corrected by fat grafting to increase the soft tissue cover or a mastopexy to tighten the skin.

Capsular contracture: If you have had capsular contracture for no obvious reason than you are at an increased risk of this recurring.

Many studies show that the risk of recurrence is approximately 11% after 10 years with silicone implants. If you smoke, then you are advised to stop smoking as it is linked with capsular contracture.

Breastfeeding: This will not be affected by capsulectomy surgery but can be affected if you choose to combine this with an uplift (mastopexy).

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with me. Decisions about cosmetic surgery must never be rushed and requires personal research.

Your incisions will be closed with dissolvable sutures, which do not require removal.

I use a waterproof dressing which will be removed after 1 to 2 weeks following surgery. You can shower as soon as you like after surgery, and you will be given spare dressings in case they become wet and need changing. You do not normally need antibiotics after surgery but you will be prescribed analgesia as required.

Patients must wear a support bra for 6 weeks and that you need to purchase 2 bras, so you have one to wear and one in the wash. These are worn day and night for approximately 6 weeks post-surgery, before returning to any bra of your choice. You will need to purchase these prior to your surgery, and I will provide the relevant details in clinic. Details can also be found in the compression garment guide below.

Initially, your breasts may seem smaller than you expected. This is normal, and it will take time for your implants to settle into position. If you choose to have the same size implant or a larger implant inserted, then your breast will not be smaller.

Before you leave the hospital, you will be given a follow up appointment to see the nurses at one week to check your incisions and an appointment to see me in 3 weeks. You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you. If you have any concerns during this period, do contact the clinic for advice.

Scar advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from Silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square.

When you return home, you should take it easy for the first 2 weeks or so. Most people take approximately 1 to 2 weeks off from work. You should be able to start driving after 2 weeks.

If you have a capsulectomy and removal of implant alone or capsulectomy and fat graft, you can return to the gym return after approximately 2 weeks.

If you are having an implant/mastopexy then you can commence lower body exercises at 4 weeks and begin upper body workouts at 6 weeks.

You will need to wear your support bra for 6 weeks.

Surgical fees are a combination of the hospital costs, the surgeon and anaesthetic fees and any consumables such as implants.

In non-cosmetic breast surgery patients the fees are normally cover by your health insurance, however most patients have a co-pay of 20% and certain policies only cover one breast and half of the other breast. This means you are likely to have to pay towards the cost of your surgery. Any fees will be calculated, and you will be informed of the potential fees at your consultation.

Capsulectomy - Nicotine and Surgery

Capsulectomy - Post-Op Bras