Surgical Tactics in Breast Explants

Abstract

Introduction

Demand for breast implants and capsule removal has increased over the last 5 years. Plastic surgeons have the skills to perform capsulectomy, but there are surgical tactics details that depend on the degree of contracture and the plane of implant placement. Breast reconstruction following this procedure also has its particularities. Therefore, it would be ideal to identify the significant factors in choosing surgical tactics for intact total capsulectomy and to develop a decision-making flowchart to assist the surgeon in each case.

Materials and Methods

Description of surgical tactics and decision-making flowchart based on the author's experience in 712 patients undergoing total intact capsulectomy from June 2021 to 2023 in São Paulo, Brazil.

Results

Most patients (78%) presented subglandular explants, followed by submuscular ones in 22%. Implants consisted of silicone alone in 89% and polyurethane coated in 11% of cases. In this series, 55% of patients underwent explantation with mastopexy, followed by explantation with mastopexy and fat grafting in 18%, explantation alone in 14%, and explantation with fat graft in 13%.

Conclusion

Capsular contracture degree, implant position, and previous scarring on the breasts are important factors in surgical planning for intact total capsulectomy. The choice of breast repair tactic depends on factors such as breast volume and sagging. Observation of the decision flowchart for these procedures can be an instrument for planning and standardizing surgical tactics.

Keywords

breast - breast implantation - breast implants - implant capsular contracture - mammaplasty

Publication History

Received: 27 August 2023

Accepted: 20 May 2025

Article published online:
25 August 2025

• Referências

• 1 Magnusson MR, Cooter RD, Rakhorst H, McGuire PA, Adams Jr WP, Deva AK. Breast Implant Illness: A Way Forward. Plast Reconstr Surg 2019; 143 (3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma) 74S-81S
• 2 Glicksman C, McGuire P, Kadin M, Barnes K, Wixtrom R, Lawrence M. et al. Longevity of Post-Explantation Systemic Symptom Improvement and Potential Etiologies: Findings From the ASERF Systemic Symptoms in Women - Biospecimen Analysis Study: Part 4. Aesthet Surg J 2023; 43 (10) 1194-1204
• 3 Swanson E. Breast Implant Illness, Biofilm, and the Role of Capsulectomy. Plast Reconstr Surg Glob Open 2020; 8 (07) e2999
• 4 Gerzenshtein J. The Dishonesty of Referring to Total Intact Capsulectomy as “En Bloc” Resection or Capsulectomy. Plast Reconstr Surg 2020; 145 (01) 227e-228e
• 5 Glicksman C, McGuire P, Kadin M, Lawrence M, Haws M, Newby J. et al. Impact of Capsulectomy Type on Post-Explantation Systemic Symptom Improvement: Findings From the ASERF Systemic Symptoms in Women-Biospecimen Analysis Study: Part 1. Aesthet Surg J 2022; 42 (07) 809-819
• 6 Melmed EP. A review of explantation in 240 symptomatic women: a description of explantation and capsulectomy with reconstruction using a periareolar technique. Plast Reconstr Surg 1998; 101 (05) 1364-1373
• 7 Afshari A, Nguyen L, Glassman GE, Perdikis G, Grotting JC, Higdon KK. Incidence and Preoperative Risk Factors for Major Complications After Capsulectomy: Analysis of 3048 Patients. Aesthet Surg J 2022; 42 (06) 603-612
• 8 Rohrich RJ, Parker III TH. Aesthetic management of the breast after explantation: evaluation and mastopexy options. Plast Reconstr Surg 2007; 120 (01) 312-315
• 9 Katsnelson JY, Spaniol JR, Buinewicz JC, Ramsey FV, Buinewicz BR. Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients. Plast Reconstr Surg Glob Open 2021; 9 (09) e3813
• 10 Abboud MH, Dibo SA. Immediate Large-Volume Grafting of Autologous Fat to the Breast Following Implant Removal. Aesthet Surg J 2015; 35 (07) 819-829
• 11 Kim HY, Jung BK, Lew DH, Lee DW. Autologous Fat Graft in the Reconstructed Breast: Fat Absorption Rate and Safety based on Sonographic Identification. Arch Plast Surg 2014; 41 (06) 740-747
• 12 Kandulu H, Terzibasioglu AE. Male Pectoralis Major Muscle Augmentation with Autologous Fat Transplantation Using VASER Lipoaspirate: Evaluation with MRI. Plast Reconstr Surg Glob Open 2023; 11 (04) e4945
• 13 Herold C, Ueberreiter K, Cromme F, Grimme M, Vogt PM. [Is there a need for intrapectoral injection in autologous fat transplantation to the breast? - An MRI volumetric study]. Handchir Mikrochir Plast Chir 2011; 43 (02) 119-124
• 14 Scioscia PJ, Hagerty RC. Internal mastopexy following explantation. Plast Reconstr Surg 1996; 97 (05) 1014-1019 , discussion 1020–1022
• 15 Azevedo DM, Pinto EBdS, Romani HM, Gonçalves Júnior P, Morela MMV, Morelli LHU. Mamoplastia redutora com cicatriz vertical assistida por lipoaspiração. Rev Bras Cir Plást 2010; 25 (3 Suppl 1): 58 . Available from: https://www.rbcp.org.br/details/668/pt-BR
• 16 Mangialardi ML, Ozil C, Lepage C. One-Stage Mastopexy-Lipofilling after Implant Removal in Cosmetic Breast Surgery. Aesthetic Plast Surg 2022; 46 (04) 1542-1550
• 17 Graf RM, Closs Ono MC, Pace D, Balbinot P, Pazio ALB, de Paula DR. Breast Auto-augmentation (Mastopexy and Lipofilling): An Option for Quitting Breast Implants. Aesthetic Plast Surg 2019; 43 (05) 1133-1141
• 18 Avashia YJ, Rohrich RJ, Gabriel A, Savetsky IL. Surgical Management of the Explant Patient: An Update on Options for Breast Contouring and Volume Restoration. Plast Reconstr Surg 2020; 146 (05) 978-985
• 19 Bark Jr AA, Minikowski GC, Mujahed IBU. Multiplane L-Scar Augmentation Mastopexy: An Individualized Approach to Muscle, Glandular Tissue, and Skin. Plast Reconstr Surg 2024; 153 (04) 801-809
• 20 Oliveira KCd, Pereira RMR, Salgado IV, Baptista EVdP, Arantes GC, Luna IC. Options for capsulotomy and capsulectomy in the treatment of capsular contracture: are there clinical treatment alternatives to surgery? A literature review. Rev Bras Cir Plást 2015; 30 (01) 123-128
• 21 Mowlavi A, Asghari A, Heydarlou D, Gavilanes E, Sin Z, Mirzania H. Breast Lift Algorithm for the Treatment of Breast Implant Illness Requiring Implant Removal. Aesthetic Plast Surg 2023; 47 (03) 934-943
• 22 Tanna N, Calobrace MB, Clemens MW, Hammond DC, Nahabedian MY, Rohrich RJ. et al. Not All Breast Explants Are Equal: Contemporary Strategies in Breast Explantation Surgery. Plast Reconstr Surg 2021; 147 (04) 808-818
• 23 Nahabedian MY. The Capsule Question: How Much Should Be Removed with Explantation of a Textured Device?. Plast Reconstr Surg 2021; 147 (5S): 44S-50S
• 24 Hung CC. Endoscopic transaxillary capsulectomy with immediate reimplantation performed as a single-operator outpatient procedure. J Plast Reconstr Aesthet Surg 2020; 73 (12) 2225-2231
• 25 Bark Jr AA, Minikowski GC, Moreto L, Mujahed IBU. Creating a New Inframammary Fold, Raising the Breast Footprint, and Elongating the Torso with a Multiplane Concept. Plast Reconstr Surg 2024; 154 (06) 1084e-1090e
• 26 Atiyeh B, Ibrahim A, Saba S, Karamanoukian R, Chahine F, Papazian N. The Inframammary Fold (IMF): A Poorly Appreciated Landmark in Prosthetic/Alloplastic Breast Aesthetic and Reconstructive Surgery-Personal Experience. Aesthetic Plast Surg 2017; 41 (04) 806-814
• 27 Weissler JM, Banuelos J, Jacobson SR, Manrique OJ, Nguyen MDT, Harless CA. et al. Intravenous Tranexamic Acid in Implant-Based Breast Reconstruction Safely Reduces Hematoma without Thromboembolic Events. Plast Reconstr Surg 2020; 146 (02) 238-245
• 28 Ausen K, Fossmark R, Spigset O, Pleym H. Safety and Efficacy of Local Tranexamic Acid for the Prevention of Surgical Bleeding in Soft-Tissue Surgery: A Review of the Literature and Recommendations for Plastic Surgery. Plast Reconstr Surg 2022; 149 (03) 774-787
• 29 Miranda REd. What is the impact of capsulectomy on systemic symptoms attributed to silicone breast implant? Systematic literature review. Rev Bras Cir Plást 2023; 38 (04) e0816