Treatment depends upon the patients desires.
Most women in the first category who want implants out and a lift with normal soft capsules will benefit from implant removal and a mastopexy (breast lift) with or without fat grafting.
The capsule is generally left in place in this scenario but could be removed if the patient desires. Capsule removal (capsulectomy) adds 45 min to 1.5 hours of surgical time
Women with breast implant illness (BII) will have explantation of the implants with en bloc resection of the capsule. This means the capsule will be removed in total and any extravasated (leaky) silicone will be removed as part of the dissection. Options to be discussed at the time of consultation include need for mastopexy or fat grafting (or both) or staged reconstruction/revision
Women with recurrent capsular contracture or other devastating problems may choose to have implant removal, capsulectomy and reconstruction with fat grafting and/or mastopexy. The above scenarios really vary from patient to patient and will be discussed in detail at the time of consultation. As always, out of town patients may submit medical and surgical histories and photos for review prior to initial consultation.