When patients begin researching breast implant removal, one of the first and most confusing questions they encounter is whether the capsule should also be removed. It's a topic that sparks debate, generates countless messages in my inbox, and understandably creates anxiety for anyone facing explant surgery.
Today, I want to break this down clearly—what the capsule is, why it forms, what can go wrong inside it, and why its removal matters for many patients.
What Is the Capsule?
Any foreign object placed in the body—whether a hip replacement, knee implant, breast implant, dental implant, pacemaker, or neurologic stimulator—will naturally trigger the formation of a capsule.
This capsule is made of scar tissue. It's not a "bad reaction"; it's simply how the body walls off something it recognizes as foreign.
Every single person with an implant forms a capsule.
Capsules vary in thickness—think anywhere from thin magazine pages to a stack of paper. The thickness depends on many factors: the implant's characteristics, your unique biology, inflammation, and how your body heals.
Early Healing: Swelling, High Implants, and Muscle Tension
After augmentation, swelling is completely normal, particularly when implants are placed under the muscle. In some patients, implants sit higher than expected during early healing, which can be alarming. But most of the time, this is simply the pectoralis major muscle holding the implant up until swelling decreases.
Tools that help during this phase include:
- Muscle relaxation (to allow the implant to settle)
- Post-operative bras with straps to prevent implants from rising
- Patience, as the settling process can take weeks to months
While the implant settles, the capsule is already forming—starting within the first 24 hours after surgery.
How Capsules Can Cause Pain or Other Symptoms
Capsules can be thin and pliable—or thick, firm, even calcified. In addition, a too-wide implant (especially on a petite frame) can irritate tissues and nerves, particularly around the side of the chest near the serratus anterior.
This is the area many people refer to as the "side-boob" region.
I've seen patients experience:
- Pulling or aching sensations
- Throbbing or burning
- Deep, persistent itching
- Electrical, tingling, or sharp nerve pain that can wake them up at night
These symptoms often stem from scarring or nerve irritation within or around the capsule. I've even seen a patient tear their capsule during a workout, causing severe nerve pain until we addressed it.
Firm or hardened capsules—what people often call "capsular contracture"—are also a frequent issue. One of my TikTok videos showing a calcified capsule has over 4 million views because the transformation can be so dramatic.
Why the Capsule Matters in Explant Surgery
In 2019, I testified before the FDA about implant safety. Before I spoke, a woman described her devastating experience: she underwent explant surgery, but her capsule was left behind. That capsule contained anaplastic large cell lymphoma (ALCL).
I was stunned—not only by her story but because removing a capsule safely is not technically difficult for a surgeon trained in oncologic and reconstructive surgery.
With my background in cancer reconstruction, microsurgery, and oncology, I immediately recognized that her situation was preventable. During my testimony, I committed as President-Elect of the Aesthetic Surgery Research Foundation to support research to avoid these outcomes.
My connection to cancer is also personal: my sister passed away from recurrent breast cancer. If a surgeon had performed an incomplete procedure like that on her, I would have been furious. Patients deserve better, and they deserve thorough, safe surgical care.
Cancer Isn't the Only Concern: The Bacterial Contamination Problem
Cancer is rare, but not the only risk. Research inspired by the concerns raised at the FDA hearing revealed something startling: 48% of capsules contained bacterial contamination.
That number was far higher than my own clinical experience, so I conducted a much larger study. In our paper—now submitted for publication—we analyzed over 694 capsule samples.
The contamination rate was 29%.
That means nearly one-third of patients had bacterial contamination inside the capsule—even without classic signs of infection like fever or redness.
This explains why so many patients continue to experience symptoms if their capsule is left behind during explant.
These contaminants live inside the capsule or between the capsule and implant. Removing the implant alone does not remove the problem.
So Why Do Some Surgeons Leave the Capsule In?
Some surgeons argue that partial capsule removal is "good enough." But the scientific evidence says otherwise:
- Bacterial contamination lives in the capsule
- Lymphomas associated with implants arise in the capsule
- Irritating or inflamed tissue is found in the capsule
- Symptoms often persist if the capsule remains
This isn't about surgical philosophy—it's about science and patient safety.
Anyone can numb the breast, make a small incision, and pull out an implant in an office procedure. But that is not the same as a complete capsulectomy.
And while I'm not here to debate surgical terminology, I am here to advocate for practices supported by evidence.
Real Patient Stories: When the Capsule Tells a Different Story
One of my public patients, Tiffany Blackmon, is a perfect example. During her surgery, I discovered a deep breast cancer. It wasn't inside the capsule; it was outside it. But we never would have found it without a thorough, methodical approach.
This is not a game of "what can we leave behind." It's a matter of detecting and treating real conditions that affect real people.
The Bottom Line: Why I Remove the Capsule
After thousands of explants and extensive research, my stance is clear:
If you want the safest, most complete, and most effective outcome, the capsule should be removed.
Why?
- It can harbor bacteria
- It can harbor rare cancers
- It can irritate nerves
- It can perpetuate symptoms
- It can hide abnormalities
- And the scientific literature overwhelmingly supports removing it
Doing the right thing means performing a thorough, evidence-based procedure—not the fastest one.
Final Thoughts
Patients deserve transparency, safety, and a surgical plan rooted in science. Explant surgery is not just about removing an implant—it's about restoring health and giving patients the best chance at recovery.
The research is clear. The stories are compelling. The data is overwhelming.
When performed correctly, removing the capsule is not just an option—it's the responsible choice.
Take the Next Step Toward Better Health
If this episode resonates with you, I encourage you to take action. Whether that means scheduling a consultation, doing more research, or simply trusting your instincts about your health, you deserve answers.
📅 Schedule a Free Discovery Call
Let's discuss your symptoms, concerns, and whether explant surgery is right for you.
Additional Resources
Want to dive deeper into breast implant illness, inflammation, and holistic recovery? Check out these resources:
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