What is a capsulectomy?

A capsulectomy is surgery to remove the capsule, the layer of scar tissue the body forms around a breast implant. It is different from a capsulotomy, which cuts the capsule to release tension but leaves it in the body. Capsulectomy can be total, meaning the whole capsule is removed, or partial, meaning only part of it is.

Do I need a capsulectomy when my implants are removed?

Not always. Whether the capsule is removed depends on why the implants are coming out and what the surgeon finds. Capsulectomy is standard where there is capsular contracture, rupture, or suspected implant-associated cancer. For removal without those findings, practice varies and the decision is made with your surgeon.

Capsulectomy — ExplantHealth

Capsulectomy means removing the capsule of scar tissue around an implant. The word gets used loosely, and the modifier in front of it — total, partial, en bloc — describes genuinely different operations with different risks.

What a capsulectomy is

Your body forms a layer of scar tissue around any implant. That layer is the capsule. A capsulectomy is surgery to take it out.

That is the whole definition, and everything that follows is about how much of it comes out and in what condition. Those distinctions matter because they change the length of the operation, the amount of dissection, and the risks you are accepting.

Implant and capsuleThe starting point. The capsule is the thin shell of scar tissue between the implant and your own tissue.

CapsulotomyThe capsule is cut open to release tension or to take the implant out. Most of it stays in the body. This is not a capsulectomy.

Total capsulectomyThe entire capsule is removed, though not necessarily in one piece. This is what most people mean when they say capsulectomy.

En bloc capsulectomyImplant and capsule removed together as one sealed unit, dissected from outside the capsule. A wider dissection.

Schematic drawings made to show the difference between the operations. Simplified, not to scale, and not a depiction of a patient or a surgical result.

The words, precisely

Capsulotomy— the capsule is cut. Not removed. Used to release tightness, or simply to get the implant out. The suffix is -otomy, meaning to cut into.
Partial capsulectomy— some of the capsule is removed, some is left. Often because the remaining part is stuck to something it would be risky to dissect off, such as the ribs or the lung lining.
Total capsulectomy— all of the capsule is removed. It may come out in several pieces. This is the operation most people mean when they say capsulectomy.
En bloc capsulectomy— the implant and the capsule are taken out together as a single sealed unit, with the dissection carried out entirely outside the capsule.

Our comparison page goes through the first two in detail, because that is the distinction most often blurred in consultation.

Which one you need

Established

The 2024 Breast Surgery Collaborative Community consensus statement, endorsed by the American Society of Plastic Surgeons, The Aesthetic Society and ISAPS, defines these terms and their indications. It reserves en bloc capsulectomy for established or suspected breast implant-associated cancer following appropriate workup, and supports total capsulectomy for breast implant illness.

Established

En bloc requires a more extensive dissection than total capsulectomy, with a higher reported risk of complications including haematoma and pneumothorax, and can remove more healthy tissue than the situation requires.

In practice the decision is also made partly during the operation. A capsule that is thin and mobile comes out differently from one that is calcified or adherent to the chest wall, and no surgeon can promise you the second scenario in advance. That is why the useful question is about judgement rather than technique — covered on the en bloc page.

When the capsule is definitely removed

Capsular contracture — the capsule is the problem, so leaving it defeats the operation. See capsular contracture.
Implant rupture, particularly silicone, where material may have collected within the capsule.
Suspected or confirmed implant-associated cancer — the one situation where en bloc specifically is indicated.
Calcification or infection of the capsule.

Where implants are being removed without any of these findings, practice varies more than patients expect. Asking your surgeon what they would do and why is a reasonable question with a reasonable answer.

Pathology

Ask whether the capsule will be sent for pathology. It is how implant-associated cancer is detected, and it is not always done by default. It is a small addition to the cost and the single most useful thing the removed tissue can tell you. Our cost page lists it as a line item worth confirming is included.

In this section

Capsulectomy vs capsulotomyTwo words one letter apart that mean very different operations. What each involves and why the distinction changes your recovery.Do you need en bloc?The most argued-about decision in explant surgery, and why the surgical consensus differs from the community answer.Capsulectomy for contractureWhen capsule removal is done to treat contracture rather than as part of explant, and how often it recurs.

Sources

Breast Surgery Collaborative Community. Consensus statement on breast implant capsulectomy definitions and management, 2024.
U.S. Food and Drug Administration. Breast implant labelling recommendations, boxed warning and patient decision checklist, October 2021.