When a breast implant is placed the body attempts to wall it off forming a capsule around the implant. This capsule can be present within a week after surgery & is eventually present in all breasts containing implants. The end result look of a breast containing implants is due to
the implant itself
the patient’s breast tissue-skin,gland,fat,chest wall muscle
the capsule formed around the implant.
The capsule can be of variable thickness & have different properties from patient to patient & even right breast vs. left breast. Thicker capsules can contract squeezing the implant, misshaping the breast, making the breast feel firm & in some cases causing pain. It is not known exactly why some capsules become more problematic cosmetically speaking than others. It is thought that blood around the implant at the time of surgery or low grade infection early or late after surgery is the culprit. Some capsules cause problems early after surgery & some take years to transform into a problematic capsule. It’s not known whether all capsules eventually become problematic but this is a distinct possibility. In the mid 1980s texturing was added to implant surfaces in an attempt to decrease the incidence of capsular contracture. Some surgeons now use only textured implants & others use only smooth surfaced implants saying one is better than the other for cosmetic or other reasons. At least in animal experiments texturing decreases the contracture rates.
When reoperating on a breast with implants in place the preoperative situation & goals of the surgery should be kept in mind. If the patient just wants the implants out it’s important to remove as much as the capsule as possible unless the capsule is gossamer thin. If the implant is removed & the capsule left behind virtually intact various problems can occur:
the capsule can contract down into a small sphere since there is no longer an implant to maintain its size – this would crenate (notched or shriveled in appearance) the breast
the capsular surface in some cases can secrete fluid similar to serum or joint fluid which would require drainage
Having said all that it is probably impossible to remove every single cell & non-cellular part of a capsule. Firstly because that’s just the way the human eye & hand work-we can’t see microscopically. Secondly because especially in very thin individuals it may be dangerous to scrape the back of the capsule off the chest wall. No one wants to enter the chest cavity especially if gel from a ruptured gel implant is present. The problems of crenation & fluid production should be adequately treated by removing the vast majority of the capsule.
There are no external balms, medications etc. that effectively treat capsular problems. The capsule needs to be surgically removed & all consent forms for breast implant surgery should discuss the existence of/possible problems with capsules. Interestingly, of all the non-plastic surgeons out there performing breast augmentation I’ve never heard of one of them willing to perform breast reconstruction or treat capsular problems