Breast Implant Removal With Capsulectomy is a procedure done to remove a breast implant and perform partial capsulectomy. The need for removal of a breast implant will vary with each patient but generally, it is performed if the breast implant is ruptured or ruptures, or painful. This condition can cause inflammation and other complications.
In this guide, we review the aspects of Breast Implant Removal With Capsulectomy, cpt code for removal of breast implant with partial capsulectomy, does capsulectomy include implant removal, and is breast implant removal surgery dangerous.
Breast Implant Removal With Capsulectomy
Your body forms a protective capsule of thick scar tissue around any foreign object inside of it. When you get breast implants, this protective capsule helps keep them in place.
For most people, the capsule feels soft or a little firm. However, for some people who get implants, the capsule can tighten around their implants and create a condition called capsular contracture.
Capsular contracture is the most common complication for breast implant surgeries and occurs in about 10.6 percent of women with implants. It can lead to chronic pain and distortion of your breasts.
Serious cases of capsular contracture are usually managed with surgery.
A capsulectomy is the gold-standard treatment option for capsular contracture.
In this article, we’re going to take a look at what you can expect during a capsulectomy. We’ll also look at when this surgery may be needed and how long it takes to recover from it.
Weeks before having a capsulectomy, if you smoke, you’ll likely be asked to stop. Smoking reduces your blood flow and slows your body’s ability to heal itself.
Quitting smoking is often difficult, but a doctor can help create a smoking cessation plan that works for you.
You may also be asked to stop taking certain supplements or medications about 2 weeks before your surgery.
Here’s what happens during a capsulectomy:
The most common complications of breast capsulectomy include bleeding and bruising.
You might be able to return home the same day as the surgery, or you may need to spend a night in the hospital.
Capsulectomy surgery removes the tough scar tissue around your breast implants known as capsular contractures. Capsular contracture can be measured using a method called the Baker scale, which has four grades:
Grade I and grade II capsular contracture aren’t considered clinically significant and don’t require surgery.
Women with grade III and IV capsular contracture often require either a capsulectomy or a less invasive surgery called a capsulotomy to reduce pain and regain the natural appearance of their breasts.
People who receive breast implants will develop a capsule around their implant to keep it in place. However, only roughly 10.6 percent of people with implants develop capsular contracture.
It’s not entirely clear why some develop capsular contracture and some don’t. It’s thought that capsular contracture may be an inflammatory response that causes your body to produce an excess of collagen fibers.
People who’ve had radiation therapy in the past have an increased risk of developing capsular contracture. Capsular contracture may also have a higher chance of happening if one of the following occurs:
In addition, a genetic predisposition to developing scar tissue may increase the risk of capsular contracture.
Some evidence suggests that textured breast implants lower the risk of developing capsular contracture compared to smooth implants. However, it’s unknown whether this is actually the case. As well, the Food and Drug Administration (FDA) has banned many brands of textured implants.
Capsulectomy is an open surgery, which means that it requires a surgical incision. Capsulectomies can be divided into two types: total and subtotal.
Total capsulectomy
During a total capsulectomy, a surgeon removes your breast implant and your entire capsule of scar tissue. Your surgeon may remove the implant first before removing the capsule. They then replace your implant once the capsule is removed.
En bloc capsulectomy
An en bloc capsulectomy is a variation on a total capsulectomy.
During this type of surgery, your surgeon removes your implant and capsule together instead of one at a time. This may be the best option if you have a ruptured breast implant.
In some cases, this type of capsulectomy may not be possible if the capsule is too thin.
Subtotal capsulectomy
A subtotal or partial capsulectomy only removes part of the capsule.
As with a total capsulectomy, your breast implant is likely to be replaced during this type of surgery. A subtotal capsulectomy may not require as large of an incision as a total capsulectomy, so it may leave a smaller scar.
Even though a capsulectomy and capsulotomy may sound similar, they’re different surgeries. The suffix “ectomy” refers to a surgery that involves removing something. The suffix “tomy” refers to making an incision or cut.
A capsulectomy is more invasive and has a higher risk of complications including nerve damage. During a capsulectomy, a surgeon removes all or part of your capsule from your breast and replaces your implant.
During capsulotomy surgery, the capsule is partially removed or released. The surgery can be open or closed.
During the open surgery, your surgeon makes an incision in your breast so they can access the capsule.
During closed capsulotomy, external compression is used to break up the capsule. Currently, closed capsulotomies are rarely performed.
An open capsulotomy performed on one breast takes about 20 to 30 minutes. A capsulectomy takes about an hour longer. Capsular contracture has similar reoccurrence rates in both surgeries.
After your surgery, your breasts may feel sore. You may be instructed to wear a compression bra on top of your surgical dressing for several days or weeks.
Depending on how thick the capsule was or if your implants were ruptured, your surgeon may place temporary drainage tubes in the area to help decrease swelling. These tubes are usually removed in about a week.
Your surgeon can give you a specific time frame for your recovery. In general, a breast capsulectomy takes about 2 weeks to recover from completely.
cpt code for removal of breast implant with partial capsulectomy
For the Current Procedural Terminology (CPT®) 2021 code set, AHA revised or deleted a significant number of codes. This is especially true in the Breast subsection of the Integumentary System section. In addition, AHA added new introductory guidelines to the Repair and/or Reconstruction subsection. There were also numerous instructional parenthetical notes, for CPT codes 19342, 11970 and 19370. AHA made these changes to reflect current practice, simplify terms, and clarify physician work.
Examples of Proper Coding
However, coders still struggle with using these codes for some coding scenarios, such as stage 2 reconstructions. We refer to replacement of a tissue expander with a permanent implant as a stage 2 reconstructions. Based on updated CPT guidelines for 2021, the AHA updated their previous recommendations. This specifically applies to coding tissue expander replacements with permanent breast implants. Let’s look at the previous advice and the new current advice.
Coding Clinic for HCPCS 4Q 2020 pg. 1 instructed coders to report code 19342, Insertion or replacement of breast implant on separate day from mastectomy, when the tissue expander is replaced with permanent implants and significant (more than minor) adjustments are made to the capsule (AHIMA, 2021).
Coding Clinic for HCPCS 1Q 2021 pg. 11 issued a correction to the previous advice with an effective date of March 17, 2021, instructing coders to now assign codes 11970, Replacement of tissue expander with permanent implant, and 19370, Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy, to capture the replacement of a tissue expander with implant and capsulorrhaphy (AHIMA, 2021). The article also warned of an NCCI edit that prevents the reporting of CPT code 11970 with code 19370.
Based on the current updated references from the AHA and the current NCCI edit, coders should use code 19370 to report when a providers replaces a tissue expander with permanent implants. This also applies when providers make significant adjustments to the capsule. We remind coders that if only minor revisions are made to the capsule, then they should still report code 11970 alone for stage 2 reconstruction.
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does capsulectomy include implant removal
Breast Explant Procedure: What Is En Bloc Capsulectomy?
Recently, I have received more inquiries at my Northbrook plastic surgery practice regarding breast implant removal surgery. The most common reasons for a woman to choose to have her breast implants removed are health concerns, changes to the implants and the breasts over time, and the feeling that the implants are too large or heavy for her body.
When you choose to have breast implant removal surgery, or breast explant surgery, there are some options available, which you should discuss with a board-certified plastic surgeon. The simplest approach is to remove the implants while leaving the scar tissue capsule in place. A more complex approach is to perform an explant capsulectomy, in which the implants and the scar capsule are removed from the breasts. The most complex option for removing breast implants is an en bloc capsulectomy, in which the implants and scar capsule are removed intact.
Since this is the most complicated option for breast implant removal, I will provide some additional insight into the en bloc capsulectomy procedure.
What is en bloc capsulectomy?
En bloc capsulectomy is a procedure in which the scar tissue around the implant, known as the breast capsule, is removed in one piece with the implant enclosed within it. The benefit of removing the capsule en bloc is that it prevents the implant (or implant material) from coming into contact with normal tissues left behind. This is especially useful in the case of implant rupture but also may benefit those concerned about implant toxicity and breast implant illness. Total capsulectomy means removing the entire capsule but not necessarily in one piece.
En bloc capsulectomy is not a simple procedure. It poses challenges to surgeons and patients alike.
Who is a candidate for en bloc capsulectomy?
Not all patients are candidates for en bloc capsulectomy. On occasion, the capsule is so flimsy (imagine wet toilet paper) that it is impossible to remove in one piece. This is especially true for thin capsular tissue adjacent to the ribcage, where cutting too deep can lead to a punctured lung cavity or prolonged pain. Because of this I rarely guarantee en bloc capsulectomy; but I do promise a good faith effort to remove all of the capsule tissue in a way that minimizes creating additional injury.
How will I look after implant removal surgery?
A lot of women ask whether they will look good after en bloc capsulectomy. This can be a very difficult question to answer. The appearance of the breast depends on its size relative to the implant, the degree to which the breast tissue has been displaced over time, and the degree of skin elasticity that remains. Whether things look good depends on these physical factors, but also on how a woman perceives her “new” breasts in the context of how she feels about her body and whether her breasts play the same role they did when the implants were placed.
In experienced hands, breast lift procedures can go a long way toward restoring a natural breast appearance. However, a lift creates new scars and may be associated with more surgical risk. So it’s really important to make this decision in conjunction with your surgeon, in person, so that you understand what to expect and what other patients like you have experienced. You can see some of my patients’ breast implant removal before and after pictures, with and without breast lifts, to get an idea of the type of results that are often possible.
is breast implant removal surgery dangerous
Mammograms
Depending on the placement of your breast implants, they can make your mammograms more difficult. The type of breast implant, such as silicone or saline, will also affect the results of your mammogram. ‘How?’ you may ask. Breast implants can be placed above the pectoral muscle or below it. If the implants are above the pectoral muscle, then the mammogram won’t be able to see that area using the imaging devices.
Silicone and saline implants also inhibit the x-ray from seeing the breast tissue, and you’ll likely need to see an OB-GYN with an imaging device that can see past the implants. Removing the implants means your mammogram results are clear, which is important if your family has a history of breast cancer.
Pain Be Gone
Is one of the reasons why you’re considering breast implant removal pain? Then you’re not alone here either! It’s no secret that breast augmentation can cause pain later on down the line. Larger implants lead to shoulder, back, and neck pain because of the weight your chest is supporting. Also, the surgery to get your breast implants may have caused capsular contractures around the implants. This stiffens the scar tissue causing pain, and hard, misshapen breasts. Once you get the breast implant removal surgery and have fully recovered, you’ll notice a distinct lack of pain. What a weight off of your shoulders!
Boosts Your Confidence
You don’t have to regret getting your breast implants to want to remove them later on. We’re sure that getting those implants made your day and helped you view your body in a new light. But now that light has diminished, and the implants don’t fit the image you have in mind anymore. Implant removal will boost your confidence in yourself and your body just like it did when you got them.
MRI’s for Ruptures
A breast implant, no matter the type, always have the possibility of rupturing. MRI’s are an expense that adds up over time, and it’s expensive too. The average cost of an MRI in the United States is approximately $2,000. That’s a cost you’ll have to pay out-of-pocket every two years. The cost gets even higher if a rupture is found. Once you get those implants removed, it’s a cost you’ll never have to think about again!
No Fear of Ruptures
Having breast implants, you’ll already know that the implants can rupture. The most common reasons a breast implant ruptures are intense physical pressure, defective implants, aged implants that have weakened, and capsular contracture. We already know that capsular contracture occurs when the scar tissue around the implant hardens. If the condition is bad enough, it can rupture a weak implant. Breast implants are not lifetime devices, and the shell will weaken over the years. Without implants, you no longer need to worry about ruptures and the costs of fixing them.
No More Replacements
As we mentioned earlier, breast implants can and will age over time. It’s recommended for you to replace your implants every 10 years.
However, that’s an expensive cost that isn’t covered by your insurance either. Having breast implant removal surgery means you don’t have to worry about replacing your implants every time they get old.
Recovery Is Short
If you do decide to remove your implants once and for all, you’ll be happy to hear that recovery time post surgery is a whopping 2 weeks. Of course, during this time your doctor will tell you all the things you won’t be allowed to do such as lifting heavy objects, driving, and so on. However, you can always tell your co-workers you went on vacation in the meantime.
Shopping
Depending on the size of your breast implants, finding clothes that fit and looked good was probably a chore. A cute shirt that was in your size not fitting because your breasts were popping out doesn’t make shopping easy or fun. Then there’s the pain of bra shopping to consider.
Getting rid of those pesky implants will change the world of shopping for you. Of course, it’ll take some time to adjust, but now you don’t have to buy the expensively large bras or go up two sizes to find a shirt that fits your chest too.
Breast Implant Removal Cons:
Sagging
Just as there are pros to breast implant removal, there are also cons, and sagging is one of them. Breast implants give your chest perkiness and a full look. Removing those implants will return your breast to their original shape, but now gravity has free reign. Your breasts will sag as they did before. However, they may even sag worse than they did before. If you were originally a B cup and went up to DD, then you’ll likely experience more sagging; especially, if you had your implants for several years.
Loose Skin
Loose skin is the cousin to breast sagging and will happen for much the same reason. Like with sagging, the size of your implants and the length of time you had them will contribute to loose skin. Another factor is the elasticity of your skin. If there’s too much sagging or loose skin, your doctor may recommend a breast lift if they haven’t already done one.
Mastectomy
With this con, we don’t mean you’ll need a mastectomy or that the surgery will be a mastectomy. It’s possible that when removing your implant because of a rupture, your surgeon may need to remove so much breast tissue that it’ll appear you had a mastectomy. Remember how implant ruptures are a problem you’ll always need to look out for with implants? If a gel implant does rupture there will be leakage of the gel into the breast tissue. The more leakage there is, the more tissue your surgeon needs to remove along with the ruptured implants. Losing too much breast tissue will give your breasts a similar look to individuals who had a mastectomy or a partial mastectomy.
Infection
Breast implant removal is a major surgery, and like with any major surgery there is the risk of infection. The infection will likely occur around the incision site post surgery or in the cavity the implant was located. Infections will slow down recovery, and the severity of the infection may require drain tubes or antibiotics.
More Scarring
While techniques are developed to minimize as much scarring as possible, there will always be scarring at the incision site. You may even notice more scarring than before as well depending on how your body heals. The breast implant removal surgery will always use the incision sites from your original breast augmentation surgery. However, the scar will be visible and will take time to lessen.
Loss of Feeling in the Nipples
Most breast augmentation surgeries will use one of two incision sites, just under the breast (an inframammary incision) or around the bottom of the areola (a periareolar incision). If your original breast augmentation surgery used the periareolar incision, then you may have already experienced loss of feeling in your nipples. The removal surgery, which often uses the original incision, can contribute to even more loss of sensation or cause it if you didn’t have sensation loss before. The loss of feeling occurs because the nerves that send those signals to your nipple are accidentally cut during surgery. The nerves are so small that it’s difficult to see them. If you still have sensation and don’t want to risk losing it, then the breast implant removal surgery may not be for you.
Anesthesia Complications
As we mentioned, breast implant removal is a major surgery. As such, you’ll likely have to be put under either a local or general anesthesia.
With anesthesia, there come potential complications. Such complications may include pain, nausea, vomiting, backache, headache, and damage to your teeth. In more serious cases, you might experience hypothermia, anaphylaxis, hematoma formation, and more.
Loss of Confidence
Just like how the breast implant removal surgery can boost your confidence, it can also lower it too. It’s entirely possible that when you see yourself for the first time in a mirror after fully recovering from the surgery, you won’t like what you see. Sometimes the image you had of yourself isn’t the same as reality. You may even lose confidence in yourself if you have no choice in removing your implants because of a breast cancer diagnosis. Either way, the feeling that your body is wrong now will remain.
The Cost
Unless your breast implant removal is necessitated by a health problem, you’ll have to pay for it yourself. The surgery can cost anywhere from $1,000 to $4,000 depending on the surgeon you go to. If the cost is something you can’t consider at the moment, then you’ll want to put off the removal for later.
It’s Your Body
Before you make any hard decisions about breast implant removal, remember that this is your body. Unless you are 100% confident that this is something you want for yourself, you’ll want to take your time. Be sure that you’re ready to let go of your implants because the most important factor in your decision is how you’ll feel afterward. In the meantime, contact us if you want to know more about the pros and cons of breast implant removal.