Does a new pocket mean the same thing as removing a whole capsule?

I got cc and 7 months later had the scar tissue scored/removed with the same implant put back. I would like to have the whole capsule removed, a new pocket and new implant. Does a new pocket mean the same thing as removing the whole capsule?

Answers from doctors (17)


ELLIOT B. DUBOYS, MD, FACS

Published on Jul 14, 2016

Your doctor did the right procedure. Typically, one incises the capsule (capsulotomy) rather than remove it (capsulectomy). A capsulectomy is a much more involved procedure and doesn't necessarily decrease the risk of recurrence.

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Answered by ELLIOT B. DUBOYS, MD, FACS

Your doctor did the right procedure. Typically, one incises the capsule (capsulotomy) rather than remove it (capsulectomy). A capsulectomy is a much more involved procedure and doesn't necessarily decrease the risk of recurrence.

Published on Jul 11, 2012


Barry J. Kaplan, D.O.

Published on Jun 09, 2016

Not the same; the pocket is lined by the capsule. I presume you are over the muscle or have had multiple procedures. The more aggressive the procedure, the more likely subsequent contracture. The posterior portion of the capsule need not be removed unless contracture and if so, change from over to under the muscle. The implant does not get hard. If you have hardness, try Accolate 20 mg twice daily for 3 months.

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Answered by Barry J. Kaplan, D.O.

Not the same; the pocket is lined by the capsule. I presume you are over the muscle or have had multiple procedures. The more aggressive the procedure, the more likely subsequent contracture. The posterior portion of the capsule need not be removed unless contracture and if so, change from over to under the muscle. The implant does not get hard. If you have hardness, try Accolate 20 mg twice daily for 3 months.

Published on Jul 11, 2012


Edward Domanskis M.D.

Published on Apr 28, 2016

I make my neo-pockets between the capsule and the breast tissue, rather than remove the capsule, which is more traumatic and causes more scar tissue!

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Answered by Edward Domanskis M.D.

I make my neo-pockets between the capsule and the breast tissue, rather than remove the capsule, which is more traumatic and causes more scar tissue!

Published on Jul 11, 2012


David C. Yao MD, FACS

Published on Apr 19, 2016

Thank you for asking. A new pocket can mean a total capsule removal or switching positions of the implant (i.e. subglandular to submuscular most commonly, although not always). It often means removing the whole capsule but not always. The reason it varies is that these cases are a revision breast implant and a patient's specific history will be unique to her treatment. Hope that helps. Best wishes.

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Answered by David C. Yao MD, FACS

Thank you for asking. A new pocket can mean a total capsule removal or switching positions of the implant (i.e. subglandular to submuscular most commonly, although not always). It often means removing the whole capsule but not always. The reason it varies is that these cases are a revision breast implant and a patient's specific history will be unique to her treatment. Hope that helps. Best wishes.

Published on Jul 11, 2012


Paul Wigoda M.D.

Published on Jun 17, 2015

When a surgeon says they are going to place an implant in a new pocket, it generally means going from above the pectoralis muscle, to below, or visa versa. When you remove an entire capsule, you are technically in the same pocket, but with fresh tissue surrounding the implant, not the scar/capsule surrounding the implant.

Paul Wigoda, MD
www.painlessbreastimplants.com

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Answered by Paul Wigoda M.D.

When a surgeon says they are going to place an implant in a new pocket, it generally means going from above the pectoralis muscle, to below, or visa versa. When you remove an entire capsule, you are technically in the same pocket, but with fresh tissue surrounding the implant, not the scar/capsule surrounding the implant.

Paul Wigoda, MD
www.painlessbreastimplants.com

Published on Jul 11, 2012


Andrew Trussler MD, FACS

Published on Jun 17, 2015

Early capsular contracture (cc) is typically related to a breast hematoma not picked up or drained after the initial surgery. It could also be secondary to an infectious process around the implant. If the capsule has matured and full capsulectomy would be optimal with changing out the implants to help decrease any biofilm. This is easier said then done when the implants are under the muscle which does relate to pockets. The capsule on the chest wall is usually difficult to remove and can cause more harm than good.
There are multiple pockets or planes in breast implant surgery.
Subglandular is over the muscle under the breast tissue, which is a valid option
Subfascial is over the muscle but under the lining of the muscle (fascia)and breast tissue
Subpectoral is under the pectoral muscle with a third to a half sitting under the actual muscle
Submuscular which provides complete coverage with muscle and is typically used for reconstruction.

Removing the capsule is a capsulectomy, which is different from a plane change and new pocket, however both combined with new implants may be beneficial for secondary breast augmentation.

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Answered by Andrew Trussler MD, FACS

Early capsular contracture (cc) is typically related to a breast hematoma not picked up or drained after the initial surgery. It could also be secondary to an infectious process around the implant. If the capsule has matured and full capsulectomy would be optimal with changing out the implants to help decrease any biofilm. This is easier said then done when the implants are under the muscle which does relate to pockets. The capsule on the chest wall is usually difficult to remove and can cause more harm than good.
There are multiple pockets or planes in breast implant surgery.
Subglandular is over the muscle under the breast tissue, which is a valid option
Subfascial is over the muscle but under the lining of the muscle (fascia)and breast tissue
Subpectoral is under the pectoral muscle with a third to a half sitting under the actual muscle
Submuscular which provides complete coverage with muscle and is typically used for reconstruction.

Removing the capsule is a capsulectomy, which is different from a plane change and new pocket, however both combined with new implants may be beneficial for secondary breast augmentation.

Published on Jul 11, 2012


William Hedden, M.D.

Published on Jun 16, 2015

It is not the same thing but basically gives the same over all result

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Answered by William Hedden, M.D.

It is not the same thing but basically gives the same over all result

Published on Jul 11, 2012


Bahram Ghaderi, MD, FACS

Published on Jun 16, 2015

To create a new pocket you have to remove the old one as much as possible. So, yes, it does mean removing the whole capsule. If your implant pocket is behind the muscle, some of the capsule that is adherent to the ribs may not be able to be removed, but most of it can be. I would recommend seeing your surgeon to discuss your concerns and to determine if surgery is worth the risk right now.

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Answered by Bahram Ghaderi, MD, FACS

To create a new pocket you have to remove the old one as much as possible. So, yes, it does mean removing the whole capsule. If your implant pocket is behind the muscle, some of the capsule that is adherent to the ribs may not be able to be removed, but most of it can be. I would recommend seeing your surgeon to discuss your concerns and to determine if surgery is worth the risk right now.

Published on Jul 11, 2012


Robert Kearney, MD

Published on Jun 15, 2015

When I tell my patients I am going into new pocket it means going from under to over the muscle or visa versa. Some PS define a neo pocket as a space that is in the same pocket but they have reflected the scar capsule down or up and left it in place. A capsulectomy is removing the old capsule as opposed to scoring it which simply means cutting it to expand it and leaving it in place. A capsulorrpahy is when we alter the pocket with sutures.

In short when I say new pocket I don't mean one that the capsule has been removed. Ask your PS to verify what they mean.

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Answered by Robert Kearney, MD

When I tell my patients I am going into new pocket it means going from under to over the muscle or visa versa. Some PS define a neo pocket as a space that is in the same pocket but they have reflected the scar capsule down or up and left it in place. A capsulectomy is removing the old capsule as opposed to scoring it which simply means cutting it to expand it and leaving it in place. A capsulorrpahy is when we alter the pocket with sutures.

In short when I say new pocket I don't mean one that the capsule has been removed. Ask your PS to verify what they mean.

Published on Jul 11, 2012


Gerald Minniti, M.D., F.A.C.S

Published on Jun 15, 2015

The best treatment for cc is to remove the entire capsule in one piece, and replace a new implant under the muscle. If the implant was already under, it is not recommended to put it over the muscle. Simply scoring the capsule, partially removing the capsule, and replacing the same implant leads to higher rates of recurrence. I hope this was helpful for you.
Best,
Dr. Minniti

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Answered by Gerald Minniti, M.D., F.A.C.S

The best treatment for cc is to remove the entire capsule in one piece, and replace a new implant under the muscle. If the implant was already under, it is not recommended to put it over the muscle. Simply scoring the capsule, partially removing the capsule, and replacing the same implant leads to higher rates of recurrence. I hope this was helpful for you.
Best,
Dr. Minniti

Published on Jul 11, 2012


Daniel C. Mills, M.D., F.A.C.S

Published on Jun 15, 2015

Usually a new pocket means that you're going into a virgin dissection. That usually means that if the implant was on top of the muscle you're putting it under the muscle. Or if it was under usually a new pocket means that you're going into a virgin dissection. That usually means that if the implant was on top of the muscle you're putting it under the muscle. Or if it was under the muscle you're now going to place it on top of the muscle. The key is to have a virgin space. If you are worried about any bio forms, or if it was under the muscle you're now going to place it on top of the muscle. The key is to have a virgin space. If you are worried about any bio forms would put in a new implant after doing a complete total capsulectomy.

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Answered by Daniel C. Mills, M.D., F.A.C.S

Usually a new pocket means that you're going into a virgin dissection. That usually means that if the implant was on top of the muscle you're putting it under the muscle. Or if it was under usually a new pocket means that you're going into a virgin dissection. That usually means that if the implant was on top of the muscle you're putting it under the muscle. Or if it was under the muscle you're now going to place it on top of the muscle. The key is to have a virgin space. If you are worried about any bio forms, or if it was under the muscle you're now going to place it on top of the muscle. The key is to have a virgin space. If you are worried about any bio forms would put in a new implant after doing a complete total capsulectomy.

Published on Jul 11, 2012


John J. O'Brien, Jr. M.D.

Published on Jun 15, 2015

hello, and thank you for this question. These are separate procedures. Generally we talked about removing a capsule which includes all of the scar tissue around a breast implant and relocating into another pocket whether this is above the or below the muscle.this is something you could discuss with your perspective plastic surgeon.there are also some new her options available for recurrent capsular contracture. She out a qualified board certified plastic surgeon. Best of luck.

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Answered by John J. O'Brien, Jr. M.D.

hello, and thank you for this question. These are separate procedures. Generally we talked about removing a capsule which includes all of the scar tissue around a breast implant and relocating into another pocket whether this is above the or below the muscle.this is something you could discuss with your perspective plastic surgeon.there are also some new her options available for recurrent capsular contracture. She out a qualified board certified plastic surgeon. Best of luck.

Published on Jul 11, 2012


Remus Repta M.D.

Published on Jun 15, 2015

Thank you for the question. A new pocket usually means that a new pocket is created above or below the existing pocket with the old capsule either removed or left in. In your case, for example, if your implants were initially placed above the muscle a new pocket can be created below the muscle and the old capsule removed.

All the best,
Dr. Remus Repta
Scottsdale AZ Plastic Surgery

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Answered by Remus Repta M.D.

Thank you for the question. A new pocket usually means that a new pocket is created above or below the existing pocket with the old capsule either removed or left in. In your case, for example, if your implants were initially placed above the muscle a new pocket can be created below the muscle and the old capsule removed.

All the best,
Dr. Remus Repta
Scottsdale AZ Plastic Surgery

Published on Jul 11, 2012


Otto Placik, MD

Published on Jun 15, 2015

Not necessarily. In some instances this is called a Neo pectoral pocket and can be done without removing the capsule. The implant is taken out of the old capsule and put in a new plane. An analogy would like taking something out that rests between your top sheet and bottom sheet of your bed and then placing it between your bottom sheet and mattress. if you want your capsule removed you should ask for a total capsulectomy but this may be a longer more involved procedure.

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Answered by Otto Placik, MD

Not necessarily. In some instances this is called a Neo pectoral pocket and can be done without removing the capsule. The implant is taken out of the old capsule and put in a new plane. An analogy would like taking something out that rests between your top sheet and bottom sheet of your bed and then placing it between your bottom sheet and mattress. if you want your capsule removed you should ask for a total capsulectomy but this may be a longer more involved procedure.

Published on Jul 11, 2012


Joseph M. Perlman, M.D.

Published on Jun 15, 2015

Sometimes the plastic surgeon will remove the whole pocket, but in most situations. They'll remove the dome of the capsule and keep the base. The idea is to remove as much of the capsule as you can so that the pocket is "starting fresh." Sometimes you also reposition the implant in a different tissue plane. This could be going from under breast tissue to going under the muscle or vice versa. Many times when you going to a different tissue plane creating a new pocket you leave most of the capsule intact.

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Answered by Joseph M. Perlman, M.D.

Sometimes the plastic surgeon will remove the whole pocket, but in most situations. They'll remove the dome of the capsule and keep the base. The idea is to remove as much of the capsule as you can so that the pocket is "starting fresh." Sometimes you also reposition the implant in a different tissue plane. This could be going from under breast tissue to going under the muscle or vice versa. Many times when you going to a different tissue plane creating a new pocket you leave most of the capsule intact.

Published on Jul 11, 2012


More About Doctor Christopher Pelletiere, MD

Published on Jun 15, 2015

No, a new pocket simply means changing the position of where the implant sits internally, irrespective of the scar tissue. If the implant is subglandular, it means switching to submuscular or vice versa.

However, it is rare to switch someone from submuscular to subglandular in the face of scar tissue since the rates of contracture are higher on top of the muscle as opposed to underneath. Removing scar tissue is a separate procedure. Sometimes all of the scar tissue is removed and the same pocket is used, or a new pocket is created and some of the scar tissue is let behind. There are pros and cons to each approach. I would discuss it with your plastic surgeon and see what they recommend. I hope this helps.

Answered by Christopher Pelletiere, MD (View Profile)

No, a new pocket simply means changing the position of where the implant sits internally, irrespective of the scar tissue. If the implant is subglandular, it means switching to submuscular or vice versa.

However, it is rare to switch someone from submuscular to subglandular in the face of scar tissue since the rates of contracture are higher on top of the muscle as opposed to underneath. Removing scar tissue is a separate procedure. Sometimes all of the scar tissue is removed and the same pocket is used, or a new pocket is created and some of the scar tissue is let behind. There are pros and cons to each approach. I would discuss it with your plastic surgeon and see what they recommend. I hope this helps.

Published on Jul 11, 2012


Aristocrat Plastic Surgery

Published on Jun 15, 2015

Thank you for your question. Sorry to hear you have capsular contracture. In the pocket doesn't necessarily mean removal of the entire capsule, however, removal of the entire capsule and placement of new implants is a good plan. Other considerations maybe the use of singulair, Alloderm and Perioperative Aspen external ultrasound. You would need to have a consultation for precise recommendations by a board certified plastic surgeon with expertise in revisions.

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Answered by Aristocrat Plastic Surgery

Thank you for your question. Sorry to hear you have capsular contracture. In the pocket doesn't necessarily mean removal of the entire capsule, however, removal of the entire capsule and placement of new implants is a good plan. Other considerations maybe the use of singulair, Alloderm and Perioperative Aspen external ultrasound. You would need to have a consultation for precise recommendations by a board certified plastic surgeon with expertise in revisions.

Published on Jul 11, 2012


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