Implant Removal Should Include Scar Tissue.

• Position: Breast implant removal

While thousands of women have breast implants removed each year, there is little information on whether to remove the scar tissue that forms around them. According to V. Leroy Young, professor of plastic and reconstructive surgery, Washington University School of Medicine in St. Louis (Mo.), the body reacts to implants by walling them off in a sac of scar tissue called a capsule, which sometimes becomes as hard as an eggshell. "Most of the time, we recommend that the capsule should come out as well, though there are certain circumstances where it does not need to be removed or only a portion can be removed."

About 1,000,000 American women have breast implants, most of which are filled with silicone gel. The usual reasons for removing or replacing them are implant rupture or contraction of the capsule, which can shrink over time, making the breast round and hard. Less common reasons are infection of the breast, fear of autoimmune reactions to silicone, or the desire to change to another size of implants or eliminate them completely.

As well as taking out the implant, the surgeon may cut away the capsule, leaving only breast tissue. This procedure, capsulectomy, requires a larger incision and adds about $1,000 to the total cost. Young says capsulectomy should accompany implant removal when:

* The implant won't be replaced, since capsules left in place may appear as abnormal masses on mammograms.

* The new implant will occupy a different position with...