Capsulotomy
Removal of Breast Implant Capsule

A capsulotomy is a surgical procedure to remove the connective tissue capsule that naturally forms around the implant after any breast implant surgery. In most cases, this capsule remains soft, thin, and completely asymptomatic—it is a normal part of the body’s natural healing process. However, in some patients, this tissue thickens and hardens, contracts, and can cause pain, changes in shape, or a sensation of a foreign body. This condition is known as capsular fibrosis—and a capsulotomy is often the safest and most effective long-term solution.

I am Dr. Juliane Bodo, a board-certified specialist in plastic and aesthetic surgery at my licensed private clinic in Berlin-Charlottenburg, just a few minutes’ walk from Kurfürstendamm. I perform capsulectomies with the utmost surgical precision—including the technically demanding en-bloc capsulectomy, in which the implant and capsule are removed in one piece without opening the capsule wall.

What is a capsulotomy—and when is it necessary?

Every time a foreign object is introduced into the human body, the immune system forms a protective layer of connective tissue around it—known as the periprosthetic capsule. This always happens with breast implants; it is biologically normal and initially desirable because the capsule stabilizes the implant.

Problems arise when this capsule thickens, calcifies, or contracts. This condition—capsular fibrosis—is classified into four severity levels according to the Baker classification system:

• Baker I: Soft capsule, implant not palpable—no treatment necessary
• Baker II: Slight hardening is noticeable; the breast still looks normal
• Baker III: Significant hardening, visible change in shape—surgical treatment recommended
• Baker IV: Severe swelling accompanied by pain and tenderness—surgical treatment is strongly recommended

Other reasons for a capsulotomy may include: implant rupture (tearing of the silicone shell), the desire to replace or remove the implant, infections, asymmetry, the so-called Breast Implant Illness (BII) syndrome, and the rare but serious condition known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

A capsulotomy is not a substitute for a gynecological or oncological evaluation. During the consultation, I will carefully evaluate your findings—if necessary, in conjunction with imaging results such as ultrasound or MRI.

En-bloc capsulotomy—what is it all about?

En-bloc capsulotomy is considered the most complex and precise form of capsulotomy. In this procedure, the implant and the surrounding capsule are removed from the body as a single unit without opening the capsule wall. There is no contact between the contents of the capsule and the surrounding tissue.

I choose this method especially when:

• there is a ruptured or leaking implant (silicone gel leak)
• there is a reasonable suspicion of BIA-ALCL—in this case, en-bloc capsulectomy is the standard procedure recommended by medical societies
• the patient wishes to have all implant remnants and fibrous tissue completely removed
• Symptoms that are described by the term "Breast Implant Illness" (BII) are present

En-bloc capsulotomy places high demands on the surgeon: The capsular tissue must be precisely and completely removed without perforating the capsular wall. I perform this procedure and will discuss in detail beforehand whether this technique is medically indicated and anatomically feasible in your case.

Note on BIA-ALCL

Breast implant-associated anaplastic large cell lymphoma is a rare but treatable disease of the lymphatic system that is closely associated with textured breast implants. If the diagnosis is confirmed or suspected, complete en-bloc capsulotomy is the recommended surgical treatment. If you notice symptoms such as persistent swelling, pain, or a new effusion around an implant, please contact me or your gynecologist immediately.

How is a capsulotomy performed?

For me, every capsulotomy begins with a detailed consultation. I analyze your symptoms, discuss your medical history, and determine which technique is best for you.

Generally speaking, I distinguish between three approaches:

Total Capsulotomy

Complete removal of the entire capsule—recommended in cases of severe capsular fibrosis (Baker III/IV), implant rupture, and BIA-ALCL

En-bloc capsulotomy

Removal of the implant and capsule as a single unit without opening the capsule—maximum precision, especially in cases of BIA-ALCL and rupture

Partial capsulotomy

Only in justified exceptional cases where complete removal is anatomically impossible—for example, when the pleural capsule is very thin

The procedure is performed under general anesthesia and lasts approximately 1.5 to 2.5 hours, depending on the findings and the technique used. An overnight stay at my private clinic is recommended—my team will be there for you around the clock during the initial postoperative phase.

The incision is made primarily in the inframammary fold—this approach is particularly gentle on the tissue, and the glandular tissue remains largely unaffected.

Capsulotomy with or without new implants?

After a capsulotomy, you have several options:

• Implant Removal Without Replacement: Many patients choose to forgo implants entirely. Depending on the initial situation, a concurrent breast lift can optimize the aesthetic result.
• Implant Replacement: If you would like new implants—a different model, size, or position—the new implants can be placed during the same procedure or in a second surgery.
• Breast augmentation with autologous fat: As a natural alternative to new implants, the body's own fat can be used to correct volume and shape.

Risks & Potential Complications

As with any surgical procedure, there are risks associated with capsulotomy that I will discuss with you in full:

• Postoperative Bleeding & Wound Healing Disorders: Rare, minimized through careful technique and postoperative care
• Infections: Very rare when performed under sterile conditions
• Injury to surrounding structures: With en-bloc capsulotomy, there is a technical risk of injuring the capsular wall—I work with the utmost precision to avoid this.
• Changes in Breast Shape: After implant removal without replacement, the breast may appear saggy—a breast lift can correct this
• Numbness: Temporary changes in sensation usually return to normal after a few months
• BIA-ALCL: If this diagnosis is confirmed, comprehensive oncological follow-up care is necessary—I will coordinate this in collaboration with your treating physicians
• General surgical risks: thrombosis, anesthesia reactions – will be discussed during the informed consent consultation

Consulting & Personal Analysis in Berlin-Charlottenburg

During my approximately 60-minute consultation at Schlüterstraße 40, I’ll take the time your situation deserves—with no obligation to undergo treatment:

• Analysis of your symptoms, your implant history, and your previous medical findings
• Evaluation of the findings and recommendation of the appropriate technique
• Information on Options, Risks, and Alternatives
• Discussing Your Options After Capsulotomy—With or Without New Implants
• A personalized cost estimate based on your medical findings

My team and I will be with you every step of the way, from your first question through to complete follow-up care.

Cost of Capsulotomy in Berlin

• Outpatient capsulotomy: starting at €7,500 plus anesthesia costs
• In-hospital en-bloc capsulotomy: starting at €12,000

The exact costs depend on the diagnosis, the chosen technique, and the amount of work involved in each individual case. You will receive a transparent breakdown of costs during a personal consultation.

If you are experiencing discomfort following breast implant surgery or have questions about capsulotomy, I invite you to schedule a no-obligation consultation at my clinic in Berlin-Charlottenburg.