These two procedures are done when there is a serious degree of capsular contracture. Here I try to explain the treatment of this condition in a simplified manner.
Type 4, most severe contracture : A capsulectomy is necessary when the capsule is sick : this is when the capsule is thick and calcified. In that case it has to be removed. A sick capsule has to be removed because it may contain bacteria, and this may lead to new capsule formation. A thick capsule behaves like a foreign body, and should thereforebe removed. As this may lead to more bleeding than usually, a drain is left behind, which will be removed the next day or after 2 days. The risk for bleeding is 5 % , compared to 1 % for standard procedures.
Type 3 capsular contracture : the treatment here is Capsulotomy : is done when the capsule is not very thick, but when the implant is squeezed together by the capsule, causing pain and hardness. Through an inframmary incision (= in the breast fold) the implant is removed, and then the capsule is incised so that the implant gets more space. Then the overlying muscle or breast gland is stretched till the implant is sitting comfortably.
At that time the same implant can be re-inserted, or new implants (smaller, larger or same size) can be inserted in case the original implants are old or ruptured.
The wound is closed as usually, in 3 layers.