The periprosthetic mammary capsule is a fibrotic scar or shell formed by patient's tissues around the breast implant like around any other kind of foreign body, to insulate and fix it; this capsule is an unique mold matching exactly one and not other implant's shape and size and sets an unique location as well; additionally and due to the chronic action of the immune system cells the capsule contains micro amounts of silicone inside such cells, beside other elements like calcifications, cysts, etc; finally to mention that once the original implant is torn apart from its capsule the new prosthesis will be unable to form adhesion to the previously existing capsule, leading therefore to chronic seroma and malpositioning issues.
Due to all the former it is absolutely mandatory performing a total or subtotal periprosthetic capsule removal in every and each breast implant renewal so that the new prosthesis is hosted in a raw, clean, well vascularized bed within which a new and again unique capsule will be formed around the implant by perfect molding, and also in most cases of complicated breast implants removal to prevent further issues like seroma, infection, etc.
Such important capsulectomy is not feasible through approaches to the breast pocket other than areolar incisions, that is the reason why the latter is the mandatory access in these cases.
Breast implants may require periprosthetic capsule removal due to renewal, explantation, capsular contracture, rupture, malpositioning, plane conversion, etc.