Breast Capsulectomy 

Breast Capsulectomy SurgeryBreast augmentation cosmetic surgery involves insertion of saline or silicone implants in the breast tissue to enhance the size of breasts. However, sometimes a capsule formation may occur around the implants. These capsules can become thick and hard, causing the implants to squeeze and resulting in distorted breast appearance. Capsule formation may also lead to implant damage with the breast tissue.

This condition can be address with breast capsulectomy surgery. The procedure may be performed on one or both breasts, depending on the capsule position and the amount of irritation it may be causing. The procedure is also called full implant capsule removal. Dr. Paul Fortes is an experienced plastic surgeon providing breast capsulectomy surgery to patients in Katy, Houston, TX, and surrounding areas.

Causes of Capsule Formation

Following breast augmentation plastic surgery, the body’s natural immune response leads to the formation of a thick barrier of scar tissue, which is called a capsule. This capsule envelopes the implant. The thickness and size of the capsule can vary from one patient to another.

The capsule normally does not pose any problem, except in some cases, where it can become excessively tight or thick around the implant. The cosmetic surgeon will remove the capsule partially or entirely as a part of capsulectomy. The breast implant is then re-inserted into the breast pocket or replaced with a new one. Dr. Fortes receives patients from Katy, Houston, TX for capsulectomy.

Types of Capsular Contracture

Capsular contracture can be categorized into four types on the basis of a ‘Baker’ grading as follows:

  • Grade 1 – the breast appears soft and natural looking
  • Grade 1 – the breast appears normal but slightly firm
  • Grade 3 – the breast looks abnormal and firm to touch
  • Grade 4 – the breast is hard, rigid, and looks abnormal

Patients who experience any discomfort at any stage after breast implant surgery or a notice a change in the look and feel of the breast should immediately contact a breast capsulectomy surgeon.


Breast capsulectomy is performed as an open surgery, which means that the plastic surgeon will cut through the scar tissue. This will open up the capsule and remove the breast implant. This technique is preferred over the closed surgery procedure that would involve squeezing the implant to break open the scar tissue. Risk of implant damage is high in that old technique.

The surgeon may adopt total capsulectomy or sub-total capsulectomy technique. In the total capsulectomy approach, the complete capsule is removed and the breast implant replacement is performed. In the sub-total capsulectomy, the capsule is only partially removed, provided the implant has not shifted or broken. In any case, the breast implant gets removed in most situations. The entire procedure can be completed in about two to three hours.


Breast capsulectomy is typically a more complex procedure than primary breast augmentation. The recovery process will be similar or slightly longer for most patients. Initial pain can be managed with prescribed pain medications. The patient can expect to return to normal work in about 10 to 14 days.

For more information about the cosmetic surgery treatments and procedures performed by Houston | Katy TX Plastic Surgeon Dr. Paul F. Fortes please click here or call 713-489-7996.

Breast Implant Replacement

Breast Implant Replacement SurgeryBreast augmentation ranks as the second most sought after cosmetic surgery procedure in the US after liposuction. Success rates of the procedure are very high, but in a few cases, problems with the breast implants may still occur at any stage after the surgery. Implant ripping, moving of the implant to a wrong position, the implant losing its original shape, and capsular contracture are some of the key problems that can take place.

The plastic surgeon may recommend breast implant replacement surgery as the appropriate procedure to correct such problems. In some cases, the patient may require implant replacement simply due to change in aesthetic preferences. Dr. Paul Fortes is a pre-eminent breast surgeon providing breast implant replacement and other procedures to patients in Katy, Houston, TX, and surrounding areas.

How Long Do Breast Implants Last?

Even if the breast implant does not develop any problem, but the shelf life of an implant is normally limited to 12 to 18 years, depending on the quality. Patients should ideally get their implants checked after 10 years. Most patients who are keen to retain their enhanced breast size may have to be prepared for an implant replacement surgery in about 12 to 18 years.

Implant Replacement Surgery

Breast implant replacement plastic surgery is usually performed with the patient under general anesthesia or via intravenous sedation. The procedure begins with the surgeon placing an incision in the natural crease below the breast or around the areola. Through the incision, the surgeon will cut open the protective breast capsule and take out the implant from its pocket.

Silicone gel implant will be removed carefully with its gel core intact. In case of saline implant, the cosmetic surgeon may deflate it prior to removal. Following the removal, a new replacement implant will be inserted. Dr. Fortes receives patients from Katy, Houston, TX, and nearby areas for breast replacement and other procedures.

Once the new implants have been placed and adjusted into their desired position, the surgeon will close the incisions with removable or dissolvable sutures. The procedure may be performed on an outpatient basis, but in some cases the patient may have to stay overnight at the surgical facility. This will depend on the risks and complications involved in a particular case.


Breast implant replacement surgery is considered to be a safe surgery with predictable outcomes as long as it is performed by a qualified and experienced surgeon. Risks involved in this procedure are similar to any surgery, which will include infection, adverse anesthesia reaction, bleeding, numbness in the nipple area, blood clotting, or poor healing.

Recovery and Results

The patient is likely to experience only mild pain or discomfort during the initial week after the surgery. The surgeon may prescribe a pain relieving medication for a few days. Most patients will take about 10 to 14 days to recover well, and return to their work or regular activities.

Results can be successful and satisfying in most cases, subject to the condition that the patient has chosen the right surgeon for the procedure, and the patient has realistic expectations.

For more information about the cosmetic surgery treatments and procedures performed by Houston | Katy TX Plastic Surgeon Dr. Paul F. Fortes please click here or call 713-489-7996.

Fat Grafting 

Breast augmentation is a cosmetic surgery procedure involving surgical insertion of saline or silicone implants to increase the size of breasts. Advanced surgical techniques and improved qualities of FDA-approved implants over the years have made the procedure safer and more predictable. However, problems with implants may still occur sometimes at any stage after the procedure.

One of the common problems may be implant rippling, which can adversely impact the breast appearance. An innovative surgical technique to address this condition in a less invasive manner is fat grafting. Dr. Paul Fortes is an experienced plastic surgeon providing fat grafting and other procedures to patients in Katy, Houston, TX and surrounding communities.


Causes of Rippling

If the patient chooses implants that may be disproportionately large for her breast anatomy, or if the cosmetic surgeon makes an error of judgment by recommend oversized implants, it can result in over-stretching of the breast tissue. Rippling is likely to occur if the available breast tissue is insufficient for covering the breast implant.

Breast revision or replacement surgery is the most obvious way to correct implant rippling, but that procedure is complex and costly. Fat grafting is a simpler, safer, and a more affordable alternative to address the condition of implant rippling. Grafting will provide more coverage and volume to the existing implant. It will not fix the rippling problem, but make it considerably less conspicuous.

Targeted Results

One of the benefits with fat grafting plastic surgery technique is the highly targeted results it can achieve. Extra fat can be placed in a very precise location to achieve the desired amount of coverage optimally. Harvested fat cells can be placed in the targeted areas to enhance fullness and shape. For thinly-shaped women, fat grafting offers substantial benefits in case of rippling.

The surgeon can build a kind of padding over the rippled breast implants. This will cause the thickening of the breast tissue. Upper pole of the breasts will be volumized, giving more coverage to the underlying implants. Asymmetrical breasts can also be improved with fat grafting. Dr. Fortes receives patients from Katy, Houston, TX and nearby areas for fat grafting.

Surgeon’s Expertise

While fat grafting can seem to be a fairly simple procedure on the surface, but it actually involves a sensitive technique and should be performed only by a surgeon with high skills and experience. Consistency of results is a challenge, and only an experienced surgeon would be able to achieve that in fat grafting. Every stage of the procedure, starting from fat harvesting to purification to grafting, will influence the final results.

One of the key challenges with fat grafting is that some amount of fat loss is bound to occur during the fat harvesting stage. It depends on the expertise of a surgeon to minimize the loss of this precious body fat. When the fat loss is minimal, it not only preserves the patient’s health and safety in a better way, but also may help to reduce the number of grafts. An expert surgeon will normally ensure that at least 70 to 90% of the injected fat survives.

For more information about the cosmetic surgery treatments and procedures performed by Houston | Katy TX Plastic Surgeon Dr. Paul F. Fortes please click here or call 713-489-7996.