GRRRR, beat me by a few minutes. Interesting the hollow did it's best Alien impersonation and infiltrated her body? Good ole Urahara freaking knows everything, his knowledge knows no limits. Chapter seemed to fly by though.
"I got rid of my teeth at a young age because... I'm straight. Teeth are for gay people. That's why fairies come and get them. "
Aqua Team Hunger Force
So may be Makoto did not give up her place among Quincy royalty but was thrown out because of contamination by whatever Aizen used for experiments. And if the process of healing her took out Isshin's power this would explain his absence from Soul Society, his friendship with Ishida's dad, and his lack of regret about her death at the hands of Grand Fisher - he did all he could to save her and had no powers left at the moment.