Do I Need an En Bloc Capsulectomy?

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As a board certified plastic surgeon with many years of experience removing breast implants, I consult with numerous women who hope to have their implants removed or are concerned about changes to their health. Whether your desire to have your breast implants removed is connected with breast implant illness, BIA-ALCL, an implant-related complication, or a change in aesthetic preference, I want to help you fully understand all of your options.

Explantation, or breast implant removal, is a nuanced combination of medicine and art—even when it is being done purely for health reasons—and you’ll want to be sure you’re choosing the right approach for your situation.

Recently, I have been hearing a lot of questions about breast implant removal through en bloc capsulectomy. This type of explantation is key for some women, while other patients can get similar benefits from other implant removal methods which have less associated risk.

To help you understand more and find the best breast implant removal technique for you, I’ll answer some of the most common questions here.

What does en bloc capsulectomy mean?

When breast implants are placed, your body naturally forms scar tissue around the implant. This is a normal and expected response and, because of this, all breast implants have what we call a “capsule” around them.

“En bloc” means “as a whole,” and the term “en bloc capsulectomy” refers to removing the entire, intact scar tissue capsule with the breast implant inside as one piece. To do this, the capsule must be physically separated from surrounding tissues while the breast implant is still inside of it and then carefully removed through a large incision.

En bloc capsulectomy is less common than other explantation methods but has recently become a topic of discussion online, particularly in breast implant illness forums. The phrase breast implant illness (BII) is used to describe a range of symptoms that some women with implants experience and associate with their breast implants. These women are understandably curious about the most thorough methods for having their implants removed.

What are the downsides of en bloc capsulectomy?

Because en bloc capsulectomy involves removing the capsule of scar tissue and the breast implant in one piece, it requires a larger incision and resulting scar. The surgery itself is also more complex and lengthy.

Your surgeon must carefully detach the scar capsule—which is well-attached to surrounding tissues—while limiting damage and keeping it intact. Because the implant is still inside and the surgeon has not made an incision to see into the capsule, their view is also more limited.

An en bloc capsulectomy is called for when there are risks associated with opening the capsule, such as an implant rupture. In other cases, the implant and its entire capsule can be removed with a technique called complete capsulectomy.

Furthermore, it’s also not always safe or practical to perform an en bloc capsulectomy. In cases where only a very thin layer of scar tissue formed around the implant or the capsule is closely fused to the chest muscle, for instance, attempting to remove the capsule intact can create more problems.

As such, en bloc capsulectomy is usually only called for in very specific circumstances, such as patients with BIA-ALCL or those with a ruptured implant. For other patients, it is unnecessary because we can still remove the implant and its entire capsule with a “complete capsulectomy” implant removal procedure.

Complete Capsulectomy vs En Bloc Capsulectomy

When patients express concern about removing all tissue that has been in direct contact with their implants, I typically recommend a complete capsulectomy. (In fact, I recommend this method for all of my breast implant removal patients.) This approach results in both the implant and capsule being completely removed from your body, in one operation—just not in one piece.

With this technique, I lift the tissues off of the capsule up to the midway point and then make a small incision in the capsule through which I remove the intact implant. Next, I clamp the capsule closed and remove it. This allows the capsule of scar tissue to collapse slightly so I do not have to make such a large incision.

When is an en bloc capsulectomy needed?

An en bloc capsulectomy is most appropriate when a silicone implant rupture has occurred so as to avoid the contents of the implant leaking into other parts of the body. Similarly, in cases of BIA-ALCL, a non-Hodgkins lymphoma that has been associated with breast implants, the capsule should be removed en bloc to ensure the cancerous cells are no longer in the body.

Outside of these two instances where there is a risk in opening the capsule, an en bloc capsulectomy is usually unnecessary and a complete capsulectomy is a better, safer choice.

Will breast implant removal get rid of my breast implant illness (BII) symptoms?

For some women, removing their implants has resolved symptoms, and for others it hasn’t—but even in the cases where symptoms persist, implant removal often provides increased peace of mind. That’s why I fully support patients looking into breast implant removal for health reasons.

That said, even experienced, supportive surgeons can not guarantee that implant removal will cure an individual’s BII symptoms. Breast implant illness is a general term and, though research is ongoing, it has not been proven that having breast implants leads to generalized illness or that removing implants will cure any systemic symptoms.

Therefore, breast implant removal is ultimately performed to see if breast implants are a factor in your symptoms. After surgery, you’ll know more. You may feel better after having your breast implants removed, or you may continue to experience symptoms.

If you have an underlying condition not associated with your breast implants, surgery could have added risks. It is crucial to have a broad understanding of your current health status before surgery.

Before proceeding with implant removal due to health concerns, it’s critical to have other conditions ruled out. This will ensure you get the right kind of medical attention and treatment. The most common symptoms experienced by those concerned they have breast implant illness overlap with symptoms of other inflammatory or autoimmune diseases, including multiple sclerosis (MS) and Lyme Disease, and ruling those out is an important first step.

How do I rule out other conditions? Why is it important to do that?

Ruling out other conditions before breast implant removal involves being tested for other inflammatory diseases, getting full work-ups, and determining if you have markers for conditions that are proven to cause the symptoms you are experiencing. Ultimately, this is to protect you on multiple fronts:

  1. A proper diagnosis is needed to receive the best course of medical treatment and increase your chances of relieving your symptoms.
  2. Breast implant removal surgery is expensive and not typically covered by insurance.
  3. If you do have an underlying condition not associated with your breast implants, surgery could have added risks. It is crucial to have a broad understanding of your current health status before any surgery.
  4. If you prefer the way your breasts look with implants and your primary goal is to reduce unexplained health symptoms, it makes sense to rule out other possibilities before changing your appearance.

During my breast implant removal consultations, I go over all of these details with each patient and together we determine what the best course of action will be for both their health and happiness.

Ultimately, who you choose is more important than what you choose

My primary concern with the conversation around en bloc capsulectomy is that some patients are now focusing on finding surgeons who offer this technique rather than seeking plastic surgeons who are willing to explain all of your implant removal options.

While of course you need to choose a surgeon certified by the American Board of Plastic Surgery with extensive experience in implant removal, I urge you to keep an open mind when going into each consultation. If you have only one goal in mind—an en bloc capsulectomy—and the doctor makes a different recommendation, you may miss out on an option that is a better match for your concerns and goals.

As a board certified plastic surgeon in Fairfax, VA, I have worked with many women over the years removing breast implants. You’ll find that I am a good listener, ready to answer all questions, and I will fully detail out your options. My philosophy is patient-first care, and your treatment plan will be tailored to your unique circumstances.

If you no longer want your breast implants or have health concerns related to them, I encourage you to contact my office to schedule a consultation.