En Bloc Capsulectomy
Are you considering having your breast implants removed? You are not alone. While the vast majority of patients are very happy with their breast augmentation results, occasionally things can change, whether for cosmetic reasons, because of a change in lifestyle or aesthetic preferences, or due to complications.
In this case, explantation, or breast implant removal, may be the right option. Dr. Hess’s goal with implant removal is the same as with any procedure: to achieve the patient’s desired outcome safely, while providing the most natural looking result possible. One technique he is experienced in and that more patients are asking about is en bloc capsulectomy.
What is en bloc capsulectomy?
With en bloc capsulectomy, the plastic surgeon removes the breast implant and the surrounding capsule as one single unit. To perform the procedure, the surgeon makes an incision in the inframammary fold, and then carefully separates the capsule from the surrounding tissue. The capsule is then taken out with the implant still sealed inside.
What is a capsule?
After breast augmentation, the body responds by forming a layer of scar tissue around the implant. This is the capsule. In most cases, the capsule cannot be felt or seen; it is a completely natural part of having breast implants.
Occasionally, the capsule will harden or thicken unnaturally as it forms; this is a complication called capsular contracture and occurs in about 10% of patients. Capsular contracture is treatable, either with a non-surgical method in mild cases, or breast revision surgery in other cases.
Is en bloc capsulectomy the best option for breast implant removal?
The en bloc technique for breast implant removal has gained attention lately, and some are under the impression that it is “the best” way to remove breast implants safely. In some cases, for example if the implant is ruptured or if BIA-ALCL or another serious complication is suspected, it is the most favorable option. However, the en bloc procedure is not without its own drawbacks, and Dr. Hess doesn’t recommend it for everyone. Reasons for this include:
- En bloc implant removal requires a long incision and resulting scar. Dr. Hess generally does not want to create a larger scar than necessary for a patient, unless there is a medical need or other compelling reason for doing so.
- The procedure is longer and more complex. While breast surgery and anesthesia are statistically very safe—and Dr. Hess works with some of the most qualified and experienced anesthesiologists in northern Virginia—prolonging surgery does increase some risk and can make the early days of recovery a little tougher on the patient.
- Sometimes the capsule and/or breast tissue are too delicate to perform the procedure safely.
En bloc vs. total capsulectomy: what’s the difference?
While the entire capsule is indeed removed during an en bloc capsulectomy, it is different from a total or complete capsulectomy. In the complete capsulectomy, the capsule is partially released from the breast tissue and then carefully opened to extract the breast implant. Once the implant is removed, the capsule is re-closed and removed from the breast. The advantage of a complete capsulectomy is that it requires a much shorter incision, yet the capsule and any breast implant matter are still fully removed from the body.
When is en bloc capsulectomy appropriate?
When performed by an experienced, qualified plastic surgeon, en bloc capsulectomy is a safe breast implant removal option, and there are a few circumstances for which it really is the best treatment option. If there is a known or suspected silicone implant rupture, it is much better to keep the implant sealed inside the capsule if possible. Additionally, en bloc capsulectomy is the standard implant removal procedure in the case of diagnosed or suspected cancer, including BIA-ALCL.
Contact Dr. Hess with your questions or request a personal consultation
If you are considering having your breast implants removed, it’s important to choose a board certified plastic surgeon who is experienced in multiple implant removal techniques, so you can be sure you receive the most appropriate care and a great aesthetic result. At a personal consultation, Dr. Hess will be happy to answer your questions and help you understand all of your options.