Removing breast implants and leaving them out is a big deal. It may leave the breasts deformed. On the other hand, science has proven that the implants are not linked to systemic illnesses. I do acknowledge (and have on this site before), that despite this, some women seem to experience improvement in happiness and health after removal of implants- I have seen this, but it is very rare.
In my practice, I tell patients exactly the same thing. If they want the implants out, I am happy to do it, as long as they understand that they may get no relief, and they may get deformed breasts. In such cases, I always do a capsulectomy (what you call en bloc).
I would also add, I haven't had much demand for explant with capsulectomy since the silicone implant scare in 1992.
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