for breast implant explant there is a proceedure called enbloc, which removes tissues around the implant as well, it makes sure there is no scar tissue etc. is how i understand it to be the gold star way to remove them?
I Have Heard That Enbloc is the Way to Go? Anyone Have This Proceedure?
Doctor Answers (10)
En bloc removal of silicone and capsule in breast surgery
It is possible to remove the silicone shell, ruptured implant and scar tissue in one piece, or en bloc.
This is a relatively easy procedure for most board certified plastic surgeons to perform.
The incision for en bloc removal is a bit longer since after all the entire old implant plus scar tissue must be removed through that incision.
Enbloc Implant and Capsule Removal
Capsular contracture which is one of the most common complications of breast implants can be a frustrating result. Many different methods of dealing with contracture has been described. It is widely accepted today that the best method to treat an established contracture is to remove the implant and the capsule around it. This is perhaps what is being called an "en bloc" removal. Furthermore replacement with a new implant is another important element of success. So, a simple opening of the capsule is not sufficient and often leads to recurrence. This "en bloc" removal is the ideal method. Best wishes.
It's Not the Gold Standard
If your surgery is being done for treatment of capsular contracture or a leaking silicone implant, an "en bloc" resection is usually not the best choice. It involves total removal of the capsule and implant which increases the risk of postoperative bleeding which leads to a higher risk of capsular contracture. A partial removal of the capsule with the implant, or removal of the implant combined with placement of a new implant in a different location, usually works better.
Some patients are convinced that they are having an immunologic response to the implants and reason that the implant and everything that is contact with it must be removed for the optimal treatment. Discuss this with your plastic surgeon, but this may be a good reason to choose the "en bloc" resection.
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Breast implant removal may require removal of the capsule
When silicone gel breast implants are in place for a very long time, a leak into the capsule can cause a contracture and calcification of the capsule. When this happens, it is necessary to remove the capsule completely with the old implant to give a fresh start for the new implant. Some will call this 'enbloc' a rather fancy term for 'in one piece'. The capsule and implant are removed together. This is not a gold standard or only way to go, as often the capsule can be left and a new pocket created behind the old if the old has not thickened and calcified.
Best of luck,
Using a sledgehammer when a flyswatter will suffice: enbloc vs neopectoral pocket
Using a sledgehammer when a flyswatter will suffice is not always a good idea even if it accomplishes the job. IF you have an intact silicone implant with a capsular contracture, a neopectoral pocket is a perfectly reasonable alternative without radical and unnecesary resection of the capsule, surrouding breast tissue, muscle, etc which could result in an increased risk of secondary problems. There are no data to suggest the superiority of this technique in uncomplicated cases of silicone implant augmentation.
The enbloc technique is really more for cancer resection to remove all the tumor and some surrounding normal tissue. This prevent tumors cells from going into healthy tissue. What I think you are talking about is a total capsulectomy which is removal the all the capsule with the implant still in it. The reason this is done is to try to avoid silicone from going into the tissue if the implant is ruptured. It does NOT cause any disease, but is messy to deal with. If you have saline implants this is not even a consideration. Sometimes when the implant is under the musscle it is more difficult to remove the entire capsule and only a portion of it is removed.
After capsulectomy most patients opt to have re-augmentation with saline or silicone implants in a new position or they may have a lift. Good luck, Dr. Schuster from Boca Raton.
En bloc capsule removal
Nothing new here but usually not practical. Even with ruptured gel implants, the only way to do an en bloc removal is with a pretty long scar.
Removal of implant plus capsule is called "en bloc"
The term "en bloc" refers to any surgical procedure where something is removed in one piece. If there is a problem with the implant that has affected the scar capsule then it is a good idea. It's not anything unique, just a matter of terminology. The more important question is what to do if new implants are to be put in, since en bloc removal leaves less of your own tissue to cover and support the new implant. This is something you should discuss with your plastic surgeon.
Implant and capusle removal
Removing the capsule and implant as one unit is often attempted when a silicone implant has ruptured but the contents have leaked and stayed within the capsule.
Removal of Breast Implants
When removing breast implants, if there is an easily removed capsule, my preference is to remove it (open capsulectomy). If the capsule surrounds ruptured gel implants and harbors silicone, indications for capsulectomy are more exigent. Dr. Pat Maxwell of Nashville has popularized a procedure for implant removal and replacement in a new pocket without capsulectomy, and in my experience, this is another good approach. In any case, if the capsule or a very large part of the capsule cannot be removed or is not removed with the implant, post surgical drainage to prevent seroma originating from the capsule should be strongly considered, in my opinion.