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  • Breast Implant Capsular Contracture: The Doctor Explains the En Bloc Technique (GRAPHIC)
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Dr. Lu-Jean Feng: Hello. I'm Dr. Lu-Jean Feng, from Cleveland, Ohio. The video you're about to see is about the implant en bloc removal procedure. I've been doing this implant removal for over 20 years, to help women with health problems associated with it. This is a story of a woman who has undergone this procedure and I'm truly grateful for her willingness to share her story with you. Today, I'm operating on a patient named Cindy who is having a lot of health problems relating to her breast implants. She's currently 40-years-old. She had her first augmentation in 1999 using a saline implant.

Then in 2007, because of malposition and the implant felt hard the implants were switched. She started having symptoms and her symptoms are as follows. She developed some contracture on the right side, then she had this intractable pain that goes down the center of her right arm, as well as into the right hip and down the center of the right thigh. This pain was evaluated by a neurology, by other specialty with multiple imaging to determine the cause of it. She had no MS. She had no other connective tissue disease, so there was no diagnosis and she was just placed Lyrica to control her pain.

I have seen patients like this as a result of a change in the implant or as a result of a certain type of implant. So all of the connective disease objective findings are ruled out, and so, we're left with a woman with intractable pain relating to the right side of the breast, and I hope today that we can help her. So now we will proceed to the operating room. The first thing I'll be doing is a intercostal block for the breast. It is putting a long-acting local in the interspaces, T2 to T7. We're done with the lateral medial intercostal blocks. Now we'll make an incision.

We'll use the original inframammary incision and extend it a little bit, so that we can see and clearly define where the capsule is located. We made a nine-centimeter incision which is a little bit longer than her original incision and encountered the capsule. The capsule is actually a combination of the previous saline implant and the present gel implant. There was a lot of fluid in the capsule which tells me that the implant has a textured surface. So we're ready to deliver this capsule with the implant held within.

As you can see the capsule is very tightly bound to the tissue indicating contracture. Part of the implant is over the muscle, part of the implant is under the muscle. Now I'm separating the implant from the muscle. The texture of all this major muscle is very fibrotic. This is so-called en bloc technique because we're keeping the implant and the capsule together. You can see we're almost done. Here is the implant. This is the capsule. Inside is the implant. We will have to repair the muscle here. The interior portion of the pectoralis major has been disinserted.

We usually take a picture of the specimen. It is a textured surface, gel implant. It's the same implant, 320 cc, textured anatomical shaped implant. We always like to identify the implant. Some of the implants have the lot numbers on them. We always examine the capsule. The capsule is very thick on both sides and very tight around this implant. We generally photograph everything that we remove from the patient. After the implants are removed, I always look for potential deformities. One of the deformities that can easily be created is when the implanting surgeon disinserts the muscle.

And in that case, by repairing the muscle it will restore better contour, which is what we will do right now. Underneath the breast we see the muscles is disinserted which may be partly responsible for the dent that we see. But we also see underneath the capsule... Excuse me, underneath the muscle there is another capsule here, from the previous implant which this blue forcep is holding. We will also proceed to remove this. Here we have excised the residual capsule from the previous saline implant, which you can tell, the capsule is very thick and very contracted.

That's why the patient had the second implant put in. We will send that to pathology as well. Before this breast had a dent here, and somewhat of a dent here, like in here. In order to correct this we did some breast parenchymal repair with sutures, so that the breast tissue is repaired together in areas of the dent, in order to remove the dent. So now she looks much better and we're going to take a photograph. The suction makes it look worse. However, we need to suction in order to heal the wound, the raw surface area inside.

Once we take out the drain, the breast will fluff to that original shape. So not only is it important to take out completely all of the capsules, but also, we need to restore the breast and make the breast as normal as possible.

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Breast Implant Capsular Contracture: The Doctor Explains the En Bloc Technique (GRAPHIC)

This 40-year-old woman has had a number of health problems with her breast implants. See how Dr. Lu-Jean Feng helps her heal.