Is EnBloc really necessary if you don't have BIA ALCL?

Hello, Dr. Chao here, thank you for your question.
So when choosing to perform an enbloc procedure compared to a capsulectomy procedure, the Physician and patient should sit down and discuss this in detail based off of the patients concerns.
Implant Removal With Capsulectomy:
This procedure consists of removing the breast implant, as well as removing the capsule surrounding the implant. This procedure can be a partial capsulectomy or total capsulectomy. A total capsulectomy involves removing the entire breast capsule from around the implant. A partial capsulectomy involves removing only part of the capsule. Since the capsule does not disappear on its own after the implant is removed, some patients opt to proceed with a capsulectomy. Sometimes during a partial capsulectomy when the entire capsule cannot be removed for whatever reason, the remaining capsule will be cauterized to sterilize the area and promote healing.
Implant removal with capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient’s rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.
Implant Removal En Bloc:
En Bloc breast implant removal refers to a procedure where the breast implant and the surrounding capsule is removed as a single unit. The procedures is performed such that the contents within the breast implant capsule do not come into contact with the surrounding tissues. Generally, the procedure requires a longer incision (6-7 centimeter) usually in the inframammary fold, in my experience. The procedure is more successful when capsules are thickened as opposed to when patients have very thin (normal) capsules. Also, sometimes complete capsulectomy is not safely possible; for example, breast implants placed in the sub muscular position may have a capsule that can be densely adherent to the patient’s rib cage. Removal of this posterior capsule can be potentially dangerous.
Generally speaking, unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about “medical conditions” related to the breast implants, capsulectomy is not universally necessary. For these patients, En Bloc removal of breast implants is a good procedure.
Thank you for your time,
James J. Chao, MD. FACS

EnBloc approach is where the implant and capsule are removed as one unit. As you mentioned this is indicated when implants are ruptured to minimize risk of leakage of implant contents to surrounding tissues, and in certain other situations. If you are not wanting this approach and your surgeon is suggesting it I encourage you to discuss your concerns. It is important to feel confident and comfortable in your surgical plan as you prepare for surgery.

With old gel implants, before 1992, I recommend removing them with the capsule as one unit if possible to minimize the gel leaking into surrounding tissue. For women who have developed a think capsule with other implants, I also recommend removing the capsule completely with the implant since there might be some bacteria involved. For women who want their textured implants removed and don't have thick capsules, the capsule can also be removed completely.