Is the en bloc method of removal best for 18-year old implants?

The en bloc method includes removing the capsule or scar tissue around the implant along with the implant.  This is not necessary in all cases.  If the capsule is thick or calcified it should be removed or if you think you have silicone toxicity.  It is more complicated to do an enbloc removal and the necessity depends on your particular situation.

Typically the surgeon should decide whether the capsule should be removed en bloc at the time of the surgery, depending on the appearance of the capsule.

Good day! For your guidance, this type of procedure will enable the surgeon to remove as much silicone as reasonable without creating significant deformity. However, this operation may require a larger incision and longer surgery and recovery time. General anesthesia is usually necessary and subsequently all of the costs associated with this operation will be higher. Do not hesitate to ask your doctor if this is the right route for you and discuss realistic goals and expectations. Best of luck! #RealSelf100

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contractureis seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc). Without knowing your issues andwithout an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with yourplastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

The capsule is your body's response to your implants. It may contain silicone gel, silicone shell fragments, bacteria, calcification, and inflammatory cells which have been mobilized by your immune system to react to different components of the implant. Research has shown that the capsule does not disappear on its own when only the implant has been removed (See Nancy Hardt's paper in Plastic and Reconstructive Surgery.) In addition, if you have pain around the implants, it is usually due to the pulling effect of the scar on surrounding muscle and tissue. If you have health problems that could be from the presence of the implants, removal of the capsule is critical in improving your health.