En Bloc Breast Implant Removal?

I have 18 year old breast implants placed behind the muscle wall. I want the implants removed. I do not want replacement of implants. Is the en bloc method of removal best for my case?

Doctor Answers 10

En Bloc Breast Implant Removal?

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Thank you for the good question.  Generally speaking,  if the breasts and the underlying  breast implants feel soft (to deep palpation) and the breast implants seem to move freely (not fixed for firm), then it is very likely that the capsules are thin/normal. 

 Some general thoughts regarding this issue may be helpful to you: generally speaking (in my opinion), 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 block removal of breast implants is a good procedure.

On the contrary, capsulectomy can expose you to additional risks, such as bleeding and minimal size loss.  In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity).

 Recently I have  become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy  is always necessary and undergo unnecessary surgery  associated with additional morbidity and unnecessary expenses.

 I hope this, and the attached link, helps. Best wishes for an outcome that you will be very pleased with.

En Bloc Technique

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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. 

En bloc implant removal?

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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 contracture
is 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 and
without 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 your
plastic surgeon who will assist you in determining the right modality 
for you. Hope that this helps! Best wishes!

Breast implant removal

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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.

Depends on the capsule thickness

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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.

En Bloc removal

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En bloc removal of the implant and scar capsule is important for older silicone implants and any textured implant that is adherent to the capsule.

En bloc removal of breast implants

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En bloc removal can be an easy procedure or an exceptionally complex procedure that may make if very difficult and nearly impossible to remove the entire capsule. This is especially true where the implants have been placed under the muscle and the posterior wall is adherent and contiguous with the ribs.

Implant removal

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 If after 18 years you no longer want your implants, they certainly can be removed.  En bloc removal is questionable.  Removing the implants with or without the surrounding capsule is usually recommended.

I don't perform en bloc removal in most cases

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If the implants are ruptured silicone gel, with evidence on MRI that the gel has moved beyond the capsule, then there may be a reason to do so.  My opinion is that the en bloc resection can remove too much breast tissue.

Options for en bloc implant removal

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En bloc removal of your breast implants may not be necessary. It would depend on what your goals are. If your implants are saline, there would not be any need to do an en bloc removal as the scar tissue/capsule around your implant will shrink and eventually be resorbed once the implant is removed. Taking the additional time to remove the capsule off the back of the muscle and the front of the ribs would needlessly add cost and prolong your recovery with no benefit.

For silicone implants it may be a different story. All silicone implants have microscopic amounts of "gel bleed" meaning microscopic amounts of silicone leak across the shell and some of this is trapped in the scar tissue/capsule surrounding the implant. Although the best studies to date do not show any problems with this, some patients wish not only the implant removed but "as much of the silicone as possible" removed.

An en bloc removal would remove both the implant and the scar tissue/capsule around it. If the silicone implant is already ruptured inside the capsule, en bloc removal would prevent spillage of the silicone during removal. Again this is not an issue with saline implants.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.