My breast look squared 5 years post op. Can this be capsular contracture? (Photos)

You probably have a capsule. En bloc is a term used for surgery for cancer and does not mean removing the implant and its capsule. It is much more involved and removes more breast tissue.

Capsular contracture is a common yet frustrating complication of breast augmentation. Most often it occurs many years after the surgery. Treatment of it involves releasing the capsule around the implant. En bloc resection of the implant and capsule all in one piece is not necessary and has not been recommended in patients with capsule contracture. There are patient's in whom capsular contracture is the first sign of breast implant associated anaplastic large cell lymphoma. In these patients the capsular contracture is usually only on one side and treatment would involve removal of the capsule and implant, however what we some refer to as "en bloc resection) is not necessary.

It looks like a severe case of capsular contracture. There seems to be a superior malposition in which the implant goes up.I would recommend total capsulectomy to remove the implant and remove the entire thickened capsule.You can do that alone, or you can insert a new implant or do a fat graft to alleviate the sagging of the breasts.