I am explanting. Is it important to explant en bloc and does the muscle have to be sewn back?

hello niptuck123 The removal of breast implants that have been placed either for cosmetic or reconstructive purposes is a surgical operation.  Breast implant removal may be performed as a single surgical procedure or combined with additional procedures, as follows:

Simple breast implant removal, without removal of capsule tissue around implant
Removal of tissue surrounding the breast implant (capsulectomy)
Removal of escaped silicone gel in breast tissue (extracapsular, outside of capsule layer) from silicone gel-filled implants (breast biopsy)
Breast lift (mastopexy following breast implant and/or capsule removal) #options #enbloc 

Patients seeking implant removal have many options now.  En bloc does ensure that the implant and the surrounding capsule are removed in one piece. I always recommend muscle repair in situations that the implant was originally placed under the muscle.  Learn more about en bloc in the video link to make a more informed decision.  Good luck.

It is advised to have the capsules removed along with the implants under certain circumstances.  Some include if the capsule is thickened, if there is contracture, or if there is rupture of the implant.  Your surgeon can advise what is best for you.  Muscles can be reattached if needed.

If you have capsular contracture due to silicone implant rupture, then total capsulectomy recommended. The muscle reattachment can be done if indicated. please see the link 

Hi and thanks for your questions.  If the capsule is not causing you discomfort (thickened capsule, capsular contracture, calcification, ruptured silicone implant), then there is usually no need to remove it.  If the above are occurring, then en bloc removal is a good option. I also agree with several of the other RS surgeons answering this question - if the implant was below the muscle, and the muscle was completely released, a repair should be attempted but may not be successful.  Discuss your particular situation at length with your surgeon.To assure that you get the result that you are looking for, I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons.  Membership in these societies demonstrate a surgeons commitment to safety and specialization in aesthetic and cosmetic surgery.  Assure that they have multiple before and after photos of results that you like so that you can have an informed discussion about your breast revision and possible results.

Best wishes,
Dr. Brown

Thank you for the question. Don't be surprised if you receive a variety of differing responses.
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 bloc removal of breast implants is a good procedure.
On the contrary, 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.
 
I hope this helps. Best wishes.
 

If the capsule is thick and causing pain then removing as much of the capsule as possible is best.   I do not routinely sew back down the muscle because the sutures will likely tear through.

There are a variety of options for you when you remove your implant.  If there is a reason to remove the capsule (the scar tissue sac your body makes around the implant), I usually recommend removing it completely (this is what people typically mean by en bloc).  You do not have to remove your capsule if you do not have a contractue or rupture of a silicone implant.  Removal of the capsule adds time to your operation, risk,  and limits how aggressive we can be doing things to repair the stretching of your tissue from the implant (fat grafting and breast lift).  If your implant  is located under the muscle, you should have the muscle repaired or it will continue to jump abnormally after the implant is out.  It will not seal back down or heal as there is a smooth capsule under it now.  

It is important to have the entire capsule removed.  The technique will vary based on the implant.  Yesterday I saw someone with a rupture who I will have a difficult time with because of the rupture but I will remove all of the capsule.  I don't try to sew the muscle down.  This doesn't work in patients who have had implants in for long periods of time.  I have my information and videos on my site that can help you.