Likelihood of muscle and/or chest wall damage with en bloc explant?

Question

What is the likelihood of damage to the chest wall and muscles with an en bloc capsulectomy of sub pectoral silicone implants? I am a rock climbing guide and worried that I may be injured from surgery and no longer physically able to do my job.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs or told us your bra size.  En bloc resection can de-vascularize the remaining breast tissue.  Many women who undergo explantation alone are dissatisfied with the excess hanging skin and require a lift.  It is best to do both at the same time.  The technique I recommend is explantation using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Urmen Desai, MD, MPH, FACS · Answer

Unlikely any significant damage.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear tv89,as long as your plastic surgeon is board certified, there is a small chance of that kind of complication. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ross Blagg, MD · Answer

Hello,It is unlikely that you would be injured to the point of being unable to do your job. With a thick capsule, like in "capsular contracture", it is rather easy to removed the capsule and implant "en-bloc" but with a soft, normal capsule this is more difficult and therefore some surrounding tissue is more at risk. However, with a well-qualified board certified plastic surgeon, you should be fine. Be sure you talk with your surgeon about this concern so he/she can effectively speak with you about the plan. All the best,Dr. BlaggAustin, TX

Camille Cash, MD · Answer

If you see an experienced board certified plastic surgeon the risk of damage to the chest wall  during an en bloc capsulectomy would be very low.  I encourage you to discuss your concerns with your surgeon and ask about his/her experience with this particular procedure.  You can find board certified plastic surgeons near you by visiting the ASPS website.

Khashayar Mohebali, MD, FACS · Answer

Thanks for your question. I do en bloc removal on a weekly basis.  I've never had an issue with injury to chest wall or muscles and is very unlikely.  In general, I try and re-attach the muscle after implant removal; which should give you better function long term.  If seriously interested in en bloc removal, consult with surgeons who are familiar and do the procedure often. Good luck.

Stacey Folk, MD · Answer

An “en bloc” resection is a treatment for cancer. Thick contracted capsules are easier to remove intact and in their entirety. This surgery is more difficult with very thin capsules and one has to question why it is even necessary in these circumstances. Peeling the thin capsule off the chest wall is the hard part and can lead to more bleeding or rarely possible injury to the lung. As the scar tissue reforms there’s can be puckering or folds to the breast tissue, and muscle contraction distortion can still be visible. It is doubtful that the pectoral muscle function would be different than it is now. Scar tissue in the intercostals between the ribs might add some post op pain. Be sure to plan adequate recovery time because of your type of work (6 weeks likely).

Likelihood of muscle and/or chest wall damage with en bloc explant?

Answers (7)

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