"En Bloc" Procedure on a Person with Scleroderma Can It Be Done?

Hi, I have had my Mentor silicone implants for 11months and have recently tested positive for scleroderma. I would like to remove them doing the "en bloc" procedure. Would this be to harsh on my body or cause to much trauma that the condition could possibly progress rapidly? What are my chances of coming out of this procedure well? I also have a lump on my right lymph under my arm pit. Could this be a sign of rupture? Any assistance in this matter would be greatly appreciated. Thank you.

Doctor Answers 3

"En Bloc" Procedure on a Person with Scleroderma Can It Be Done?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

En bloc breast implant removal refers to a procedure where the breast implant and the surrounding capsule is removed as a single unit.  The procedures is performed such that the  contents within the breast implant capsule do not come into contact with the surrounding tissues.  Generally, the procedure requires a longer incision (6-7 centimeter) usually in the inframammary fold, in my experience.  Also, in my experience, the procedure is more successful when capsules are thickened as opposed to when patients are very thin (normal) capsules.  Also,  sometimes complete capsulectomy is not safely possible;  for example, breast implants place in the sub muscular position may have a capsule that can be  densely adherent to the patient's rib cage. Removal of this posterior capsule can be potentially dangerous.

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 (again), 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.

You may find the attached link, dedicated to breast implant removal surgery concerns, helpful to you as you learn more. Best wishes.

Removal of breast implants with scleroderma

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Removing a silicone or saline implant is normally a simply procedure.  It can be done a lot of the time under local and you can be back at light duty work in 2-3 days.  Removing a capsule will definitely add significantly to the surgical trauma.   If you don’t have a pathological capsule contracture removing the capsule will not be very simple.  This is due to the flimsy nature of the capsule.  I’m not sure if the risk/benefits will make it worth the aggravation.  

Good luck and thank you for the question


Anire Okpaku MD FACS


Anire Okpaku, MD FACS
Miami Plastic Surgeon

Breast Implant Removal, Scleroderma Patient

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you choose to have the implants removed, your options include simple removal, vs. removal along with removal of the periprosthetic capsule.

Implant removal alone is quite a simple procedure, while removing the capsule is a more considerable undertaking. The latter takes longer, causes more discomfort, has a longer recovery period, and has more risk of post-operative complications. As is always the case, this requires a balance of risk and benefits.

Early in the days of the implant scare in the 1990ies, en bloc resection was often recommended. Today, with information that has accumulated from studies, that is not a universal recommendation. In the absence of evidence of leak, many would suggest simple removal. 

You mention an enlarged lymph node. This can be suggestive of a leak if the node has silicone. Check with either your surgeon or your rheumatologist as to whether any imaging studies would benefit you in the decision making process. Once you have all the information you need, have a discussion with both the rheumatologist and the plastic surgeon to help decide on the best treatment, if any indeed is recommended.

Although the en-bloc resection has added risks compared to simple implant removal, a well-trained and experienced plastic surgeon can carry out either procedure. 


Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.