Explant of Ruptured Sub-muscular Cohesive Gel Implant: is En Bloc Necessary?

Hi- I recently discovered, and confirmed through MRI, an intracapsular rupture of my sub-muscular 410 cohesive gel implants. They are about four years old. My surgeon is recommending en bloc removal, however this also seems to be this doctor's standard operating procedure.

Is en bloc necessary with cohesives, and are the potential health risks significant either way? I would be extremely grateful for professional input.

Doctor Answers 8

Ruptured implant

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Once the diagnosis of ruptured breast implant is made, the implant should be removed enblock.

Breast implants are made to be contained in a shell. Before silicone migrates, remove it.

You have several options, discuss with your plastic surgeon the pros and cons and the risks of each recommendation.

Baltimore Plastic Surgeon

Removal of a ruptured implant

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For a ruptured silicone implant, I would prefer to do a full capsulectomy (en bloc removal of capsule and implant) to minimise any spill of the escaped silicone. Though silicone is relatively harmless, it still can travel to the lymph glands in your armpits and cause enlargement of the glands/discomfort etc. With cohesive gel, theoretically, the risk for spread of the silicone is lower - but perhaps not completely eliminated. So I would agree with your surgeon's proposal.

Anindya Lahiri, FRCS (Plast)
Birmingham Plastic Surgeon

Would favor removal

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I favor removal with complete capsulectomy if possible.  En bloc sounds very severe but is not really more than a complete capsulectomy since this is still an intracapsular rupture.  En bloc is much more substantial procedure for extracapsular rupture into the breast parenchyma.

While it remains an intracapsular rupture, risks of any problems are minimal.  The problem is that we do not know when it may progress to an extracapsular disruption. For this reason, I favor removal while it is a relatively simple and easy procedure.

Chen Lee, MD, MSc, FRCSC, FACS 

Chen Lee, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 21 reviews

Ruptured implants should be removed

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My  recommendation is to remove ruptured implants.  I would not recommend leaving them in.  If the rupture is intracapsular the goal of surgery is to remove the ruptured implant as well as any silicone.  That requires removal of the capsule in order to assure containment of the silicone that has "leaked" out.  I would agree with an en-bloc removal.

Albert Dabbah, MD
Boca Raton Plastic Surgeon

Removal of ruptured silicone implants

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Most surgeons would recommend removal of a ruptured silicone implant however if you are not having any symptoms (pain) you do not necessarily have to remove them.  If you are on a special study or trial with the 410 implant, removal may be required. There are no known health risks of having a ruptured silicone implant in your body.

Consult with you surgeon to find out the specifics of the study with regard to implant removal.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

Explant of Ruptured Sub-muscular Cohesive Gel Implant: is En Bloc Necessary?

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Thank you for the question.  Given that you have a ruptured silicone gel breast implant, I think that your plastic surgeon has a good plan.

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 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, and the attached link, helps. Best wishes.

Explant of Ruptured Sub-muscular Cohesive Gel Implant: is En Bloc Necessary?

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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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Treatment of a possible rupture of a Style 410 highly cohesive anatomic implant

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If you have a  Style 410 implant then it is unlikely that you would have any migration of silicone since the implant is made of highely cohesive gel.  This could just be a fracturing of the gel and not rupture.  If it is causing problems then consider a remove and replace.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

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.