I have had small 270cc cohesive gel implants over the muscle for 10 years. I now wish to remove and not replace. I am not symptomatic nor do I believe they have ruptured. Should I insist on enbloc removal? I am in the UK not many surgeons do this procedure. Thank you
Best Way to Explant Cohesive Gel Implants 10 Years Later?
Doctor Answers 4
Enbloc removal of breast implants
There is no reason to do an enbloc removal of your implants even if the implants are ruptured. It would require a longer incision and be technically more difficult and risky. There is no real advantage to it either. I typically dissect around the outside of the capsule as far as I can reach before removing the implant. If the implant is ruptured most of it can be pulled out into a bowl and a little more dissection is all that is needed to free the capsule and pull out the rest of the implant and gel. I always irrigate and scrub the pocket thoroughly. Occasionally it is not possible to get the posterior aspect of the capsule off the chest wall without risking a puncture into the space around the lung and in those cases it is best to leave it. If you have already made up your mind to have your implants removed there is really no need to know ahead of time whether or not the implant it intact. MRI scans are expensive and would not change the surgical approach (at least for me). You should look for a surgeon who has done a lot of capsulectomies.
Consider Tradeoffs of Enbloc Removal, Rather than Insist
Enbloc removal of gel implants is the removal of the implants while still in intact capsules: the surgeon dissects the capsule away from the surrounding breast and muscle tissues and removes the capsules without taking the implant out of the capsule.
The surgeon tries to do this without penetrating the capsule so that there will be no leakage of gel, if the implant shell has failed (the capsule is now containing the leaky gel and preventing the gel from coming in contact with the surrounding tissue).
If there is no leak, this can require a longer incision and be a considerably more tedious and time consuming process. It is also potentially more traumatic than removing the intact implant and then doing subtotal capsulectomy: removing enough capsule for the pocket to heal, without trying to remove the more adherent segments of capsule that might require a more traumatic dissection. In such situations, after implant removal, small remnants of capsule are harmlessly reabsorbed by the body.
In other words, if there is no implant leak, enbloc removal or total capsulectomy is not necessary and may involve unnecessary tissue trauma.
To verify that there is no leak before surgery, you and your surgeon may consider a high-resolution ultrasound and/or MRI to determine if there is evidence of an implant leak.
En bloc removal not necessary
Unless there is documentation of implant rupture, there is no real reason to remove the capsule surrounding the implant. This can be done with great accuracy using preoperative MRI imaging. If indeed there is a rupture, complete removal of the implant and capsule is the best option.
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If implants are ruptured, it is sometimes better to remove them enbloc if the capsule is intact and the tissue are thick enough, so to avoid silicone leakage onto the tissues. While it is inert, it can sometimes be a bit messy to remove all the gel.