I Have Heard That Enbloc is the Way to Go? Anyone Have This Proceedure?

for breast implant explant there is a proceedure called enbloc, which removes tissues around the implant as well, it makes sure there is no scar tissue etc. is how i understand it to be the gold star way to remove them?

Doctor Answers 14

Breast Implant Removal En Bloc Method

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In experienced hands, it is entirely possible to do most cases of explantation with the en bloc procedure. Please see video.

Cleveland Plastic Surgeon
4.6 out of 5 stars 95 reviews

Removal of Breast Implants

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When removing breast implants, if there is an easily removed capsule, my preference is to remove it (open capsulectomy).  If the capsule surrounds ruptured gel implants and harbors silicone, indications for capsulectomy are more exigent.  Dr. Pat Maxwell of Nashville has popularized a procedure for implant removal and replacement in a new pocket without capsulectomy, and in my experience, this is another good approach.  In any case, if the capsule or a very large part of the capsule cannot be removed or is not removed with the implant, post surgical drainage to prevent seroma originating from the capsule should be strongly considered, in my opinion.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

I Have Heard That Enbloc is the Way to Go?

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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 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.

Recently I have become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy is always necessary and undergo unnecessary surgery associated with additional morbidity and unnecessary expenses.

I hope this, and the attached link, helps. Best wishes.

En bloc removal

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Enbloc removal is not necessary in all cases.  It should be done when there is a thickened capsule or if you believe you have symptoms is silicone toxicity.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

I Have Heard That Enbloc is the Way to Go? Anyone Have This Proceedure?

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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

Enbloc Implant and Capsule Removal

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Capsular contracture which is one of the most common complications of breast implants can be a frustrating result. Many different methods of dealing with contracture has been described. It is widely accepted today that the best method to treat an established contracture is to remove the implant and the capsule around it. This is perhaps what is being called an "en bloc" removal. Furthermore replacement with a new implant is another important element of success. So, a simple opening of the capsule is not sufficient and often leads to recurrence. This "en bloc" removal is the ideal method. Best wishes.

Sepehr Egrari, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

Breast implant removal may require removal of the capsule

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When silicone gel breast implants are in place for a very long time, a leak into the capsule can cause a contracture and calcification of the capsule. When this happens, it is necessary to remove the capsule completely with the old implant to give a fresh start for the new implant. Some will call this 'enbloc' a rather fancy term for 'in one piece'. The capsule and implant are removed together. This is not a gold standard or only way to go, as often the capsule can be left and a new pocket created behind the old if the old has not thickened and calcified.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Using a sledgehammer when a flyswatter will suffice: enbloc vs neopectoral pocket

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Using a sledgehammer when a flyswatter will suffice is not always a good idea even if it accomplishes the job. IF you have an intact silicone implant with a capsular contracture, a neopectoral pocket is a perfectly reasonable alternative without radical and unnecesary resection of the capsule, surrouding breast tissue, muscle, etc which could result in an increased risk of secondary problems. There are no data to suggest the superiority of this technique in uncomplicated cases of silicone implant augmentation.  

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

En bloc capsule removal

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Nothing new here but usually not practical.  Even with ruptured gel implants, the only way to do an en bloc removal is with a pretty long scar. 

Removal of implant plus capsule is called "en bloc"

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The term "en bloc" refers to any surgical procedure where something is removed in one piece. If there is a problem with the implant that has affected the scar capsule then it is a good idea. It's not anything unique, just a matter of terminology. The more important question is what to do if new implants are to be put in, since en bloc removal leaves less of your own tissue to cover and support the new implant. This is something you should discuss with your plastic surgeon.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 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.