Do I need en bloc treatment of my Capsule Contracture Baker Level 3.5? What's the best treatment option?

Question

I am 50 years old and have 330 saline implants. I have seen my original surgeon and was confused on the best treatment option. He diagnosed with Baker Level 3.5. I have very dense breast tissue with a biopsy of fibersistic tissue prior to implants. I am ok removing the implants and not replacing but am worried about being extremely deflated. I had a lift when the implants were put in. The doctor said he didn’t feel there would be an issue with appearance. I assume I don’t need en block?

Camille Cash, MD · Answer

From the information given a capsulectomy would be recommended.  You can then elect to reinsert the implants or take them out completely.  If you elect not to replace them you may appear deflated as you are losing the volume the implants provide.  I encourage you to speak further with your surgeon about your goals for this procedure to help determine which is the best course for you.

Derek Fletcher, MD · Answer

Thank you for your questions!
1. Management of capsular contracture: In general, if a person has grade 3 or 4 cap con, I recommend capsulectomy. If the implants are under the muscle, I will usually perform a partial capsulectomy because the capsule is often highly adherent to the rib cage and capsule removal in this location can cause injury to the chest wall or lungs. If the implant is on top of the muscle, total capsulectomy is much safer and, therefore, my preferred strategy. 
2. Whether or not to replace implants: Having saline implants is an advantage in this instance. When I am caring for someone with saline implants who needs additional surgery, but is not sure they want to have the implants replaced, I will offer to deflate the implants in the office with a needle and a syringe (percutaneous implant deflation). The patient can then see approximately what their breasts will look like if the implants are not replaced. I have found this to be extremely helpful for patient decision making when it comes to planning and satisfaction after surgery. I have also found that deflating the implants can make capsule removal easier. 
Hope this helps and good luck!

Daniel Barrett, MD · Answer

Dear Seanie401,
in case of capsular contracture, it is important to remove implants and capsules. 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

Anshu Gupta, MD · Answer

If you are planning to remove the implant a complete capsulectomy (removing the entire capsule) is advised. When we refer to En Bloc that means a complete resection to matter what, this term is typically used when referencing cancer. However if removing the entire capsule could cause potential damage to your ribs, muscle or lungs then it is not beneficial to have an en bloc resection.

Ralph M. Rosato, MD · Answer

If your implants are above the muscle, then removal of the capsule will be done. If you implants are under the muscle the back of the capsule is on the ribs and removal of this part of the capsule may cause complications. Trust in your surgeon to take care of you.

If cancer were present en bloc is required.

Do I need en bloc treatment of my Capsule Contracture Baker Level 3.5? What's the best treatment option?

Answers (5)

Answer: Implant removal

Answer: Implant removal

Answer: En bloc

Answer: En bloc

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Everything you need to know about Capsular Contracture Treatment

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Do I need en bloc treatment of my Capsule Contracture Baker Level 3.5? What's the best treatment option?

Answers (5)

Answer: Implant removal

Answer: Implant removal

Answer: En bloc

Answer: En bloc

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Recommended reading

Everything you need to know about Capsular Contracture Treatment

Our mission is to create a world where every investment in modern beauty is Worth It.