How important is it to remove implants "en bloc"?

I am searching for a qualified surgeon who takes pride in breast explant knowledge and experience. Help me weigh the benefits or having this procedure "en bloc", totally removing implant, capsule, scar tissue, etc. versus "leaving something as fill matter" for the soon to be flattened breast. Also, who do you know that is good at it?

Doctor Answers 4

How important is it to remove implants "en bloc"?

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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 would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.

Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to SEE lots of examples of their work AND preferably speak/see patients who have had similar procedures done.

In many areas of plastic surgery, including breast implant removal surgery, you will find many different (often strong) opinions as to the best way to handle a specific situation. In my practice, generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic, I do not remove them. On the contrary (unless indicated), capsulectomy can expose you to additional risks, such as bleeding and some breast size loss. Your plastic surgeon, based on your physical examination, will be able to inform you whether the breast implant capsule is thickened or abnormal.


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

Removing implants

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Dear Rachel,

Decisions about the technique used are influenced by what type of implant you have, and what are your plans following removal.

When removing silicone implants I like to dissect around the outside of the capsule ("en block") if they are possibly ruptured, if a capsular contracture is present, or if there is no plan to replace the implants.
When removing saline implants, if you are sure you don't want to replace the implants, I might remove a portion of the capsule or cauterize it to promote adhesion and prevent a potential space for fluid to accumulate.

Capsules that are soft are very thin (like panty hose or cellophane) and don't provide much in the way of "fill". Extremely thick capsules (up to orange peel thickness) are sometimes also calcified and I personally would not leave this intentionally to provide bulk.

If you are planning on replacing implants, there are more decisions regarding what type (smooth or textured), what shape (round or anatomic), and what plane (sub-glandular, below the muscle, or neo-subpectoral pocket) that all need to be planned out.

Obviously, a through consultation with a skilled board certified plastic surgeon will be very important. If you can also bring any records, implant information, and recent mammogram, ultrasound, or MRI results to your consultation, that would be very helpful for your surgeon.

Best of luck to you,

Removal depends on particu lar situation

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Thanks for your question. With a contracture and especially a silicone implant rupture the entire implant and capsule are removed. Sometimes a portion of the capsule is used to help strengthen the pocket. There is no real indication to remove the entire capsule if it's thin and normal. Best of Luck!

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En bloc removal

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En bloc removal means removing both the implant and the capsule around it.  This is often necessary in silicone gel implants that are hard.  Soft saline implants don't require removal of the capsule usually, but every case is different.

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.