When to perform En Bloc and complete capsulectomy vs. simple removal of ruptured silicone implants?

Question

I have bilateral ruptures of silicone breast implants. I am very lean with very little natural breast tissue. I have a grade II capsule therefore En Bloc/capsulectomy are not indicated. I have chronic Lyme disease, tend to heal slowly and hemorrhage. I've read that all of the capsule needs to be removed to ensure proper healing, plus risks of developing cancer, infection and biofilms (which is risky with chronic Lyme) when any tissue is left in the chest wall. Is an En Bloc and capsulectomy indicated?

Camille Cash, MD · Answer

Since you have bilateral ruptures of silicone implants the en bloc approach is indicated.  This will remove the implant and capsule as one unit and minimize the occurrence of free silicone in the breast space.  See a board certified plastic surgeon near you to learn more.

Lewis Albert Andres, MD · Answer

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 is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. 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).  But, I completely believe in removal of the entire capsule, en bloc, for several reasons. Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I 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 yourplastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  Hope that this helps!  Best wishes!

James Knoetgen, III, MD · Answer

When deciding between En Bloc capsulectomy, complete capsulectomy, or simple removal of ruptured silicone implants, the choice depends on the implant condition, complications, and patient health.

1. En Bloc Capsulectomy
•	Best for: Suspected breast implant illness (BII), BIA-ALCL, or extensive silicone leakage.
•	Pros: Removes the implant and capsule as one unit, reducing contamination risk.
•	Cons: More invasive with longer recovery.
2. Complete Capsulectomy
•	Best for: Ruptures with capsular contracture or contained silicone leakage.
•	Pros: Removes all capsule tissue and silicone.
•	Cons: Still invasive, though less so than En Bloc.
3. Simple Removal
•	Best for: Contained ruptures with no symptoms or complications.
•	Pros: Quicker recovery and less invasive.
•	Cons: Risk of leaving behind silicone or scar tissue, potentially requiring future surgery.
In summary:
•	Use En Bloc for severe leakage or health risks.
•	Opt for complete capsulectomy if the capsule is problematic.
•	Simple removal is suitable for localized ruptures without major concerns.

Sean Kelishadi, MD · Answer

Hi!  Your situation seems a little more complex and requires in depth history, examination, and discussion of risks and benefits. At face value, a grade II capsule does not need removal. If you have silicone implant ruptures, a total capsulectomy may be needed to ensure no silicone is left behind. Please seek the expertise of a board certified plastic surgeon.Sincerely,Dr. Sean Kelishadi

Edward J. Domanskis, MD (in memoriam) · Answer

Yes, esp if you are not having implants put in than that is a better alternative and it keeps the ruptured silicone from contaminating the breast cavity.

When to perform En Bloc and complete capsulectomy vs. simple removal of ruptured silicone implants?

Answers (5)

Answer: Hard to tell for sure without a complete history and physical examination

Answer: Hard to tell for sure without a complete history and physical examination

Answer: Can I have an en bloc capsulectomy if I am thin?

Answer: Can I have an en bloc capsulectomy if I am thin?

Recommended reading

Everything you need to know about Breast Implant Removal

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

When to perform En Bloc and complete capsulectomy vs. simple removal of ruptured silicone implants?

Answers (5)

Answer: Hard to tell for sure without a complete history and physical examination

Answer: Hard to tell for sure without a complete history and physical examination

Answer: Can I have an en bloc capsulectomy if I am thin?

Answer: Can I have an en bloc capsulectomy if I am thin?

Browse related questions

Recommended reading

Everything you need to know about Breast Implant Removal

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