What is the difference of bilateral capsulecotomy and en bloc/total capsulectomy?

 Both procedures involve removal of the capsules (scar tissue) surrounding the breast implants.  The difference is in the details.En bloc breast implant removal refers to a procedure where the breast implant and the surrounding capsule is removed as a single unit.  The procedures is performed such that the  contents within the breast implant capsule do not come into contact with the surrounding tissues.  Generally, the procedure requires a longer incision (6-7 centimeter) usually in the inframammary fold, in my experience.  Also, in my experience, the procedure is more successful when capsules are thickened as opposed to when patients are very thin (normal) capsules.   Complete or total capsulectomy refers to complete removal of the capsule tissue but not necessarily in one piece (and not necessarily in continuity with the breast implant).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 bloc removal of breast implants is a good procedure.
On the other hand, capsulectomy (of any kind) 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 believe that there are plastic surgeons practicing 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 helps. 

"En bloc" refers to removing the capsule and the implant as one unit.  With a total capsulectomy the complete capsule is removed, but may or may not be done separately from the implant.  The term "bilateral" simply refers to both breasts versus one.

Thank you for your question! The term "enbloc" is a newer term that means the removal of the implant capsule and implant in one.  A capsulectomy is the complete removal of the capsule but not necessarily still surrounding the implant at the same time.  As long as the capsule is completely removed, there is no scientific evidence suggesting it is better to do one over the other. Both of these methods are typically done bilaterally. Best of luck to you!