Sub Muscular PIP Capsule Removal or En Bloc?

I have Lupas and other auto immune issues. I would like my implants removed and have seen two surgeons in London that will remove and uplift for me. The first will remove part of the capsule and the second will remove all. Neither will do it en bloc. I have read so much on en bloc and is it really necessary to remove in this way Can anyone recommend a good surgeon to explant and uplift without replacing in London?

Doctor Answers 5

Sub pectoral PIP implant removal

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It should be your choice to remove your breast implants but there is no good evidence that this caused your lupus or that it will be made better by removing the implants (PIP or any type). There is also no need to automatically lift the breast when implants are removed. Implants do not lift the breast and removing them does not make them sag. Breasts look lifted in some situations when they are filled out with implants but they are filled out, not up. The same thing happens in reverse. Removing implants can make the breast look as if it sagged but it is an illusion due to the lost volume. 

There is no scientific or established reason to remove any of the capsule unless it is abnormal. There is certainly no support for the concept that an "en bloc" removal is even better. The tissues will not be cleared of microscopic silicone regardless of whether the implant was intact or if the capsule is removed. A plastic surgeon has to use experience and sound medical/scientific judgment for performing procedures and cannot be expected to do whatever the patient says they want for whatever reason. I would remove all visible implant and silicone and only remove the capsule if it was abnormal and I would probably not do a mastopexy at the same time but consider it later as a separate procedure if desired after the implant is out and things settled. 


Boulder Plastic Surgeon

Sub Muscular Capsule Removal or En Bloc...

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Thank you for the question.  

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 (especially removal of the capsule along the posterior surface of breast implants) 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 hope this, and the attached link, helps. Best wishes.

Sub Muscular PIP Capsule Removal or En Bloc?

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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!

My Recommendations fro En Bloc Capsulectomy

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Here are My Guidelines for en bloc Capsulectomy for PIP implants:

In general I would follow these recommendations - If there is no evidence of rupture of your silicone gel implants and your breasts are soft, that is no capsular contracture,  then I do not recommend capsulectomy to my patients. However if there is a rupture or what is called "silicone bleed" where there is visible sticky silicone on the outer capsule, especially with PIP implants then I recommend capsulectomy to rid your body of traces of free silicone

Breast implant removal and capsule treatment

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If the capsules are soft are not significantly calcified it may not mbe necesary to remove them. Sometimes if can be quite difficult to remove the whole capsule as well.  A lift sounds reasonable if the implants are removed.

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.