En Bloc through areola incision?

Question

My silicone implants were placed through the areolas and under the muscle. Is it possible to have an explant and en bloc (no lift) through the same areola incisions? I would like to avoid additional scarring.

Alan Gonzalez, MD, FACS · Answer

Hello @Trustworthy134889, thank you for your question. Ultimately, it depends on the specific surgical technique and the patient's characteristics. The specialist can determine during surgery whether a complete capsulectomy is in bloc, but the entire capsule must be removed. This requires knowledge and dexterity. Keep in mind that an en bloc explant surgery has two different variations: one where you remove the prosthesis along with the capsule, and most people call that an en bloc explant surgery, but we also need to state that an en bloc explant surgery is when the prosthesis is taken out and the whole capsule is removed in pieces. Whichever the case, the entire capsule is explanted. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

Finny George, MD · Answer

Hi, thank you for sharing your question. While it is possible to remove the capsule through this incision, an en-bloc removal of implant and capsule would be very challenging due to the size of the mass and the discrepancy with the size of the incision.

Shaher W. Khan, MD · Answer

It is impossible to do an EN BLOC through a nipple areola incision and ABSOLUTELY not recommended. The dissection in the right plane, especially on top of the rib through a small incision is virtually impossible. A horizontal incision in the crease is safe and practical for removing the entire implant and capsule, in EN BLOC/total capsulectomy fashion.

Jeffrey Lisiecki, MD · Answer

It might be possible, but I would not typically advise en bloc removal without a clear reason to do so, because the risk of complications is higher than implant removal and a complete capsulectomy (not en bloc). If removing an implant en bloc, I would not typically do it through a periareolar incision. It might not be possible depending on the size of implants, the grade of capsular contracture, the size of your areola, etc, and even if it is possible it would be better visualization to perform the operation safely. See a plastic surgeon and discuss your options with them!

David Parizh, DO · Answer

The danger of taking out an implant en bloc under the muscle isn’t small. To do so you would want the best visualisation possible. That’s usually done through an incision in the fold. Larger than one you would place an implant through. Doing so through a periareola incision I don’t think is possible.
The only indication for a true en bloc capsulectomy is cancer. Otherwise, literature suggests a subtotal capsulectomy (most of the capsule) is acceptable for contracture or breast implant illness. 
I think you need a good consultation to understand your reasoning for desiring explanation. Hope that helps.

Richard Baxter, MD · Answer

A lot depends on what size your implants are but I would not advise trying an en bloc removal through an areolar incision. Also, recent studies show that en bloc isn't necessary most of the time; you can get just as much benefit with total capsulectomy or even partial capsulectomy. En bloc is a radical and riskier operation.

Eric Wright, MD · Answer

I would discuss with your plastic surgeon the reasons you are requesting this procedure.  The areolar incision is small and subsequent surgeries risk puckering in this area or sensation loss.  Being under the muscle would make this challenging to perform any significant capsule removal.

Daniel Barrett, MD · Answer

Dear Trustworthy134889,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

Shana Kalaria, MD · Answer

Yes it is possible to remove the implant and capsule through an areolar incision. Just be sure to discuss with your plastic surgeon as not all will feel comfortable doing so. Also discuss the reasons for the en-bloc and the possibility of leaving some of the capsule behind for safety reasons. I recommend meeting with a board-certified plastic surgeon for your consult and surgery. Good luck!

Anne-Sophie Lessard, MD · Answer

Hello! It depends on the width of your areola and the size of your implants but in general, to perform en bloc capsulectomy safely, it usually requires a bigger incision and so, in those cases, it is usually better hidden at the infra-mammary fold (the breast to chest junction) than extending the one you already have on the areola. The good part of it is that the infra-mammary incisions usually heal beautifully. I hope that help you.

En Bloc through areola incision?

Answers (15)

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