Implant exchange or removal to treat capsular contracture grade 4?

First, en bloc surgery is cancer surgery only and not to describe removal of capsules. Yes, the capsule, as much as possible, needs to be removed and the implant should be replaced. An examination is needed to see if you can have a lift at the same time, or should wait. The nipple can be reduced. Reducing nipples does carry the risk of numbness, depending upon the technique used, but many keep sensation. Removing the capsule usually does not increase the risk of numbness very much as all since no breast sensory nerves are in the capsule. A lift might reduce sensation, but the biggest risk is with the augmentation, which has already been done.

Dear jordynbhf,
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

There is a lot that would go into answering this question. You should work with a Board Certified Plastic Surgeon and a full consultation would be necessary. Consider asking about use of allografts and/or pocket exchanges along with the total capsulectomy discussion. Get more ideas about the nipple sensitivity risks at each consultation.