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"En bloc" is a term used to describe the removal of the capsule and implant together. The capsule is your body's response to your implants. It may contain silicone gel, silicone shell fragments, bacteria, calcification, and inflammatory cells which have been mobilized by your immune system to react to different components of the implant. Research has shown that the capsule does not disappear on its own when only the implant has been removed (See Nancy Hardt's paper in Plastic and Reconstructive Surgery.) In addition, if you have pain around the implants, it is usually due to the pulling effect of the scar on surrounding muscle and tissue. If you have health problems that could be from the presence of the implants, removal of the capsule is critical in improving your health. Linked is my en bloc video.I recently had a webinar where I answered questions about explantation. It is available for streaming on my website.
Capsulectomy refers to the removal of the scar capsule. With a capsulectomy the implant may be removed, followed by the capsule. En bloc is an approach where the capsule and implant are removed as one unit. This is method is used in many cases, but especially when there is a ruptured implant.
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. I have always favored a complete capsulectomy vía en bloc method. Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure. 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 - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo. These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space. 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, and suturing the muscle back to where it started from. I would discuss your issues with your plastic 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. I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast. Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time. Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra. Hope that this helps! Best wishes!
Good day! For your guidance, capsulectomy or the removal of the capsule will enable the surgeon to remove as much silicone as reasonable without creating significant deformity. On the other hand, en bloc will remove both the implants and capsule, but this operation may require a larger incision and longer surgery and recovery time. General anesthesia is usually necessary and subsequently all of the costs associated with this operation will be higher. Find a board-certified surgeon and discuss realistic goals and expectations. Best of luck! #RealSelf100
En bloc usually refers to removing the entire "thing" whatever that is. In this case it is a capsule. Sometimes complete removal of the capsule is not possible due to the potential for compromising the viability of thin breast skin.
