Do I need enbloc total/capsulectomy if I want an explant after 3 months?

Question

Breast explant

Kenneth Hughes, MD · Answer

En bloc refers to removing the capsule and the implant in one piece. Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.  If the capsule is left behind, the body will break down and remodel the scar tissue on its own.

Finny George, MD · Answer

Hi, thank you for sharing your question. Although it is unlikely that you will need a total capsulectomy 3-months post op from an augmentation, a detailed exam with a board certified plastic surgeon would be needed before a treatment plan is formulated. I hope this helps. Best of luck!

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Donovan Rosas, MD · Answer

Capsulectomy is only warranted/indicated in a few situations:
-Capsular contracture
-Ruptured silicone implants
-Suspicion of BIA-ALCL in the setting of a textured device (late fluid collection with ALK+ and CD30+ lymphocytes present)
A thin, soft (non-calcified) capsule in the setting of an intact silicone implant does not necessitate removal. Following explantation, it will simply shrink down. However, high grade firm/calcified capsules will remain so if not removed. In the absence of the implant this remain palpable and may be a source of discomfort.With regards to your specific question, it is unlikely that a capsulectomy will be needed in the case if explant after short term augmentation.
As always,discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Verified Member
RealSelf Top 100
RealSelf Hall of Fame

Pejman Aflaki, MD · Answer

Hello
and thank you for your question. The short answer is 'no'. I do a significant number of breast implant
removal. As long as the capsule is thin and soft, it does not need to be
removed. In the event of a ruptured gel implant, I do an en-bloc removal of the
implant with a full removal of the capsule. I will also remove the capsule if
it is thick and calcified. Removal of the capsule can be challenging and cause
bleeding and other issues, so I would only remove it if it is absolutely
necessary. I would seek consultation with a
board-certified plastic surgeon for a full evaluation and advice. Best,
Pejman Aflaki, M.D.                                             
Johns
Hopkins-trained double board-certified plastic surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Most likely after three months you could simply remove both implants and not pursue a capsulectomy to help reduce the chance of aesthetic deformity.  Hope this helps.

Gary M. Horndeski, MD · Answer

At 3 months you will probably have very little capsule formation.  It will be very soft most likely and does not need total enbloc removal.  However, you may need a breast lift at the time of explantation depending on your skin.  Without more information it is hard to recommend exactly what needs to be one.Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Imaginative515495,
there is no need for capsulectomy, unless you have capsular contracture or thickened capsules, which is unlikely only 3 months after surgery. If you are considering a surgery, I would suggest you to 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

Connie Hiers, MD, FACS · Answer

At only 3 months, your capsules have not fully formed, and what has formed may slowly resolve once the implants are removed. So, no, a routine capsulectomy at only 3 months is not usually done unless there is a very specific reason to do so. The main question, is why do you want your breast implants removed at only 3 months? You were not happy with your breasts prior to surgery, and still may not be happy once removed. You might consider going down in size instead of removing your implants. I would suggest discussing all your concerns with your surgeon.

Tracy Kayan, MD · Answer

Whether or not you wish to have an en bloc/total capsulectomy depends on the reason you are having your implants removed. 3 months is very early, and you may not have full capsule formation, but if you are having symptoms consistent with breast implant illness, I might advise strong consideration of removing your implant and as much of the capsule as possible, although an en bloc may be very near impossible with such a new and likely thin capsule. If you just want your implant removed due to mechanical issues such as it's too heavy, it's malpositioned or causing you pain from stretching the muscle, then you may choose to undergo simple removal and leave the capsule in place, as this is likely to address your issues without the need to undergo more involved surgery of complete capsulectomy.