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

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.

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

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
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