Implant removal confusion. Would I need a capsulectomy, en bloc or capsulotomy?

Question

How do I know if I just would need my implants removed versus capsulectomy, enbloc, or capsulotomy? My saline implants are 23 years old so I'm thinking they have had their time. Not sure if my graves, plaque and inverse psoriasis, and constant inflamed red eyes are from my implants or what? I am 56 years old and a fit, active woman. I also have constant tiredness but not sure if thats related to implants or menopause. I certainly am VERY confused on what my next step should be.

Alan Gonzalez, MD, FACS · Answer

Hello @Exquisite687809, thank you for your question.  For starters, it is the ideal approach to remove the capsules, all of them (total capsulectomy) during the explantation procedure since it is not known what can be found in the tissue. Afterward, it would be necessary to carry out a preventive biopsy on each capsule. The removal of the capsules avoids any future inflammatory process. I linked a video about en bloc and total capsulectomy that will shed some more light.   The most appropriate course of action is to consult one or several board certified plastic surgeons. This will allow you to get more information and options tailored specifically to your needs.  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).

Brian K. Reedy, MD · Answer

Thanks for your question! While my recommendation would be to find a surgeon in your area and have an in-person consultation, I think that an explant (removal of the implant) and a partial capsulectomy would be sufficient. That is my personal opinion. Good luck!

Shaher W. Khan, MD · Answer

Hello, thank you for your question! These are all symptoms associated with breast implant illness. It is advised to either have a 100% total capsulectomy or EN BLOC removal of breast implants performed for optimal patient outcomes. The entire implant, capsule, and all inflamed tissue must be removed for optimal recovery.

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

Mario Arturo Moran Romero, MD · Answer

Dear Exquisite687809, Based on the information you shared, I recommend removing the implants. Implants are not intended to last for a lifetime. I always advise my breast augmentation patients that they need follow-up consultations in the long term. Performing a capsulectomy is unnecessary in the absence of capsule pathology or disease. Performing a capsulectomy can harbor the risk of lung injury, more bleeding, and increasing surgical time. No clinical study shows superiority in symptom relief when performing capsulectomy against other capsule surgeries. En bloc is an oncological term. Intended to describe an oncological surgery for cancer patients. I recommend you visit a board-certified plastic surgeon to make a surgical plan.

Sean T. Lille, MD · Answer

Dear Exquisite, 
I'm sorry you have health issues. Saline implants are not questionable implants for breast implant illness. That is silicone. It would be unlikely that your saline implants are causing any of your symptoms. If you truly feel like you still need to remove them to find out, your doctor will do a capsulectomy. Enbloc is really only done with silicone implants. I wish you well!!

Robert M. Wald, Jr., MD · Answer

Since your implants are not deflated, there is no emergency to remove them. If they are encapsulated, meaning they are firm and painful, this would be a reason to remove them sooner than later. With your symptoms, there is a chance you have BII. It would be my recommendation to do a complete capsulectomy (en bloc if possible), to make sure you get the capsule out as well. Realize by doing this, there is no guarantee your symptoms will resolve.

Heather Vande Ven, DO · Answer

The decision on implant removal procedures depends on various factors like implant type, condition, and individual health. It’s crucial to consult with a skilled surgeon who can assess your specific situation and recommend the most appropriate approach, whether it’s capsulectomy, en bloc, or capsulotomy.

Shana Kalaria, MD · Answer

Hello there, great question. You just need implant removal. Capsulectomy is reserved for patients with capsular contracture. In the case of 23 year old saline implants, you probably have soft and thin capsules which are unlikely to be the cause of any symptoms. Implant removal can be done in the office under local anesthesia. Good luck!

Camille Cash, MD · Answer

If the capsules surrounding your implants have become thickened, painful, or are causing other issues it is recommended that they are removed at the time of explantation.  As you mentioned some vague symptoms which may or may not be related to BII you may want to have them removed for that reason alone.  Your surgeon will guide you after an examination and discussion of your goals.