Periareolar Vs Inframammary Fold Incision (En Bloc Capsulectomy - Ruptured Submuscular Silicone Implants) (photo)

Dear doctors, Which approach provides the most direct route for an en bloc capsulectomy and requires the least operative time? Will and inframammary incision provide less post operative discomfort and faster healing? I am having my en bloc procedure soon and my surgeon said he'd use the existing periareolar incision in order to avoid creating a new scar. However, I did not ask if it's easier /safer to remove the capsules via inframammary incision even if it means a new scar!

Doctor Answers 8

En Bloc Capsulectomy - Ruptured Submuscular Silicone Implants

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I do this procedure several times a year as patients with the older gel implants come in for a change. It is not necessary use any incision other than the one you have around one-half of the areola. If it is a small implant the surgeon will remove the implant and capsule in one piece. But if the implant is larger is can be done through the same incision by first removing the implant, ruptured or not, and then the capsule. If the tissues outside the capsule are injected with a solution containing dilute epinephrine, the total blood loss is a teaspoon or two and the procedure takes about 45 minutes per side. If their is any silicone spillage it is easy to remove with a commonly used surgical solvent called Shur-clens. I have not found any increase in hematomas, infection, or later capsular contracture with this procedure and have found no reason to use drains. If the tissues are injected with marcaine before placing the new implant the recovery has little discomfort.

Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Periareolar vs Infra-mammary Approach to Capsulectomy

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A complete capsulectomy,  also en bloc, can be performed depending on the case by an infra-mammary incision or a periareolar one (if the areolar is large enough and already has a  scar). Other scars such as a vertical mastopexy scar if present can also be used.  In most cases and in yours, I would prefer an infra-mammary approach as if needed the access can be enlarged if required.


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Enblock capsulectomy and removal of ruptured implant will require a larger incision equal to the diameter of the contracted capsule.

You have a full periareolar incison, according to the pictures, which means you had a breast lift . If you have a vertical scar as well then the combination of these two scars can remove the capsule enblock. Other wise an infra mammary incision, and i like to use the harmonic scalpel to dissect the capsule where there is less chance of entering the capsule.

Samir Shureih, MD
Baltimore Plastic Surgeon

En bloc implant removal is not as easy as it sounds

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To remove the entire capsule and the contained ruptured implant intact (so called "en bloc") requires a LARGE incision or the capsule will almost for sure pop open at some point during the removal from too much pressure and manipulation.  I really would not try it through the areola and would do a long crease incision if you want the best chance of success and the quickest surgery.  Did they discuss lifting with you after by the way?

Potential for rupture of specimen higher with periareolar.

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The goal of en bloc capsulectomy is the removal of ruptured silicone implants and their capsule as a single unit.This approach has several advantages.It hopefully removes the silicone without spillage into the surrounding tissue.It also removes a layer of surrounding breast tissue which may have silicone granulomas and associated inflammation.

This approach has the potential to remove large segments of tissue and for this reason usually requires a larger incision.For this reason, an inframammary incision is probably appropriate in most cases.Although it’s possible to perform this procedure through a periareolar approach, the potential for rupture of the specimen is definitely higher.

En bloc capsulectomy?

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Hello! Thank you for your question! Oftentimes, this revisionary procedure/capsulectomy will need to be performed through an inframammary fold incision for the best visualization and to remove the entire capsule/implant entirely.  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. 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 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).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Best incision for a capsulectomy

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I would use your existing scar but it is easier to remove the implant via the inframammary crease incision. You just get better visualization through this incision. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Removing an implant and capsule

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It is perfectly fien to use any of the incision described to gain access to remove the implant and capsule.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.