Is En Bloc implant removal necessary

I have smooth saline breast implants that were put in in 2004. I have had insomnia, mild brain fog, and mild tiredness for the last 8 years. I am not sure if the implants are the cause of these symptoms as everything I have tried medically has failed to treat my problems. IS it necessary to remove the saline implant En Bloc to potentially treat these problems that could be breast implant illness? will leaving the capsule in harm me in any way. My capsules are reported to be soft and thin.

Doctor Answers 7

Is En Bloc implant removal necessary ?

It makes me cranky how the breast implant "illness" crowd throws around this term - en bloc.  En bloc refers to a technique used to remove malignant tumors where the tumor itself is never incised.   This technique is used to prevent the spillage and possible subsequent spread of cancer cells.  Breast implants are not cancer.

As for breast implants - en bloc refers to removal of the capsule around the implant without entering the capsule and exposing the implant.  I find the en bloc technique very useful for removing old, ruptured, nasty gel implants that are surrounded by a thick and sometimes calcified capsule.  This assures a clean removal, no spillage of gel and is also very, very satisfying.  I find the en bloc technique usually impossible with saline implants with a thin and flimsy capsule and honestly it doesn't matter if the capsule is entered and the implant exposed.  The stuff in the implant is saline (salt water) and totally harmless.  The bii crowd seems to think that there is something dangerous in saline implants.  There isn't.  It's saline!  What about fungus and mold you may ask.  In 25 years of practice the only fungus and mold I have seen is on the internet and in my refrigerator. The vast majority of plastic surgeons fill their saline implants with a closed system where the saline goes directly from the sterile IV bag into the implant and is never exposed to the air so there is zero chance of contamination.   

As for the capsule, I remove as much of the capsule as I can remove safely.  Leaving the capsule behind, especially if it is thick and nasty, can result in a mass that can be felt or looks creepy on mammogram or can cause a fluid collection so it's best to go after it.  Sometimes, almost always with saline implants, the capsule is so thin and so adherent to the chest wall or pec muscle or breast tissue, it just can be completely removed with taking some health tissue along with it. 

As for the bii crowd, my guess is that you have stumbled upon their website which is teaming with disinformation and bad advice.  Their Facebook page is even worse.

My advice is for you to obtain your information from a board certified plastic surgeon who has a lot of experience with breast implants.

Oh, I am sorry you are feeling lousy but it's not because of your implants.  Check out all the ladies on the website who are years out from their implant removal and still feel crappy.  It's not the implants.


Seattle Plastic Surgeon
5.0 out of 5 stars 67 reviews

Removing implants after 8 years - should it be en bloc

Thank you for asking about your breast  implant removal.

  • I am sorry to hear of your symptoms after your implants.
  • Please be sure to have your thyroid function checked if it has not been checked -
  • You should have a TSH level of 3 or lower - if it is higher, your symptoms may be from low thyroid levels.
  • Removing the capsules is a matter of controversy.
  • Everyone agrees that a thick, calcified or otherwise abnormal capsule must be removed.
  • However if at surgery the capsule is thin and delicate, many surgeons will leave the capsule -
  • Others will remove it.
  • Removing a thin capsule in its entirety can cause bleeding and removal of remaining breast tissue because there is no clear line of separation of the capsule from your normal tissue.
  • What about discussing this with your surgeon? It would be reasonable to ask him to remove the implant end capsule en bloc if possible and to if not, to remove as much capsule as seems possible without increasing your risk of breast deformity or bleeding.
  • Usually a small lift is done at the same time to restore your breast shape.
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Is En Bloc implant removal necessary

The decision to remove the capsules is based on whether they are soft and pliable and also depends on the desires of the individual person. Some people would like the capsules removed en bloc, and that's a reasonable request. Make sure to discuss the pros and cons of removal of the capsule during your consultation.

Is En Bloc Necessary?

The capsule is your body's response to your implants. It may contain 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 hope this helps.

Lu-Jean Feng, MD
Cleveland Plastic Surgeon
4.5 out of 5 stars 84 reviews

Is En Bloc implant removal necessary

 I'm sorry to hear about the problems you are experiencing.


As you know, there are patients who present to plastic surgeons for breast implant removal surgery hoping that removal of breast implants will alleviate a variety of medical conditions that they may be experiencing.  Given that there is no science associating the presence of breast implants with these illnesses, I cannot promise the patient's relief or improvement;  on the other hand, out of respect for the patient (and with enough medical experience to know that patients are often right about their own bodies), I do remove the breast implants (en bloc). This involves removing the breast implants and the surrounding thickened capsule "in one piece".  Given the concerns, implants and tissues are sent to microbiology and pathology. 


 I think that as time goes on, as our experience increases further, we will learn more about any possible association between breast implants and "illnesses".  I think that it is important, as physicians, to keep an open mind.


 In the meantime, I hope the plastic surgeons will individualize patients care based on good ethics and not "scare" as many patients as possible to remove breast implants and capsules, exposing patients unnecessarily, in many cases, to unnecessary risk (morbidity) and expenses.

   Best wishes for better health.

Breast Implant removal (Explant)

Before you decide on removing your breast implants, you need a full medical work up by your family physician and other specialists as deemed necessary by your symptoms.

If no reason is found, and you think this is caused by your implants, then an enblock removal is best for your peace of mind. There are medical evidence that your symptoms are related to the breast implants, and no guarantee that your symptoms will improve after the enblock removal of the implant and capsule. Few opportunists will tell you of the need to "detoxify". There is no medical evidence that detoxification, antibiotics and antifungals are of any benefit other than financial benefit to the care giver


Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

En Bloc Removal

We generally do not feel it necessary, from a medical standpoint, to remove capsules around saline implants as long as the capsules are thin and soft. However, if it is you're feeling that your symptoms are arising from your implants, I think you would not be satisfied if the implants were removed and not the  capsules. In your case, it just makes sense to take everything out in one sitting so you don't feel it necessary to go back for more surgery. Please understand however there is nothing in the medical literature that would lead us to think your symptoms come from the breast implants. But, removing them is your choice, if that's what you want to do it's best to do capsules and implants.  Best of luck. I hope you feel better soon. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 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.