Is En Bloc implant removal 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.

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

Hello! Thank you for your question! 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. I have always favored a complete capsulectomy vía en bloc method.  Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today  A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure.  
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 is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. 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).  
But, I completely believe in removal of the entire capsule, en bloc, for several reasons - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo.  These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space.   Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast, and suturing the muscle back to where it started from. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast.  Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time.  Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra.  Cost will vary amongst surgeons. Discuss with a surgeon who is knowledgeable, skilled, and experienced with this technique. Hope that this helps!  Best wishes!

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.

En Bloc implant removal refers to the implant and capsule being removed as one unit. This is not necessary in your case. It is sometimes recommended with silicone implants that have ruptured. I've included a video on implant removal and BII that I hope you find helpful.

 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.

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

If you do have health issues you should consider the en bloc removal of the silicone or aline implants. The saline implants are still made of silicone. 

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.

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.