My saline implants are being removed. Do I need to insist on an en bloc or not? They are loose and move easily.

Question

I am having my breast implants removed my surgeon does not do an En Bloc or remove the Capsule. I have had no problems with my saline under the muscle implants. They are loose and move easily I just want smaller real breasts. Do people with saline implants and no issues get sick after if they don't have an enbloc or the capsule removed?

Wayne I. Yamahata, MD · Answer

Most surgeons would agree that the added risks of on en bloc capsulectomy do not warrant any potential benefits in a patient such as yourself.

Mathew A. Plant, MD, FRCSC · Answer

There is no medical need to remove the capsules at all in this case, I would definitely not insist on en-bloc or you will end up with much larger scars than a straight removal. If all you are looking for is smaller breasts then I would suggest having your saline implants drained 4-6 weeks before surgery to allow your breasts to rebound. This will give you a sense of how much excess skin will be present and let your surgeon know if a lift is needed at the same time as the implant removal. Best of luck!

Dhaval M. Patel, MD · Answer

Thank you for your question! If your implants are not causing you any illness then I dont think it is nessacary to remove capsul or enbloc.  Best of luck!Dhaval Patel 
Double Board Certified 
Plastic Surgeon
Chicago 
Hoffman Estates 
Oak Brook
Orlando Park

Peter Lee, MD, FACS · Answer

Hi, and thank you for your question. Given that you have saline breast implants, and that you are completely asymptomatic, it is not necessary for you to have an en bloc removal of your breast implants.  A complete capsulectomy at the time of removal of your breast implants should be sufficient address the problem, and allay any future concerns.

Luis Villar, MD, FACS · Answer

Normal capsules do not have to be removed in healthy patients.  At surgery, the capsule can be inspected.  If the capsule is calcified or otherwise abnormal it can be removed.  However, capsulectomy can greatly increase morbidity because a large raw surface with punctate bleeding may be created.  Dissection can be simple, or a nightmare.  Drains should be used.  Bleeding complications increase significantly.A normal capsule will shrink.  Removing strategic segments of it without creating large raw surfaces will accelerate the process.  En Bloc resection is overkill in healthy patients.If a patient thinks that her implants are affecting her health (which is very unlikely) a complete capsulectomy will be prudent to eliminate the physcological anxiety.

Farbod Esmailian, MD · Answer

If your capsules are soft as you are implying, then there is no need to remove the capsules.  The implants can easily be removed with minimal recovery time.  When the capsule is thickened or calcified then it is routine to remove the capsule completely.  It may or may not need to be removed en bloc at that time.  En bloc refers to removing all the capsule and implant together.  This is done in cases where there is a suspected rupture or such where the surgeon doesnt want to spill or leak any of the contents.Hope that helps.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question. Assuming your capsule has not hardened or thickened with time it is customary to not remove it so as to avoid bleeding risks and additional patient discomfort.  Best to have further discussions with your surgeon so as to determine the best treatment path.

Daniel Barrett, MD · Answer

Dear maryann159,
as long as you don't have capsular contracture and your capsules are thin, there is no need for en block removal. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kenneth Hughes, MD · Answer

Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted. Consult with a board certified plastic surgeon to determine if the capsule should be removed.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Genevieve F. Caron, MD · Answer

Thank you for your questionThe only case when I recommend en bloc capsulectomy for saline implant is when they are textured.If not, there is to my opinion no justification to put you at higher risk.Best Wishes
Dr Genevieve FCaron, Board Certified Plastic Surgeon
Montreal, Canada

My saline implants are being removed. Do I need to insist on an en bloc or not? They are loose and move easily.

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