20 y/o saline implants submuscular - why does en bloc removal matter?

Question

Hi and thanks for your time. I have 20 y/o saline implants submuscular. I've had significant BII sx since implant age 37 but never connected the two and thought it was not "real". I have consults for explant and am trying to educate myself. I do not understand why en bloc removal matters (in the absence of rupture). I worry about surgery complications. Also is it important to biopsy anything once it all comes out if I've been symptomatic for 18 years? I want to know the best questions to ask MD

Robert M. Wald, Jr., MD · Answer

With a patient with BII, we try to remove as much of the capsule that is possible. The thought being the capsule, which has silicone in it, may continue to upset the patients immune system. This concern is only theoretical and no one knows whether this is true. An en bloc or total capsulectomy is our goal realizing that it is impossible to do in all cases. When the capsule is very thin or is attached to the chest wall, the capsule will not be remove as one piece. In these cases, we cauterize the remaining capsule.

Gary M. Horndeski, MD · Answer

If you do not have breast cancer, which it sounds like you do not, then you do not need en bloc.  En bloc is only used for cancer treatments such as textured implants associated with BIA-ALCL.

Best Wishes,

Gary Horndeski, M.D.

Shaher W. Khan, MD · Answer

En bloc or 100% total capsulectomy is the gold standard. A capsule grows around the breast implant. That capsule is what holds the silicone toxicity, therefore the entire capsule must be removed regardless of saline or silicone. Even if your implants are not ruptured, you must still have the capsules removed in it's entirety as well as all inflamed or abnormal tissue and sent off to pathology for further testing.

Camille Cash, MD · Answer

En bloc refers to removing the capsule and implant as one unit.  If you have been having BII symptoms for some time you will want both removed.  Your surgeon will examine both the implant and capsule upon removal and send anything to pathology that looks concerning.  Be sure to visit with a board certified plastic surgeon near you to learn more.

Daniel Barrett, MD · Answer

Dear ivrn1,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

20 y/o saline implants submuscular - why does en bloc removal matter?

Answers (9)

Answer: Implant removal

Answer: Implant removal

Answer: Implant removal

Answer: Implant removal

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20 y/o saline implants submuscular - why does en bloc removal matter?

Answers (9)

Answer: Implant removal

Answer: Implant removal

Answer: Implant removal

Answer: Implant removal

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Recommended reading

Everything you need to know about En Bloc Capsulectomy

Our mission is to create a world where every investment in modern beauty is Worth It.