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

The term "en bloc" is saved for cancer surgery only and not used (correctly) to talk about capsule and implant removal. The capsules can be removed and sent to pathology to be examined if you wish. If you have textured implants, I would recommend removing the capsules. Otherwise, removing the anterior capsule if the capsules are very thin, usually works well and decreases the risk of seroma of fluid collection. If you have thick capsules, I would remove as much as possible for comfort.

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.

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.