En Bloc style Capsulectomy details
Thank you for the question. Yes, it is possible that breast tissue can inadvertently be removed while doing a complete capsulectomy; on the other hand, with careful dissection, this concern can be minimized.
Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en block removal of breast implants is a good procedure.
On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.
Recently I have become more aware of the fact that there are plastic surgeons who, instead of using good judgment and individualized patient care, are causing fear and unnecessary anxiety among patients. These patients them feel that complete capsulectomy is always necessary and undergo unnecessary surgery associated with additional morbidity and unnecessary expenses.
I hope this, and the attached link, helps. Best wishes.
En Bloc style Capsulectomy details.
An en block capsulectomy just means that the capsule and implant are removed as a unit. If under the msucle, no breast tissue is removed. If over the muscle, it is uncommon to remove any breast tissue. See link below for examples.
En bloc capsulectomy
Removing the entire capsule is performed for capsular contractors, but sometimes it is not possible because of the attachment to the chest wall, or if it is in the sub glandular pocket on a very thin person.
En block capsulectomy
When a very inelastic, and firm capsule, usually related to old broken silicone gel implants, it is quite easy to separate the capsule completely from the overlying breast and muscle and bring it outside of the breast all in one piece. In the absence of this type of capsule, the capsule can still be removed without volume loss to the breast. Find a plastic surgeon in your region with experience in revision breast surgery. Good luck.
En Block Capsulectomy
En Block capsulectomy is the removal in one piece of the scar envelope around the implant along with the implant. This is usually done in cases of old, calcified scar tissue around leaking implants or in the very rare cases (256 cases worldwide ever suspected) of a lymphoma associated with implants (ALCL). This technique is not necessary for soft scar capsules and has risks especially when removing the scar tissues off the chest wall where it could be associated with bleeding or entry into the chest. As regards removing breast tissue during the en block capsulectomy, not much is removed because the plane of surgical separation is in the space just between the scar tissue and the breast tissue. You should discuss your concerns with your surgeon and have him educate you on your options. Dr. Peter A. AldeaMemphis, TN