Implant removal only - why are my consults recommending an en bloc?

The capsule forms around the breast implant as a natural barrier. This capsule/barrier holds the toxins or gel bleed from saline or silicone implants. Even though you do not have BII symptoms, the shell of the implant breaks down causing a gel bleed which the capsule absorbs. Leaving the capsule behind could cause health issues.

Dear rmabe,
it is hard to tell for sure without an examination. In case you have thick capsules around implants, then en block removal might be an option. 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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Dear Rmabe, thank you for your inquiry.

The decision to proceed with a capsulectomy is typically based on factors such as the severity of capsular contracture or intraoperative observations like capsule thickness or calcification. En bloc capsulectomy isn't always necessary for all patients. I recommend discussing your specific concerns and preferences with your surgeon before the procedure.

Hello @rmabe, thank you for your question. Yes, removing the capsules is key. I believe that every time an explant is performed, the capsule must be removed. Complete capsulectomy. Whether it is en bloc does not matter as long as the whole capsule is removed and the tissue is sent for pathology after taking the capsule out. This will prevent future inflammatory responses from the body because capsules do not get reabsorbed. Here is a video that sheds more light on the topic. Best wishes!

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

En bloc surgery is used for breast cancer. If you do not have cancer then you do not need en bloc. You need to consult other physicians.

Best Wishes,

Gary Horndeski, M.D.

If you are wanting implant removal only and there are no other issues with the implants such as capsular contracture or rupture, then it should be fine to proceed as you wish. En bloc refers to removing the implant and capsule as one unit.

Actually, the term, en bloc, is for cancer surgery and not technically for removing implants and capsules. You can ask to just have your implants removed with no capsules unless they are textured. With textured implants, the capsule is stuck onto the implant and will be removed with it. Sometimes, once the implants are removed, the thin capsules left tend to dissolve over time. If you have smooth implants and are not worried about your capsules, just ask for the implants to removed.

You are correct, if you are asymptomatic, your breast would not need en block resection. A simple, implant removal with partial capsulectomy to freshen up Wound edges for improved healing would be suffice.