En bloc & capsulotomy - confusion on types of implant removal procedures

There is a lot of conflicting advice about capsulectomy with implant removal but we now have very good data showing that total or even partial capsulectomy is equally effective for relieving symptoms of BII as en bloc. Your surgeon is correct that en bloc is a radical and riskier procedure and not usually needed.

Confusion arises because there is no data. BII is not well defined and it makes it very difficult to study something not well defined. It is easy to study a medication that is supposed to prevent heart attacks by measuring the number of heart attacks in a group who takes the medication and those that don't. But with BII it is difficult because there are so many symptoms. So there is no consensus if removing the implant will affect any symptoms let alone if all or most of the capsule will affect anything. And all of the data we have collected over the last 30 years doesn't indicate that there is a relationship between some or all of the symptoms and implants. So that's where the confusion arises. No good data.

So without any evidence, most plastic surgeons are reluctant to take the whole capsule as removing the posterior wall of the capsule can be quite risky in certain patients (depending on the capsule)--some capsules come off of the chest pretty easily and others are plastered to the chest and removing them is dangerous or certainly can lead to more bleeding at the very least.

So we feel if there is no known benefit to removing the back wall of the capsule why expose a patient to the added risk when we don't have data that it will change the outcome.

Great question! The breast capsule is the scar tissue that forms around a breast implant. Just as you form scar tissue on the outside of your body, when an incision is made, your body also forms scar on the inside as well. This is a normal process.
En bloc capsulectomy is the recommended treatment for BIA-ALCL (breast implant-associated large cell lymphoma). It includes removal of the breast implant and the entire capsule around the implant all in one piece. This usually involves removal of some of the normal tissue surrounding the capsule in order to remove the capsule and implant as one unit.
Total capsulectomy refers to a process where all of the capsule is removed, but not necessarily as one piece with the breast implant inside the capsule. Some surgeons remove the implant before removing the capsule itself.
Women who have not been diagnosed with BIA-ALCL, do not need an en-bloc capsulectomy, En bloc capsulectomy is not indicated for the treatment of breast implant illness. During any explant surgery, after implants are removed the capsule is inspected. Any abnormal portions of the capsule are removed and sent to pathology for further testing.