Do I need a en bloc or would a total removal suffice?

Question

I’m having a explant and uplift next week. I have nagore gummy bear type 390cc I was a 34B before implants and now 34DD. I’m having breast pain and illness issues. I want a en bloc removal but my surgeon states he usually only does partial removal but will do a full removal on me but it can effect for the blood supply to the nipple and the look of the breast. Do I need a en bloc or would a total removal suffice?

Daniel Barrett, MD · Answer

Dear nenee,
it is hard to tell for sure without an examination but if you have symptoms caused by your implants, en-block removal might be the best option. In cases like yours, I always try to remove implants and complete capsules at the same time. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Luis Villar, MD, FACS · Answer

Gummy Bear is the nick name for highly cohesive shaped gel implants.  They are similar to a gummy  bear.  I do not like them because they are not as natural feeling as memory gel implants. The breast determines the shape of soft pliable implants.  Stiff rubbery implants can support and shape the breast.  The problem with gummy bears is that they may look good in the standing position, but may sit like stones when laying down.  However they have a place in reconstructive breast surgery where tissue is missing and a shaping force is needed from within.  Then shape trumps natural feel.Capsulectomy (enbloc resection) is optional in removal and mastopexy with these implants. This operation is already compromised by reduced circulation.  The flaps and nipple-areola depend on circulation from the periphery of the breast due to the dead space from the removed implant.  Your surgeon should make a determination of the risk depending on the amount and consistency of the remaining breast tissue.  Partial capsulectomy is common to allow the breast tissue to mobilize into the new shape better.  Complete capsulectomy increases the chance of post operative bleeding.  A post operative hematoma can cut off blood supply to the flaps and nipples irreversibly within hours. This is a risk/benefit calculation that requires an experienced surgeon.  When in doubt, a two stage procedure may be prudent.  This decision can be made at surgery if the capsule is suspicious or severely calcified.

Camille Cash, MD · Answer

Since you stated you are having "illness" potentially related to the implants and breast pain it is better for you to have en bloc.  If not, total capsulectomy is recommended.  I encourage you to discuss your concerns with your surgeon as it's important for you to feel comfortable and confident in your surgeon and your surgical plan.

Tom J. Pousti, MD · Answer

Given that you have concerns regarding "breast implant illness", en bloc breast implant removal or implant removal and complete capsulectomy will likely be the operation you choose to undergo.You will find that there is no "standard" practice; in other words, opinions and practices will vary. The numerous opinions you will hear about from patients as well as physicians can certainly be confusing and anxiety provoking.
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 bloc 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.
 For these reasons, plastic surgeon should use good judgment and remember priorities of safety and avoidance of complications,  as opposed to attempting to remove capsule tissue (that potentially can  expose patients to significant risk).
   I hope this helps.

Do I need a en bloc or would a total removal suffice?

Answers (4)

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