Capsulectomy vs en bloc with no rupture: which would be best in this situation for removal? (photo)

Question

I am finding conflicting reports on breast implant removal via en bloc or capsulectomy. I do not have a capsular contractor or rupture (99% sure) but am ready to have my implants and capsules removed. How much more traumatizing is en bloc vs capsulectomy? Can small pieces of a capsule left behind cause pain, swelling, or false positives on future imaging? Which would be best in this situation?

Alan Gonzalez, MD, FACS · Answer

Hello @Straightforward196692, thank you for your question. It is important to completely remove the capsule. It does not matter whether the implants are removed en bloc or if the capsule is formed independently of the implantation technique, due to the morphology of the breast and the professional findings in the surgery the capsulectomy will be done and all the capsule is taken out. This requires knowledge and dexterity. Keep in mind that an en bloc explant surgery has two different varieties: one where you remove the prosthesis along with the capsule, and most people call that an en bloc explant surgery, but we also need to state that an en bloc explant surgery is when the prosthesis is taken out and the whole capsule is removed in pieces, however the entire capsule is explanted. To obtain more information and recommendations, it is best to consult one or more board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Richard Baxter, MD · Answer

en bloc capsulectomy is a significantly riskier operation with a longer recovery, and is rarely necessary. A total capsulectomy can be done without using the en bloc method, and even if a partial capsulectomy is done it is highly unlikely that any parts left behind would cause issues.

Daniel Barrett, MD · Answer

Dear Straightforward196692,
generally speaking, if you don't have capsular contracture and your capsules are thin you can get only implant removal. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your question. In most cases of disease-free issues neither an en bloc nor total capsulectomy would be required and is a more invasive case with greater chances of aesthetic issues materializing.  Seek out in-person consultations for the best advice.

Anna Steve, MD · Answer

Cases of capsular contracture can be treated in a variety of different ways. If implants are being removed, any abnormal portions of the capsule can be removed and sent to pathology for further testing. This is called capsulectomy. 
En bloc capsulectomy is the recommended treatment for BIA-ALCL, a rare type of lymphoma associated with primarily textured breast implants. This procedure involves removal of the breast implant and all positions of the capsule together. In cases where there is no diagnosis of BIA-ALCL en bloc capsulectomy is not required and would be associated with significantly increased risks.

Connie Hiers, MD, FACS · Answer

En bloc surgery is used for cancer surgery only and does not refer to removing the capsule.  It is a much wider removal of tissue. Your surgeon will try to remove as much capsule possible while being safe.

Kevin Tehrani, MD, FACS · Answer

en bloc capsulectomy would be an unnecessary procedure in somebody without any disease in their breasts. This procedure results in unnecessary scarring and damage to breast tissue when it is not needed.  Additionally, if you were considering fat grafting replacement of volume you would need capsular tissue for fat grafting space and optimizing volume. It is best to have a virtual consultation to discuss options of course.

Capsulectomy vs en bloc with no rupture: which would be best in this situation for removal? (photo)

Answers (7)

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