En bloc capsulectomy is very different from regular capsulectomy. En bloc capsulectomy is not only the complete removal of the scar tissue surrounding a breast implant, but doing so in one complete piece. The surgery involves the removal of a breast implant while it is still encased in the entire scar tissue capsule that surrounds it, as the term “en bloc” means “all together”. Many surgeons remove the capsule in pieces, while others may leave significant portions of the capsule in the breast pocket, and neither approach is equivalent to the en bloc procedure. The difficulty for the patient is that they may never know what type of capsulectomy is being performed, even if the surgeon claims to perform en bloc capsulectomy.
This complex procedure requires a great deal of surgical precision to perform correctly, and it is wise to seek out a surgeon who has advanced training and experience in en bloc explant techniques if you need and/or desire the procedure. Based on the nature of your concerns, one of our board-certified plastic surgeons can recommend the explant procedure that is best-suited for addressing your condition and achieving your goals. When silicone implant leakage occurs, certain health problems have developed, or an elevated risk of BII (breast implant-related illness) or BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) is causing concern, your physician may suggest en bloc capsulectomy.
If you have questions about en bloc explant, we encourage you to explore the informative sections provided below and contact Pinsky Plastic Surgery to schedule a consultation.
The en bloc explant procedure aims to simultaneously remove the breast implant and the entire capsule of scar tissue that surrounds it—all in one piece. This approach to breast implant removal has what many believe to be important benefits:
The overarching hope is that by removing the breast implants with the scar capsule intact, any symptoms or risk of illness can be completely eliminated; however, this is not a guarantee and there is not adequate clinical data to support this idea. While en bloc explant can be indicated under a variety of circumstances, including when removing ruptured, old, and/or leaking silicone gel breast implants, most recently the procedure has become more widely recommended in response to concerns about confirmed cases of BIA-ALCL in patients with textured breast implants. Based on what minimal data is available, since there have only been 573 confirmed cases worldwide (as of July 2019), it appears that the interaction between the textured surface of the implant and the capsule may be a contributing factor to what causes ALCL to develop in the scar tissue. Therefore, the en bloc removal procedure emerges as what may be the most effective option for removing both the “cause” and “effect” of BIA-ALCL (that has not reached the more advanced stage of the disease).
It is important to understand that while en bloc removal may be the most desirable option in certain circumstances, this procedure is not always possible, as thin scar tissue capsules that have adhered to the ribs may be more difficult to remove all in one piece. In extremely complex cases, our doctors rely upon their renowned surgical skill and experience to remove as much of the intact capsule as possible and will then continue to dissect any challenging scar tissue that remains.
There are important differences to understand between en bloc capsulectomy, total capsulectomy, and partial capsulectomy. As mentioned previously, en bloc capsulectomy is the removal of the entire scar tissue capsule (in one piece) with the breast implant still inside. While en bloc removal is a type of total capsulectomy, total capsulectomy just means the complete removal of the scar tissue capsule—whether it is taken out in a single piece or multiple pieces—and the breast implant can be extracted from the capsule before the capsule itself is removed. Finally, a partial capsulectomy (which is sometimes simply referred to as a capsulectomy) is a procedure that is used to treat a condition called implant malposition when the implant is too high or hasn’t dropped. During a partial capsulectomy only a portion of the scar tissue is removed to allow the breast implant to drop lower and restore a more natural look and feel to the affected breast.
Make sure you understand which type of capsulectomy your plastic surgeon is performing, and you can even request photographic evidence of how your capsule was removed. En bloc requires considerably more surgical skill, precision, and time; however, many patients believe the potential health benefits are worth the additional effort. If you are expecting and paying for en bloc removal, that is precisely the procedure you should receive (in rare cases your surgeon may discover during surgery that en bloc explant isn’t possible and should explain this to you after your surgery). Below, we have included photos that show the difference between an en bloc capsulectomy and a total capsulectomy:
Your surgeon might discover that the en bloc removal procedure may not be in your best interest or cannot be safely performed. Conditions/circumstances that may prevent us from recommending the en bloc procedure would be:
If en bloc removal is not the right procedure for you, your surgeon will likely suggest a different explant procedure that is better suited to your needs and limitations.
After en bloc capsulectomy, most patients are generally able to return to non-vigorous activity and work within about a week. Many patients find that the recovery following en bloc removal is less intensive than their original breast augmentation procedure. Your doctor may suggest waiting a few weeks before returning to your usual exercise regimen. If you undergo a breast implant exchange, SIEF, or breast lift to restore your breast shape immediately following the en bloc explant procedure, your recovery will typically take longer. Your surgeon can fully inform you about what to expect during the recovery from your customized procedure prior to surgery so that you are prepared in advance.