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 like Dr. Pinsky 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, Mark Pinsky, MD, 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, Dr. Pinsky 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.
- What Is En Bloc Capsulectomy Surgery?
- En Bloc Capsulectomy vs. Capsulectomy
- En Bloc Removal Candidates
- The En Bloc Capsulectomy Procedure
- Recovery After En Bloc Removal
- Why Choose Dr. Pinsky for En Bloc Capsulectomy Surgery?
- Breast Implant Removal (Explantation)
What Is En Bloc Explant Surgery?
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:
- It prevents any fluid, silicone gel, bacteria, chemicals, and other potential pathogens from leaking out of the capsule.
- Helps ensure that all scar tissue is cleanly removed from the body, since it is all dissected in one piece.
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, Dr. Pinsky relies upon his 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.
En Bloc Capsulectomy vs. Capsulectomy
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:
Who Is a Candidate for En Bloc Explant Surgery?
There are many circumstances under which Dr. Pinsky may recommend, or you may be interested in, the en bloc explant procedure; however, please note that en bloc removal is not always the right option and this careful determination must be made on a case-by-case basis during the course of a consultation. Candidates for en bloc explant surgery may fall into the following categories:
- Desire the removal of old silicone gel implants
- Experiencing symptoms of BII or BIA-ALCL
- Have a ruptured or leaking silicone gel implant
- Want to remove textured implants to eliminate risk of BIA-ALCL
Whether you are having problems with your implants, experiencing concerning symptoms, or simply wish to prevent the possibility of BIA-ALCL, Dr. Pinsky can perform a comprehensive evaluation of your health and medical history, as well as a full examination of your breasts and implants. He may suggest further testing to diagnose or rule out BIA-ALCL or other health complications. During your appointment, he will take the time to listen to your concerns and provide you with factual information about the procedure, its benefits, and its drawbacks so that you can make a fully informed decision about your care. He may also suggest additional procedures for breast restoration after implant removal, such as breast implant replacement or simultaneous implant exchange with fat (SIEF).
Dr. Pinsky 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 him from recommending the en bloc procedure would be:
- The breast implant capsule is too thin (in some cases this determination could not be made until the surgery has already begun and an alternative method would be used).
- There is only a minimal amount of breast tissue between the implant and the skin and removing the entire capsule could create complications and/or undesirable aesthetic results.
- The combined size of the breast implant and capsule is too large to remove through a single incision that is reasonably sized.
- The risks of the procedure outweigh the benefits.
If en bloc removal is not the right procedure for you, Dr. Pinsky will likely suggest a different explant procedure that is better suited to your needs and limitations.
What Happens During En Bloc Explant Surgery?
You will be placed under general anesthesia while the en bloc explant surgery is performed. The procedure begins with an incision along the fold on the underside of the breast, called the inframammary fold. The incision needs to be long enough to allow for the removal of the entire capsule with the implant inside, and should not extend past the entire length of the inframammary fold (if the implant is too large, another capsulectomy technique should be performed to prevent an overly large scar). Next, the scar tissue capsule containing the implant is carefully separated from the breast tissue. When it has been completely dissected from the surrounding tissue, the capsule and implant can be removed through the incision in one piece. If any scar tissue remains attached within the breast, which may occur when the capsule is very thin, Dr. Pinsky removes it as thoroughly as possible. Finally, the breast pocket is cleansed and the incision is closed. For many reasons, which he will discuss during your consultation, Dr. Pinsky typically prefers to perform the en bloc explant procedure on both breasts, rather than just a single breast. If you are having your old breast implants replaced with new ones, SIEF, or a simultaneous breast lift procedure, this portion of the surgery will take place when the breast pocket has been sterilized.
Recovery After En Bloc Explant Surgery
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. Dr. Pinsky 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. Dr. Pinsky 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.
Why Choose Dr. Pinsky for En Bloc Explant Surgery?
Dr. Pinsky has been a top breast surgeon for more than 20 years and he has developed a reputation for delivering exceptional results, especially in difficult cases. His vast experience and surgical skill allow him to perform the technically complex en bloc explant procedure with consistently outstanding outcomes. Dr. Pinsky’s patients also benefit from his time as an FDA Clinical Investigator for both Mentor® Corporation and Allergan® breast implants, and as a frequent lecturer at Allergan Academies around the world. He is extremely knowledgeable about breast implants and has been on the inside-track, following the developments and clinical data surrounding textured breast implants and BIA-ALCL since the beginning. Dr. Pinsky’s impressive skill-set, professionalism, and knowledge—combined with the compassion he shows for his patient’s physical and emotional needs—makes him a rarity among plastic surgeons. Most importantly, Dr. Pinsky understands there are many reasons you may want to have your breast implants removed, and he has carefully informed and guided many women toward the right procedure for their needs and goals. Whether you are concerned that your implants are negatively affecting your health, have malfunctioned in some way, or simply want to prevent illness from occurring, Dr. Pinsky can create a personalized treatment approach aimed at reaching your goals. Dr. Pinsky is always focused on your health, comfort, and satisfaction, and at each phase of the process he will strive to create an experience that fulfills your every need.
Do you have questions about implant removal and the en bloc capsulectomy procedure? We welcome you to contact Pinsky Plastic Surgery to schedule your consultation.