What is en-bloc breast implant removal?

Sydney breast implant removal

Breast augmentation is a popular procedure, and studies show that most women are satisfied with the outcome. However, there are some women who later decide to have their implants removed. This is known as an explant procedure.

When removing breast implants, there are a few different choices that will need to be made. One of the major choices is how the capsule around the implant will be handled. All of the capsule may be removed, or part of it may be left in place. The type of capsulectomy chosen depends on the specifics of the medical situation.

One of the options is en-bloc implant removal. Although some patients have heard of this method, it does carry significant risks, and it’s important to fully understand these.

What does en-bloc breast implant removal mean?

When any implant (such as a breast implant or joint replacement) is placed into the body, scar tissue will naturally form around the implant. This is known as an implant capsule. With en-bloc breast implant removal, the surgeon attempts to remove the entire capsule along with the implant in a single piece. The idea is not to leave any part of the capsule behind, and to keep the capsule and implant intact as they are removed.

When is en-bloc removal medically indicated?

The only situation when en-bloc implant removal is a medical necessity is when a woman has the very rare condition known as BIA-ALCL. This is a type of lymphoma associated with certain breast implants that have a textured surface. In this condition, the cancer cells are actually located in the capsule. Ensuring that the entire capsule is removed intact decreases the chances of spreading the lymphoma around the body. The evolving information on BIA-SCC in 2022 may make this also a medical indication for en-bloc capsulectomy.

If an implant has been leaking, then en-bloc removal may also be indicated. This can help to keep the silicone contained within the capsule, to prevent it from spilling into the surrounding tissues. However, even in this case, it’s often best to open the capsule, remove the implant, and clean out the capsule thoroughly. The capsule itself can then be removed if the patient and surgeon have decided that this is the right thing to do.

Other than this rare situation, en-bloc implant removal is generally not medically necessary. However, patients sometimes request en-bloc implant removal, because they believe that it’s important to minimize exposure of their tissues to the silicone in the implants. There are some organizations that advocate for en-bloc implant removal for patients who are concerned about the health effects of their implants. There’s no scientific evidence that silicone implants cause any systemic health problems, and there’s actually quite a bit of evidence that they don’t. However, women may have been told that en-bloc implant removal is a good idea in order to reduce exposure of other parts of the body to silicone as the implants are being taken out.

Disadvantages of en-bloc implant removal

It’s important to recognize the significant disadvantages of en-bloc implant removal. The breast implant capsule is not an isolated structure. Instead, it adheres firmly to the other body structures around it. In order to remove the entire capsule intact, the surgeon must painstakingly dissect it away from these tissues. This process can cause a lot of damage to healthy structures of the body, such as the ribs and the pectoralis muscles.

In most cases, if parts of the capsule are left behind, the body will reabsorb these within a few months. Even if the decision is made to remove the entire capsule, it can be extremely challenging to do this with the implant still in place. It’s difficult for the surgeon to dissect the back part of the capsule away from the adjacent tissues while the implant is still in the way. If the implant is removed first, then it’s far easier to get to the back of the capsule, and a more precise removal can be accomplished with less damage to surrounding tissues.

Sometimes it’s not possible to perform an en-bloc implant removal safely. The tissue of the capsule can be extremely thin in some women, and to remove it without tearing it, it’s necessary to cut into the healthy tissues around it. In some cases, doing so could lead to very serious complications, like a punctured lung. It’s important for patients to know ahead of time that their surgeon may not be able to safely do an en-bloc removal. In many cases, we don’t really know until we open the patient and can assess the situation. Your surgeon may need to leave some pieces of the capsule behind to avoid serious damage to your healthy tissues.

The remaining consideration is scar length. A complete capsulectomy can be performed where the implant is removed to access the difficult sections of capsule in a shorter scar than an en-bloc removal requires. The delivery/removal of an en-bloc specimen (capsule and implant) requires a scar length of about the width of the implant, when often the implant is initially placed in the chest with a scar of about half the width of the implant or smaller. This is rarely a problem for patients, but if you have a tendency towards poor or hypertrophic scars, this is an additional consideration.

Do you need en-bloc implant removal?

If you’re having your implants removed, then you and your surgeon should talk over the options for implant removal. Medical indications for an en-bloc removal are rare, but a complete capsulectomy might be the correct balance of risks for you. You and your surgeon should discuss whether it’s necessary to remove some or all the capsular tissue, and if so, how this will be accomplished.

Scientific evidence has never shown that en-bloc implant removal is safer than any other method of removing breast implants or capsules. For most women, it is less safe, and is more likely to lead to complications. There’s also no evidence that any general health symptoms you may be experiencing are more likely to be reversed after en-bloc implant removal. It’s important to consider both the benefits and the risks involved before committing to a particular implant removal method.

Sydney breast implant removal

If you’re considering having your implants removed, then you’ll need to talk with a qualified specialist plastic surgeon to determine which method would be best for you. While en-bloc implant removal may be the right choice for some women, it can create unnecessary risks for others. If you’re in the greater Sydney area, Dr. Sandercoe will be happy to meet with you to talk over your various options, and the risks and benefits of each. Please contact our front desk to book your consultation appointment.