En Bloc vs Partial Capsulectomy for Breast Implant Removal

Breast implant removal or explant surgery is a procedure to remove silicone or saline implants from the breasts. This is often pursued due to complications from a previous breast augmentation surgery, changes in aesthetic preference, or health concerns related to the implants.

RELATED: Breast Implant Removal FAQs – Q&A about Explant Surgery

The choice of explant surgery technique depends on several factors, such as the patient’s health, the type of implants, the presence of complications, and the patient’s preferences.

The best technique for your explant surgery will be determined after a detailed discussion with your surgeon. The surgeon will evaluate your health history, current health status, type and condition of your implants, and your personal goals and preferences. The surgeon will also explain the potential risks and benefits associated with each technique to help you make an informed decision.

At Centre for Surgery, our highly skilled and experienced surgeons have expertise in all these explant techniques. We are committed to providing personalised care and achieving the best possible outcomes for our patients. We will guide you through the entire process, ensuring you feel comfortable and confident with your decision.

What is Capsulectomy?

Capsulectomy is a surgical term referring to the removal of a breast implant along with the scar tissue capsule that forms around it. It is typically conducted in two forms: partial capsulectomy and total capsulectomy, each having distinct characteristics and purposes.

A partial capsulectomy, also known as capsulotomy, involves surgically loosening and removing part of the scar tissue encapsulating the implant. This procedure is often chosen by patients who experience discomfort or changes in the aesthetic appearance of their breasts due to capsular contracture – a condition where the scar tissue tightens and squeezes the implant. In performing a partial capsulectomy, the surgeon selectively removes sections of the troublesome scar tissue, relieving pressure around the implant. This results in softer, more natural-looking breasts. Some patients may also opt for implant replacement during this procedure, although it’s not a compulsory part of the surgery.

On the other hand, a total capsulectomy involves the removal of the entire scar tissue capsule, typically in pieces or sections. Should a patient wish for an implant replacement, it is common for the surgeon to recommend a different type of implant and potentially suggest a change in implant placement. These recommendations are geared towards minimising the patient’s future risk of capsular contracture or other complications.

In both partial and total capsulectomy, the central goal is to alleviate discomfort and restore a desirable breast aesthetic, all the while ensuring the patient’s safety and well-being.

Am I suitable for capsulectomy?

Deciding whether a capsulectomy is appropriate for you involves several considerations. The procedure might not be suitable for individuals who:

• Have untreated breast cancer
• Active infection
• Are pregnant or breastfeeding

Further, if you experience any of the following, it’s vital to communicate this to your surgeon during the consultation:

• Suffer from a bleeding disorder
• Have a compromised immune system
• Have a history of previous surgeries
• Or have certain chronic illnesses

To assess your suitability for the surgery, your surgeon might require various tests, to ensure that the procedure is safe for you. These tests could comprise a Full Blood Count (FBC), pregnancy test, chest X-ray, Electrocardiogram (ECG), breast ultrasound, Magnetic Resonance Imaging (MRI), and in certain situations, a mammogram. These diagnostic tools help provide a comprehensive health profile, aiding in the formulation of a safe and effective surgical plan.

What Is an En Bloc Capsulectomy?

“En bloc capsulectomy” is a surgical technique derived from the French term “en bloc”, meaning “all together” or “as one piece”. In the context of breast implant removal, en bloc capsulectomy refers to the method whereby the breast implant and the surrounding scar tissue capsule are removed as a single entity, without opening or rupturing the capsule during the process. The intention is to prevent any potential contaminants within the capsule from leaking into the body.

RELATED: En Bloc Technique For Breast Implant Removal

Is En Bloc Capsulectomy challenging to perform?

It’s crucial to understand that en bloc capsulectomy is a complex, demanding surgery for both the surgeon and the patient. From the surgeon’s perspective, the operation requires extensive expertise, meticulous attention to detail, and considerable time investment.

The scar tissue capsule itself is incredibly delicate, often less than a millimetre thick, which can tear easily. Consequently, the procedure necessitates a larger incision compared to typical implant insertion or straightforward implant removal.

For the patient, the recovery process can be challenging, with common post-operative symptoms including discomfort, pain, and soreness. Sometimes, bleeding may occur post-surgery. To alleviate potential swelling and fluid build-up due to muscular trauma, surgeons frequently place drains in the breast area.

Am I suitable for en bloc capsulectomy?

Determining whether you are a suitable candidate for en bloc capsulectomy is an essential discussion to have with your surgeon. This technique isn’t appropriate for every patient. In certain situations, the scar tissue capsule becomes so delicate that it’s virtually impossible to remove in one piece. Moreover, it’s not advisable when the capsule is adjacent to the rib cage, as deeper incisions in this area may lead to a punctured lung cavity and elevated post-operative pain. Due to these complexities, surgeons often avoid making absolute promises about performing en bloc capsulectomy.

The appearance of your breasts following en bloc capsulectomy will depend on several factors, including the size of the implant, the degree of breast tissue displacement, skin elasticity, and whether you’re opting for implant replacement or removal.

Consulting with an experienced plastic surgeon will guide you towards restoring your breasts’ natural aesthetics. However, you should anticipate new scars and be aware of potential surgical risks. Extensive research and comprehensive discussions with your surgeon are key to fostering realistic expectations ahead of the procedure.

At Centre for Surgery, we encourage patients to view a range of before and after photographs from individuals who have undergone the procedure, both with and without implant replacement and lifts. This visual reference will provide a more concrete expectation of potential postoperative outcomes.

Capsulectomy for Capsular Contracture

A capsulectomy is a surgical procedure designed to rectify issues stemming from capsular contracture and other implant-related complications. Capsular contracture refers to the body’s response to foreign material, such as a breast implant. This reaction can prompt the production of collagen, which then inflames the surrounding tissues, rendering them fibrous, firm, and potentially painful.

It’s worth noting that these complications can arise immediately post-surgery or might take years to manifest. However, in many cases, these issues do not present at all, particularly when recommended precautionary measures are taken.

Capsular contracture can be categorised into four grades:

Grade 1: The breast retains a natural appearance and feels soft.

Grade 2: The breast appears natural but feels slightly firm.

Grade 3: The breast appears distorted, feels firm, and is hard to touch.

Grade 4: The breast appears distorted, is hard, and causes pain.

Addressing capsular contracture typically involves performing either a partial or complete capsulectomy, often followed by implant replacement, if desired by the patient. It’s important to highlight that capsulectomies are not solely conducted to treat capsular contracture.

Other reasons for undergoing a breast implant removal procedure include the following:

Silicone Gel Implant Rupture: This condition arises when a tear forms in the silicone implant’s outer shell, leading to gel leakage.

Capsule Infection: The region surrounding the capsule may become infected.

Implant Extrusion: Occasionally, the implant can protrude through the skin.

BIA-ALCL: This is a rare form of cancer that develops within the scar capsule that encapsulates the implant.

BII – Breast Implant Illness: This is a condition associated with a wide range of symptoms related to having implants. While a lot about BII’s causative factors remains unclear, diligent medical research continues to offer better understanding and treatment options.

How Is Capsulectomy Different From an En Bloc Capsulectomy?

The terms capsulectomy and en bloc capsulectomy are often used interchangeably, but they refer to slightly different procedures.

Capsulectomy is a broad term, referring generally to the removal of a breast implant along with its surrounding scar tissue capsule. There are two types: partial and complete. During a capsulectomy, the capsule is removed in sections or pieces.

On the contrary, en bloc capsulectomy entails removing the breast implant and scar tissue in a single, unbroken piece without slicing into the capsule. This approach is considered more invasive than a partial capsulectomy. It has gained considerable attention on the internet, and numerous plastic surgeons profess their expertise in this technique.

Despite its popularity, the en bloc technique won’t necessarily affect the outcome of the surgery. Actually, it’s considered more invasive, leading most surgeons to prefer a partial capsulectomy. However, this isn’t to say one technique is superior to the other. The choice of procedure can only be decided after a comprehensive evaluation of your condition by an experienced plastic surgeon at our Baker Street clinic.

In particular situations, like implant rupture or risk of BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma), an en bloc capsulectomy may be preferred as it minimises certain risks. This method can alleviate symptoms related to BIA-ALCL and ensures the safe removal of implants, contributing to enhancing your comfort and overall well-being.

The importance of choosing a specialist plastic surgeon for capsulectomy surgery