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What is the Difference Between En Bloc Implant Removal, Total Capsulectomy, and Partial Capsulectomy in Breast Implant Removal Surgery

For many reasons, I am seeing an increased number of patients for consultation on breast implant removal, also known as explant surgery. Some of these women are concerned about breast implant illness, others simply prefer to avoid the future ‘maintenance’ associated with breast implants, and some women and interested in breast implant removal for cosmetic or lifestyle issues. Either way, it is clear that there is confusion surrounding the terminology associated with breast implant removal or explant surgery.

To date, there are few agreed upon surgical indications for the removal of breast implants and the capsule surrounding the breast implant other than severe capsular contracture and ALCL (a rare lymphoma that can be associated with textured implants). Some large, online breast implant illness support groups strongly advocate for implant removal and total or en bloc capsulectomy as the treatment of choice for breast implant illness. However, the American Society of Plastic Surgeons as well as the American Society of Aesthetic Plastic Surgeons cautions against widespread en bloc capsule removal or total capsulectomy for patients worried about breast implant illness but without other clear surgical indications. Currently, these large plastic surgery organizations, as well as the online breast implant illness support groups, do agree, however, that there is no guarantee that implant removal with or without removal of the capsule will “cure” symptoms thought to be associated with breast implant illness. To see more information about breast implant illness, please see my previous blog posts or return frequently for more posts on this evolving topic.

Thus, I would like to clear up the confusion around the terms used for discussing breast implants, the capsules, and their partial or complete removal.

Capsule- The scar tissue that naturally forms around any foreign object placed inside the body. Any object not naturally found inside the body, such as a splinter, prosthetic knee, or breast implant, will cause the formation of a layer of scar tissue, or capsule, to form and encase the foreign body. When discussing breast implants, the capsule is the layer of scar tissue that forms around the breast implant, analogous to a baby enclosed in a placenta inside the mother’s body.

Simple Breast Implant Removal- A simple breast implant removal involves an incision down to and through the implant capsule in order to remove the unwanted breast implant. During this surgery, the capsule is left in place and not removed. The capsule will then shrink in size and often times be “broken down” and “dissolved” by the body naturally.

Breast Implant Removal and Partial Capsulectomy- A partial capsulectomy is performed when in addition to breast implant removal, small portions of the capsule are removed as well. The areas of capsule removal are often used to treat capsular contracture or to provide a tissue sample for pathological evaluation. Similar to a simple breast implant removal, the remaining capsule will then later shrink in size or possibly be incorporated by the body.

Breast Implant Removal and Total Capsulectomy- A total capsulectomy is performed when the entire capsule is removed after removal of the breast implant. In this case, I usually dissect the superficial surface of the capsule, open the capsule and remove the breast implant, then continue dissection of the deep surface of the capsule. The entire capsule is removed either in one piece, or multiple pieces, depending on the ease of surgery, and is thus called a total capsulectomy. This is analogous to delivering a baby after the placenta has broken, then delivering the placenta once the baby is safely delivered.

Breast Implant Removal and En Bloc Capsulectomy- An en bloc capsulectomy is performed when the capsule is removed in one piece with the breast implant contained inside the capsule. This is analogous to delivering a baby still encased in an intact placenta. Those active on social media breast implant illness sites advocate en bloc removal of breast implants to prevent further “contamination” of surrounding tissues during removal of intact or ruptured breast implants. However, it is not possible to guarantee en bloc removal of breast implants, particularly when the breast implants have been placed under the pectoralis muscle. When implants are placed under the muscle, it can be difficult, if not impossible, to remove a breast implant with en bloc capsulectomy because the backside of the capsule is attached to the ribs and intercostal muscles. Attempts to remove the capsule en bloc can prove disastrous if injury to the underlying ribcage and lungs then occurs during dissection. Because of this, I always tell my patients requesting an en bloc capsulectomy and removal of breast implants that I will do everything in my power to remove their implants en bloc, but I will not risk their life or injury to the ribcage or lungs. In these cases where an en bloc capsulectomy cannot be performed due to safety concerns, I then convert an en bloc capsulectomy to a total capsulectomy. The breast implant and all capsule material is removed as planned, but it is removed as separate pieces, not in one, intact unit.

If you are interested in breast implant removal or explant surgery, please call today for a complimentary consultation with me, Dr. Traci Temmen. I will do everything I can to educate, help you feel comfortable with the surgical plan, and provide peace during this potentially stressful time. My staff and I are experienced in dealing with all types of breast implant removal and capsulectomy cases, and we will treat you the way we would want our family to be treated.

Traci Temmen, M.D.
Female, Board Certified Plastic Surgeon
Tampa, Florida