Implant Removal, Total Capsulectomy, En Bloc
Breast Implant Removal with Total Capsulectomy or En Bloc
Dr. Daniel Krochmal demonstrates removal of a breast implant for severe capsular contracture. When possible, Dr. Krochmal tries to remove the implant and capsule as a single unit. When only the implant and capsule (scar shell) are removed, he carefully frees the capsule in such a way that as much of the breast tissue is preserved as possible. This technique can also be used for patients with symptoms attributed to the breast implants, also known as Breast Implant Illness. When there is a true cancer (for example, BIA-ALCL), then a formal “En Bloc” procedure is done, which includes a rim of healthy tissue around the capsule containing the cancer. The term “En Bloc” should only be used when referring to a true cancer operation.
What is En Bloc Breast Implant Removal?
“Total Capsulectomy” is a technique where the breast implant is removed along with the entire protective scar surrounding the implant (called the “capsule”). The body naturally forms a scar shell around almost every foreign object placed in the body (joint replacements, pacemakers, etc.) to try and “wall it off”, and breast implants are no exception. Normally this capsule is thin, soft, and flimsy. However, sometimes this capsule can be thickened and hardened/calcified, and can contract in such a way where the breast implant is distorted (called a “capsular contracture”). If the capsular contracture becomes significant, then sometimes it’s necessary to remove the capsule along with the breast implant. A Total Capsulectomy is also performed if patients feel their body is reacting to the implants and causing symptoms (referred to as “Breast Implant Illness”, or “BII”).
When the entire capsule is removed along with the implant and includes a rim of healthy tissue, this is called “En Bloc” breast implant removal. This scenario is becoming more common with patient concerns regarding Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). The term “En Bloc” should be reserved for a formal cancer removal procedure.
How is Total Capsulectomy and En Bloc Breast Implant Removal Done?
The procedure involves making an incision in the breast (many times the incision used to insert the breast implant can be used) and carefully separating the capsule from the rest of the breast tissue to remove the capsule and the breast implant as a single unit (when “En Bloc” removal is done, a healthy rim of tissue surrounding the capsule is also removed, as it’s a formal cancer operation). Some patients are OK with just removing the implant, while others desire to have another breast implant placed (for instance, replacing a textured implant with a smooth implant). Sometimes simply removing a breast implant can leave the breast looking saggy due to the extra skin present, so many patients elect to have a breast lift to create a more pleasing breast shape after the implants are removed.
Who is a Good Candidate for Total Capsulectomy or En Bloc Breast Implant Removal?
A good candidate for Total Capsulectomy Breast Implant Removal is a patient with a significant capsular contracture, is concerned about it developing, or a patient who believes they have BII/Breast Implant Illness. It should be noted that at this time there is significant research being conducted into the nature of BII, and which symptoms may improve or not improve with breast implant and capsule removal (for example, if there is actually something else causing the symptoms, then removing the breast implants wouldn’t improve those symptoms the patients are having). If a patient has a formal cancer surrounding the implant (e.g. BIA-ALCL), then a formal En Bloc Breast Implant Removal is performed.
Of course, a patient may just wish to have their implants removed for any reason. If a patient has smooth-walled implants, and isn’t having concerns for BIA-ALCL or BII, then many doctors (including Dr. Krochmal) will simply remove the implant and leave the harmless capsule in place, as removing the capsule is unnecessary and can possibly lead to more surgical complications or breast shape distortion.
What is the Recovery for Total Capsulectomy or En Bloc Breast Implant Removal?
Total Capsulectomy breast implant removal recovery is pretty straightforward. You’ll be a bit sore for a few days, but many times patients report the discomfort is less than the initial augmentation procedure when the implants were placed. You’ll get pain medication to help with the discomfort. Most patients are out to dinner the following day, and driving after several days. You can shower the next day, but no soaking in water, heavy lifting, or strenuous activity for 1 month to allow for the tissue on the inside to heal properly. You may have a surgical drain placed to reduce the fluid build-up and swelling, and these are typically removed within 1 week of surgery if they are used. If an En Bloc breast implant removal is performed, the recovery may be a bit more involved due to the more extensive procedure.
What About BIA-ALCL and BII?
If there is concern about your implants or the capsule (for BIA-ALCL), then some of the tissue may be sent to the lab for testing. If the tests come back positive for BIA-ALCL, then your doctor will talk to you about next steps. The good news is that en bloc breast implant removal for BIA-ALCL is curative in the vast majority of cases! You may still be referred to an oncologist as a safety measure. If one breast has BIA-ALCL, many doctors will recommend en bloc breast implant removal on the other breast as well.
For Breast Implant Illness (BII), there are no labs to check at this point in time to document success. There is no guarantee that the symptoms patients are experiencing will go away with breast implant removal and removal of the capsule (the whole thing or just part of it).