En Bloc Capsulectomy And Breast Implant Removal

What is En Bloc Capsulectomy?

En bloc capsulectomy is a surgical technique performed to remove breast implants and the surrounding scar tissue, known as the capsule, as a single intact unit. En bloc capsulectomy is a term that patients will often use if they are worried about their implants and would like to have them removed or exchanged.

The term is used where the implant has ruptured, capsular contracture has occurred, or there is suspicion of breast implant illness (BII). The idea is that by removing the entire capsule, including any potentially contaminated or damaged implants en bloc, it aims to minimise the risk of implant leakage, recurrence of contracture, and potential health issues associated with textured breast implants.

Do I Need An En Bloc Capsulectomy?

From a medical point of view, a true en bloc capsulectomy is only rarely needed and might actually be harmful in a situation if it is not indicated.

We tend to use the term ‘en bloc’ to describe the removal of a cancer and it involves removing all of the tumour with the surrounding tissues.  The idea is that you do not cut in to or see the tumour and you remove the specimen is a whole as a block.

With that in mind, the only situation where I would say that an en bloc capsulectomy and implant removal would really be indicated would be if there was a tumour of the capsule, which is a very rare situation.

Many patient requesting en bloc capsulectomy really just want the implant and the capsule removed completely, which would be a ‘total capsulectomy’ as opposed to an ‘en bloc capsulectomy’ – an important distinction to be made.

If you are not sure what a capsulectomy is, then you can read my blog post where I talk about capsular contracture around breast implants here.

I spoke about en bloc capsulectomy in one of my live Q&A’s that I host every Tuesday evening at 7pm, you can watch it here:

The Process Of Doing A Capsulectomy And Implant Exchange

The incision to put breast implants in, is usually 5cm long and sits in the fold where your bra sits.  When changing implants, I would use the same excision by cutting it out and giving a fresh scar in the same place of about the same size.  The normal process of doing a capsulectomy and implant exchange would involve dissecting out the implant with the surrounding capsule as much as possible through the 5 cm incision.

However, there comes a time during the operation where it is not possible to see over the horizon of the encapsulated implant through such a small incision.  When this time comes, I would make a hole in the capsule and remove the implant (the implant itself is soft and it only feels hard because of the scar tissue that has formed around it), which would cause the capsule to deflate and allow it to be removed through the original 5cm incision in the fold.

You can see from the photos below the difference between removing an implant with the capsule intact around it ‘en bloc’ compared with taking the implant out first and then removing the remaining capsule.



In order to remove the implant and breast capsule ‘en bloc’, we would need to make a much larger incision in the skin which would in turn, leave a much longer scar.  This is unnecessary in most cases since there is usually no proven pathology within the scar tissue and it just needs to be removed.  There is no danger in cutting in to the capsule in the same way that we would worry about cutting in to a cancer during an operation which could potentially spill cancer cells in to the wound.

The exception is if you require a mastopexy at the time of implant removal, as there is much more exposure and and en bloc capsulectomy is a more realistic expectation.

Want To Know More About En Bloc Capsulectomy?

If you have any questions about en bloc capsulectomy or if you are worried about your breast implants, then you can get in touch with us here.

If you would like a free copy of our Brochure, then you can request one here.

You can also see Mr Staiano, our director, on Instagram, YouTube and Facebook Live every Tuesday evening at 7pm, so you can ask questions there or post your questions to info@staianoplasticsurgery.co.uk beforehand using the hashtag #AskJJ.

FDA Approved Breast Implants

Do I Have FDA Approved Breast Implants?

In the UK, breast implants are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) rather than the US Food and Drug Administration (FDA).

However, there is still a great deal of confusion around whether or not breast implants in the UK need to be FDA approved.

The FDA is a US government agency that is responsible for protecting public health by regulating medical devices, including breast implants.

The MHRA, on the other hand, is the UK’s regulatory body for medical devices and is responsible for ensuring that all medical devices, including breast implants, meet certain safety and quality standards before they can be marketed and sold in the UK.

While the MHRA does not require breast implants to be FDA approved, it does require them to meet the same safety and quality standards as medical devices that are approved by the FDA. This means that breast implants sold in the UK must be tested for safety and effectiveness, and must meet strict manufacturing and labelling requirements.

However, there are a wider range of implants available in the UK compared with the US and not all of the implants that we use in the UK have been approved by the FDA.

It is important to note that there have been concerns in the past about the safety of certain types of breast implants, including those filled with silicone gel. In 2019, the FDA issued a recall of certain textured breast implants due to their link to a rare form of cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). While this recall did not affect all breast implants, it highlights the importance of ensuring that all medical devices, including breast implants, are rigorously tested and regulated for safety.

In conclusion, breast implants in the UK do not need to be FDA approved, but they must meet the same safety and quality standards as medical devices that are approved by the FDA.

The Trident Approach To Choosing The Right Breast Implant

Choosing the right breast implant can seem daunting.

There is a dazzling array of sizes and shapes of breast implants out there and you will be forgiven for thinking that it is an impossible decision.

…but fear not

It is not as complicated as it may seem.

I have specialised in breast surgery since 2007 and have developed a process that simplifies the decision making and takes away the myths and opinions that you will find freely distributed by anyone and their aunt.

Here at The STAIANO Clinic, we follow a three step process known as The Trident Approach.

Step 1: measure the base width of your breast

This is the most important part of choosing the right breast implant, yet it is the least talked about on online forums and chats.

You cannot have any implant that you want.

When you look at the vast number of breast implants in the breast implant catalogue, a huge proportion of them are already unsuitable for you because they will not ‘fit’ your breast.

It is essential to get this right because if the implant is too wide, you run the risk of synmastia which is a web between your breasts, this is sometimes referred to as uniboob and is a difficult problem to correct. The other issue with using an implant that is too wide is that it can stick out too far to the side and your arm will catch on the side of your breast.

If your implant is too narrow, then, because they usually have a round base, it may not be tall enough to fill the upper part of your breast and will not fill the footprint of your breast, so you may not achieve the fullness that you desire.

Once we have measured the base width of your breast, you will automatically be limited at to the range of implants that will suit you.

Step 2 – look at the different shapes and profiles of implants

Breast implants come in 2 shapes:

  • Round
  • Teardrop

They also  come in different profiles which means that some are more prominent than others.

They are commonly termed, low, moderate, high and extra high profile. Although not all companies use this terminology – Mentor for example have a moderate plus profile (but not a low profile) and Motiva has different names for them, although the principle for all of them is the same – some implants stick out more than others.

It is not as simple as saying that a certain shape or profile will give a certain look, because it depends on the natural breast tissue that you already have.

When choosing the shape and profile, we need to take in to account the size and shape of your breasts – it is not a one size fits all.

This is why it is not possible to give a useful opinion online. You need to have an in person consultation with a plastic surgeon so that we can discuss your aims and then examine you and assess your body and breast shape before considering the shape of implant to have.

Step 3 – choose the implant volume

This is the final thing to look and yet this is often the starting point for many people.

Contrary to popular belief, the size of the implant is not as important as people think.

In fact, if your friend tells you that they have a 300cc implant and they have a good result, that is not really helpful to you. There are a whole variety of 300cc implants.

It mainly depends on the base width.

If your friend has a wide chest, then she may have a low profile 300cc implant, whereas if you have a narrow chest, then it may be an extra high 300cc implant that will be the best fit for you.

These will give two completely different looks, not to mention the need to take in to account yours and your friend’s breast size and shape before you start.

Clearly the size of your implant plays a part and you will need to be comfortable with the volume.

We use sizers at the clinic and this will allow you to ‘try on’ different volumes to get an idea of the sort of volume that you feel comfortable with, however the volume that you can have will be dictated by the base width of your breast and the shape and profile of the implant that you choose.

You can register for my webinar on ‘Choosing The Right Breast Implant’ Here

Whilst it can be a daunting experience to choose the right breast implant, when you approach it with The Trident Approach, it brings a system that takes some of the mystery away.

To find out more details about having breast implants at The STAIANO Clinic, click here.

How to treat Breast Asymmetry

We specialise in breast reshaping here at the STAIANO Clinic and can perform breast lifts, breast reductions, breast implants and breast lift with implants.

There are many cosmetic clinics which offer breast implants but not all will treat patients with more complicated problems.
Patients with breast asymmetry will often present for surgery.

The first question we would ask is:

Are you happy with either of your breasts or do you want them both changed?

If we can just operate on one side then this will lower the risk of complications and be beneficial for all.

It may not always be possible to just operate on one side, particularly if one breast is sitting lower than the other one with uneven heights of the nipples.

It is possible to lift the nipple, but it is not possible to lower a nipple (at least not without leaving a scar where the nipple was). So we can raise the low one, but is extremely difficult to lower the high one.

The next question to ask is:

Is there a problem with the shape, the volume or both?

In general terms, problems with the shape involve a breast lift and problems with the volume involve breast implants or breast reduction, (depending whether you want them bigger or smaller).

Surgery for breast asymmetry usually involves a combination of breast implants, breast lift and sometimes breast reduction.

Different things need to be done to each breast and so there is always a risk that they will settle differently and you may have to accept some degree of asymmetry.

Everybody is born with a degree of asymmetry and this is quite natural.

What we aim to do with surgery for breast asymmetry is to bring your breasts and your frame back into balance and make it easier for you to wear clothes and bras without needing to use a chicken fillet or external prosthesis in one side.

If you have different size breasts with one sitting lower than the other (usually the bigger one), you could have them made the same size by using different size implants.

The implants come in set volumes and so we would be unlikely to make them identical and would usually need to use a sizer in theatre to work out the best match.

The implants would not do anything about the shape of your breasts and so one would still be sitting lower than the other.

This would probably not be an issue when wearing clothes but may be an issue out of clothes.

In order to correct this you would need a lift of the breast that was sitting lower, which is usually the bigger one and so it would also be possible to perform a reduction at the same time as the lift to balance out the volume.

Then we could use the same size implant in each side.

This is something that we could discuss in the clinic and there is no right or wrong answer.

Some patients would prefer not to have breast tissue removed and then replaced with an implant and would prefer different sized implants.

Others would rather have a reduction to match the size and the same size implants so as you age or undergo weight fluctuations, it is more likely to have a symmetrical change in your breasts.

Treatment of breast asymmetry is complicated and requires a bespoke approach and a partnership between the surgeon and the patient so that a plan can be made that can produce a realistic expectation with acceptable risks and an acknowledgement of the limitations of what we can do.

If you have a breast asymmetry and have any specific questions then I do a live Q&A every Tuesday at 7pm on Facebook and I would be happy to give my opinion.
If you want to come to the clinic for a consultation then you can contact us here or phone (0121) 454 3680. We would love to see you.

You can download my breast implant guide here.

You can download my breast reduction and breast lift guides.


Why does breast reduction cost so much?

If you think that breast reduction costs a lot then it is important to put it into perspective.

Some patients put breast reduction into the category of cosmetic breast surgery and think of it in the same way as other operations like breast augmentation.

Any cosmetic surgery is a major undertaking both physically and psychologically because you are changing the way you look.

However when it comes to the extent of surgery, breast reduction can be a significantly bigger procedure than breast augmentation.

When taking in to account breast reduction cost, you have to realise what is involved.

Breast augmentation surgery takes about an hour in theatre whereas breast reduction takes three hours in theatre.

If you have ever seen the inside of an operating theatre (check out my video), you will see that there are 5 to 10 members of staff at all times all of whom have specific areas of training and expertise.
Not to mention what goes on in the background to keep a hospital running with all the administrative costs and overheads.

There is usually at least a one night stay in hospital and this will all be covered in the one-off cost that you pay.

I sometimes notice that my colleagues think that we as plastic surgeons get paid a lot because they see the headline rate that we receive when doing surgery.
However there is a big difference when working in the self-pay market compare to the insured market.

Whilst the cost of breast reduction is significant, it is a one off payment and all aftercare, outpatient visits and follow-up appointments are included in the price.

My colleagues who do insured work get paid for every intervention.

If they see you in the clinic, if they perform an x-ray or other tests, or if they have to perform any other procedures “ they will be paid at every stage.

After performing a breast reduction, we will see you in the clinic on a regular basis to ensure that your wounds heal, your scars soften and the shape of your breasts settles.

We want to make sure that you are happy with everything.

Furthermore, we will continue to see you in the clinic if you ever have any problems or concerns at any time.

There may be some patients who need very little input from us but there are others for whom this will be invaluable.

It comes down to how much value you get from a procedure as to whether it is worth the cost.

Breast reduction can be life changing on several levels:

  • on a physical level by removing the weight from your chest, reducing back and neck strain and not having your bra straps digging in.
  • on a practical level by allowing you to shop on the High Street for bras and be able to wear the clothes that you want to wear.
  • and on a emotional level by feeling in proportion and more comfortable with your body and improving self esteem and self-confidence.


It is hard to put a price on this.

I understand that breast reduction cost is a major determinant when someone is choosing surgery but I don’t think it should be the only one.

Here at The STAIANO Clinic, we are very aware that many other clinics offer the same procedures and we need to be competitive.

I have built the clinic so that we can compete on a worldwide scale when it comes to the qualifications of us as plastic surgeons, the level of care and treatment that we give and the time and space that we give you as an individual patient.

Not to mention the aftercare that we offer.

It is hard to do this and still be able to compete on price and so I realise that if you shop around, you will be able to find surgery cheaper elsewhere.

Whilst we can’t always compete on price, I know that we can compete on quality.

If you want to find out more you can download our guide with some frequently asked questions here or call us on (0121) 454 3680

You can also read more by visiting our Breast Reduction page.

If you want to know what a breast reduction costs at The STAIANO Clinic, then click here and we will send you not only how much it costs but also what we offer for that cost.

As always feel free to comment and if you have any questions you can find me on Facebook with a live Q&A every Tuesday at 7 pm


Smooth Breast Implants

There has been a resurgence recently in the use of smooth breast implants for breast enlargement.

Breast implants were invented in 1961 and the first manifestation of them had a smooth shell.

This was not adherent when placed inside the breast and had a tendency to move and for visible rippling.

In 1968 polyurethane foam implants were introduced which consisted of a silicone implant surrounded by a three-dimensional foam.

The scar tissue would grow into the foam rather than forming a smooth shell around the implant and so when it contracted, it was broken up by the foam and it did not compress the implant and make it feel hard.

In the 1990s there was controversy about polyurethane implants and they were withdrawn from the market for a period of time.

It was recognised that the roughness of the foam was beneficial in the development of capsular contracture and so the shell of smooth implants was roughened in a process known as ‘texturing‘ to roughen the surface and mimic polyurethane foam.

In the UK, textured silicone implants have been the mainstay for breast enlargement with only a minority of cases performed with smooth silicone implants.

Until now…

ALCL is a cancer of the capsule around breast implants and has been associated with the texturing of the implant.

For a long time there were no cases of ALCL in patients with smooth breast implants.

There are some now, but it is a lot less likely to occur in patients with smooth breast implants compared to those with textured or polyurethane foam implants.

For this reason, many surgeons are moving towards smooth breast implants rather than textured breast implants.

Time will tell whether we start to see more problems with rippling or capsular contracture.

Here at the STAIANO Clinic, we are not tied to any make or manufacturer of breast implants.

We will talk to you about the pros and cons of smooth implants, textured implants and polyurethane foam implants so that you can make the best decision for you.

There are risks of using smooth implants which is why they were modified in the early days of implant development.

However there is now the benefit of the low risk of ALCL which needs to be balanced against these risks.

If you have any questions about breast implants you can download my guide with Frequently Asked Questions here or join me on Facebook LIVE at 7pm every Tuesday evening when I hold a Q&A every week.

I am holding a breast implant event from 5-7pm on Wednesday January 29th 2020 if you have any questions about breast implants and want to learn about the pros and cons of the different types of implants as well as alternatives to having breast implants at all.

Feel free to come along and please bring a friend. There is no need to book but if you book in advance, you can have a free sizing session with our clinic nurse Vicki.


If you have any questions you can contact us on 0121-454 3680 or email us at info@staianoplasticsurgery.co.uk


Cosmetic surgery is never just cosmetic

It’s good to see the news article about Simona Halep who has just won the ladies Wimbledon singles final.

She credits a breast reduction to be part of her success.

This was featured in an article in the Daily Mail in 2014 where one of my patients spoke about here experience – you can read it here.

You see, while she never liked the size of her breasts, it was also interfering with her ability to play tennis.

You see cosmetic surgery is never purely cosmetic, or at least not very often.

¦when it is done well.

We see patients who enjoy horse riding, running and we have a haute couture fashion model

¦but we also have mothers and wives who just feel uncomfortable or unhappy with their body shape.

Contrary to popular opinion most people don’t want to walk into a room and attract unwelcome stares and attention.

They just want to feel comfortable in their body physically and psychologically and that is what cosmetic surgery can do.

It brings psychological benefits as well as physical benefits.

You don’t have to be championship tennis player to understand the benefit of having 2kg of breast tissue removed from your chest or 3kg of an abdominal apron removed from your tummy.

It is good to see cosmetic surgery reported with a positive light because all too often, the media portrays cosmetic surgery as creating some freakish caricature of a body.

Most people who come to our clinic, walk out of the clinic looking the same or similar to how they looked when they walked in.

Perhaps they are not needing to wear ‘chicken fillets’ in their bra, or they don’t have to wear baggy jumpers anymore

¦or maybe they just look a bit less tired and more refreshed.

Their friends might think they have had their hair done or changed their make-up, when in fact they have had a blepharoplasty or botox.

It is about making people feel more comfortable, whether they are playing championship tennis or going out for lunch.

¦and that can only be a good thing, right?

If you have any questions about cosmetic surgery, I am available every Tuesday night at 7 pm for a live Q&A on Facebook.

Click here to Download our guide with Frequently Asked Questions about Breast Reduction

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Why Would Anyone Have Breast Implants?

Why Would Anyone Ever Want To Have Breast Implants?

I keep seeing adverse publicity about breast implants in the media.

Whether it be breast implant illness, ALCL or a celebrity with out of proportion breast implants or with visible rippling or strange looking breasts.

The media seems to love to focus on the negative aspects of cosmetic surgery and breast implants in particular.

Someone who would not consider having breast implants might be forgiven for wondering why anyone would go through with such a procedure.

What the media failed to focus on is the positive effects that breast implants can be bring.

Any responsible surgeon will tell every patient the risks as well as the benefits of having surgery.

Breast Implants, Like Any Surgery, Carry A Risk

 In the same way that there are potential downsides of having a hip replacement or open-heart surgery, there are also benefits and it is ultimately up to the patient to weigh the risks against the benefits and decide whether surgery is right for them.

If the media focused on a patient with an infected hip replacement or a failed coronary artery bypass graft you might be extremely nervous if you are thinking of having these procedures.
However the reality is that the vast majority of operations produce far greater benefit than harm.
I’m not trying to justify breast implant surgery or make out as if there aren’t negatives.

There is no doubt that there are people who have been unhappy with having implants but what I would like to see is balance in the media proportionate to the outcomes that can be achieved.

The mother who has had children or a young woman who has always felt out of proportion can gain immense emotional as well as physical benefits from restoring volume and shape to their breasts.

…but this would not make a very compelling magazine article.

Base Your Decisions On Facts

The things that I hear about in the media such as breast implant illness, ALCL or implant rupture are not things that I see on any sort of regular basis in the clinic.

You need to make an informed decision if you’re considering having breast implants but make sure you base that decision on evidence and facts rather than articles or personal opinions.

There is no doubt that there are potential downsides of having breast implants but the patients who really benefit are the ones that accept and acknowledge these downsides but also realise the tremendous upside that can be achieved with what is at the end of the day, a relatively simple operation.
Don’t take my word for it, do you research but try to make sure that you base your decisions on the best evidence that you can find rather than opinion in a glossy magazine.

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Liposuction for Man Boobs

Liposuction for man boobs (or gynaecomastia, which is the medical term) is the mainstay of treatment.
However, it is often not enough to perform liposuction on its own.

Man Boobs are caused by an excess of breast tissue in a male, and males have breast tissue as well as females.

Breast tissue is made up of a combination of fatty tissue and glandular tissue and patients with man boobs often have dense glandular tissue behind the nipple.
Liposuction is very good at removing the fatty tissue and contouring the chest, but it cannot remove the dense glandular tissue.

Liposuction is good, but it may not be enough

If there is glandular tissue beneath the nipple and you just have liposuction, this dense tissue is left behind and you might still have a hard lump leaving the nipple looking puffy.

No one wants a scar, but we can hide them pretty well

This is why liposuction often needs to be combined with excision using a U-shaped excision at the lower border of the areola which can be difficult to see when it is healed as shown below:

It is often by combing liposuction with excision, the dense glandular tissue can be removed and the whole chest can be contoured to give a balanced and athletic look to the male chest whilst hiding the scars, so that once they have faded they are difficult to see.

A combination of liposuction and excision allows us to directly address both the fatty tissue and the glandular tissue and effectively remove the excess breast tissue.

If you want to know more about liposuction for man boobs and other frequently asked questions, you can download my guide here.

If there is anything I haven’t covered, then join me on Facebook Live at 7 p.m. every Tuesday night when you can pitch your questions directly to me, or you can e-mail here if you would prefer a more direct reply.

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