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.

En Bloc Capsulectomy

Capsule And Implant Removed Separately

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 [email protected] beforehand using the hashtag #AskJJ.