Mark Sisco, M.D.
501 Skokie Boulevard
Northbrook, IL 60062
Phone: (847) 504-2333
Monday: 8:30 a.m.–6 p.m.
Tuesday–Friday: 8:30 a.m.–5 p.m.
Breast Explant Procedure: What Is En Bloc Capsulectomy?
Recently, I have received more inquiries at my Northbrook plastic surgery practice regarding having breast implant removal surgery. The most common reasons for a woman to choose to have her breast implants removed are health concerns, changes to the implants and the breasts over time, and the feeling that the implants are too large or heavy for her body.
When you choose to have breast implant removal surgery, or breast explant surgery, there are some options available, which you should discuss with a board-certified plastic surgeon. The simplest approach is to remove the implants while leaving the scar tissue capsule in place. A more complex approach is to perform an explant capsulectomy, in which the implants and the scar capsule are removed from the breasts. The most complex option for removing breast implants is an en bloc capsulectomy, in which the implants and scar capsule are removed intact.
Since this is the most complicated option for breast implant removal, I will provide some additional insight into the en bloc capsulectomy procedure.
What is en bloc capsulectomy?
En bloc capsulectomy is a procedure in which the scar tissue around the implant, known as the breast capsule, is removed in one piece with the implant enclosed within it. The benefit to removing the capsule en bloc is that it prevents the implant (or implant material) from coming into contact with normal tissues left behind. This is especially useful in the case of implant rupture, but also may benefit those concerned about implant toxicity and breast implant illness. Total capsulectomy means removing the entire capsule, but not necessarily in one piece.
En bloc capsulectomy is not a simple procedure. It poses challenges to surgeon and patient alike. First, it is more difficult to perform than standard implant removal. In many cases, I find doing an en bloc capsulectomy to be more physically demanding than doing microsurgery! It takes more time, more difficult lighting, more effort to retract adjacent tissue, and more meticulous attention to detail. The capsule can be less than a millimeter thick and can be easy to tear. In order to “get around” it, a larger incision must often be used than was made to place the implant. In addition, the capsule must be teased away from the adjacent tissue (which may be breast, muscle, or rib), which can cause more damage to structures left behind. Patients are more sore than after simple implant removal and are more likely to have bleeding. To prevent fluid from accumulating as a result of the additional trauma, I leave drains in place, which are also a nuisance. Finally, if the implant is replaced, the lack of scar tissue left behind can make it more difficult to control where that implant ends up.
Who is a candidate for en bloc capsulectomy?
Not all patients are candidates for en bloc capsulectomy. On occasion, the capsule is so flimsy (imagine wet toilet paper) that it is impossible to remove in one piece. This is especially true for thin capsular tissue adjacent to the ribcage, where cutting too deep can lead to a punctured lung cavity or prolonged pain. Because of this I rarely guarantee en bloc capsulectomy; but I do promise a good faith effort to remove all of the capsule tissue in a way that minimizes creating additional injury.
How will I look after implant removal surgery?
A lot of women ask whether they will look good after en bloc capsulectomy. This can be a very difficult question to answer. The appearance of the breast depends on its size relative to the implant, the degree to which the breast tissue has been displaced over time, and the degree of skin elasticity that remains. Whether things look good depends on these physical factors, but also on how a woman perceives her “new” breasts in the context of how she feels about her body and whether her breasts play the same role they did when the implants were placed. In experienced hands, breast lift procedures can go a long way toward restoring a natural breast appearance. However, a lift creates new scars and may be associated with more surgical risk. So it’s really important to make this decision in conjunction with your surgeon, in person, so that you understand what to expect and what other patients like you have experienced.