Should I have an En bloc Capsulectomy?

What is the Right Explant Surgery Technique to remove breast implants?

  • Interested in having breast implant removal surgery?
  • Wondering what surgical technique would be better?
  • Do you want to know whether an en bloc procedure is necessary?

Breast implant surgery can lead to complications. The rate of complications is fairly low when it comes to breast augmentation surgery especially if you choose the right plastic surgeon. With that being said, it can happen to anyone. You might be dealing with a rupture, breast pain, swelling, seroma, inflammation, BII or BIA-ALCL. You may need breast implant revision surgery and whether you want to get your implants replaced or implants removed entirely is up to you.

In this article, we are going to discuss the most popular breast implant removal techniques. The two most common techniques used for breast implant removal are the En Bloc procedure and other types of capsulectomy. The goal of both procedures is essentially the same: to eliminate the implants, capsule, and the scar tissue that forms around them.

Both of these procedures usually result in improved health, wellness, physical comfort, and elimination of difficulties caused by the implants.

Many patients are requesting En Bloc Removal in order to relieve symptoms associated with Breast Implants or BII – Breast Implant Illness

Dr Michael Kernohan is a renowned specialist plastic surgeon performing breast surgery in Sydney’s Southwest Suburbs and the Southern Highlands. He is committed to delivering optimal results to his patients.

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What Is an En Bloc Capsulectomy?

En bloc is a French term that literally means ‘all together’ or ‘as a whole’. The term essentially refers to a method of implant removal that completely removes the scar tissue capsule along with the implant at once. This technique does not involve opening up the capsule. The goal is to ensure that nothing from the capsule escapes into the surrounding tissue during surgery.

Difficulties with En Bloc Capsulectomy

It is important to know that the en bloc implant removal isn’t a very simple or easy procedure. It is difficult for both the surgeon and the patient. Firstly, performing an en bloc capsulectomy is much more physically demanding, takes more time, more effort and requires more attention to detail on the surgeon’s part. As the capsule itself is less than a millimetre thick and quite easy to tear, the removal involves a much larger incision (bigger than the one that was made for implant insertion or required for straight implant removal).

Patients may experience increased discomfort, pain, and soreness after the procedure. In some cases, patients also experience bleeding after the surgery.

In order to prevent swelling and fluid retention as a result of the trauma caused to your muscles, Dr Kernohan usually places drains at the level of the breasts. If the implant is replaced successfully, the scar tissue will end up affecting the placement of the new implant.

Am I the Right Candidate for En Bloc Capsulectomy?

If you wish to get En Bloc Capsulectomy, it is important to note that this technique is not suitable for every single patient who wants to get their implant removed or replaced. In some cases, the capsule gets so flimsy that it becomes nearly impossible to remove intact. It is not recommended for capsular tissue that is placed next to the rib cage. Creating a deep incision in this area can lead to a punctured lung cavity and increased pain post-surgery. That is the reason a lot of surgeons rarely offer a guarantee on en bloc capsulectomy. If you were still planning to opt for this technique, please make sure that the surgeon takes all measures to prevent additional injuries.

Warning – The implant capsule may be close to the ribs or lung and when dissecting the capsule, the lung can get punctured causing pneumothorax. Always choose a highly experienced plastic surgeon!

How Will I Look after Implant Removal Surgery Using En Bloc Capsulectomy?

A lot of women are concerned about the aesthetic results of En Bloc Capsulectomy. We get this question quite often: how will I look after en bloc capsulectomy surgery? Well, there is no straightforward answer to this question. How your breasts look is dependent on the size of the implant, the extent of displacement of the breast tissue, skin elasticity, and whether you are getting the implant replaced or removed.

If you choose an experienced surgeon, this can help restore the natural appearance of your breasts. You are bound to experience new scars that will carry some level of surgical risks. It is crucial to do a lot of research and reach this decision after a thorough discussion with your surgeon. You need to have realistic expectations before the surgery. Make sure to view plenty of before and after photographs of different patients who have had the procedure done: both with and without the replaced implants and lifts. You can always ask for these pictures during the consultation with Dr Kernohan. It will give you a fairly clear idea of what your results are going to look like.

What is Capsulectomy?

Capsulectomy is a term used to describe the removal of an implant along with the capsule. It is usually of two types: partial capsulectomy and total capsulectomy. Let’s discuss both of these briefly:

·       Partial Capsulectomy

Partial Capsulectomy also called capsulotomy is a surgical procedure that is designed to loosen the scar tissue that forms around your implant. Most patients who get this procedure are dealing with increased discomfort or capsular contracture that impacts the visual appearance of their breasts. During the surgery, Dr Kernohan will remove the affected portion of the capsule tissue. By eliminating the direct scar tissue, your implant will soften, the tension surrounding the implant will be released, and the overall appearance of your breasts can improve. In some cases, patients also go for an implant replacement. However, it isn’t the necessary part of the surgery.

·       Total Capsulectomy

During the procedure of total capsulectomy, Dr Kernohan will remove the entire capsule tissue in pieces or sections. If you want a replacement Dr Kernohan will most likely recommend a different type of implant along with the placement. These steps are essential to minimise your risk of capsular contracture or other complications in the future.

Capsulectomy for Capsular Contracture

A capsulectomy can help eliminate any capsular contracture and other problems associated with breast implants. The capsular contracture is essentially your body’s reaction to a foreign object. The collagen produced as a result of the inflammation causes your tissues to become fibrous which is the primary cause of firmness in pain. These complications can occur immediately after the surgery or years after. In most cases, they never occur especially if you take all the precautionary measures.

Types of Capsular Contracture

The four grades of capsular contracture are mentioned below:

  • Grade 1: The breast appears natural and is soft
  • Grade 2: The breast appears natural but is slightly firm
  • Grade 3: The Breast appears distorted, is firm, and hard to touch
  • Grade 4: The Breast appears distorted, is hard and painful

To correct the capsular contracture, a partial or a complete capsulectomy is needed. The surgery is followed up by the replacement of the implant if that is what the patient requires. Capsulectomy is not only done to treat contractures.

Other reasons why people decide to opt for breast implant removal surgery include but are not limited to:

  • Rupture in the silicone gel implants: It usually occurs when the tear forms on the outer shell of the silicone implant, causing the leakage of the gel
  • Infection in the capsule: The area surrounding the capsule can become infected
  • Extrusion of Implant: In some cases, the implant can extrude through the skin
  • Breast Implant Illness: This can be categorized by a wide range of symptoms: muscle aches, fatigue, malaise, and pain are the most common ones
  • BIA-ALCL: It is a very rare type of cancer that develops in the scar capsule that surrounds your implant
  • BII – Breast Implant Illness – A condition with a large number of symptoms related to having Implants. The cause of BII is presently not well understood.

Am I the Right Candidate for Capsulectomy (Partial/Complete)?

Not all candidates are suitable for capsulectomy. This is especially true if you have untreated breast cancer, are dealing with an infection, and are pregnant/breastfeeding. Moreover, if you have a weakened immune system, deal with a bleeding disorder, have a history of prior surgeries, or have chronic illnesses, it is important to inform Dr Kernohan in advance.

Dr Kernohan may run some tests to ensure your eligibility for the surgery. These tests could include CBC, pregnancy test, an X-ray of the chest, ECG, Breast ultrasound, MRI, and mammogram in certain cases.

How Is Capsulectomy Different From an En Bloc Capsulectomy?

First, it is important to know that capsulectomy is a general term used for the removal of a breast implant along with the capsule. It’s mainly of two types: partial and complete. The capsulectomy involves the removal of the capsule in pieces. On the other hand, an en bloc capsulectomy involves the removal of implant and scar tissue in one go without cutting into the capsule.

The en bloc technique is considered to be more invasive than partial capsulectomy. The term has been trending quite a lot on the Internet and a lot of plastic surgeons are claiming to be en bloc experts. It is a buzzword. A lot of patients come in requesting this technique. However, the technique won’t have any impact on the results of the surgery. In fact, en bloc is supposedly more invasive. Most surgeons prefer a partial capsulectomy.

It is not to say that one technique is better than the other. The choice of the technique can only be determined once Dr Kernohan examines your condition in detail. An en bloc capsulectomy is preferred when you experience a rupture of the implant or there is a risk of BIA-ALCL.

It is done to minimise risk. An en bloc capsulectomy can alleviate the symptoms of BIA-ALCL and ensure the safe removal of implants. Deciding to get your implants removed is a step in improving your comfort.


Choosing the Right Plastic Surgeon for Your Breast Surgery

Choosing the right surgeon for breast implant removal surgery is crucial for reducing the complications associated with breast implants. The surgeon will carefully overview your condition and select a suitable surgery. The goal of the surgery is to ensure your health and wellness. Here are a few steps that will help you select the right surgeon:

  • Choose someone who has extensive experience in performing implant removal procedures
  • Look at the credentials and experience of your surgeon and make sure he/she is credible to do the job
  • Make sure to look at before and after photographs of past patients. You can ask about them during the consultation

The goal of En Bloc and Partial/Complete Capsulectomy is essentially the same: to get rid of the complications associated with implants and improve your health and well-being. The difference lies in the technique. There are individual pros and cons to each technique. You can make the choice after having a thorough discussion with Dr Kernohan, analysing the potential risks of each technique, and then making the right choice for yourself.

Further Reading about Breast Surgery with Dr Kernohan

Medical References about Breast Implant Removal Surgery and En Bloc Capsulectomy