En Bloc Capsulectomy Breast Implant Removal

What is En Bloc Capsulectomy?

En bloc capsulectomy is a breast implant and scar tissue capsule removal technique that involves the complete excision of the intact capsule with the breast implant still inside—all in one piece. This surgical procedure theoretically offers several benefits to patients who prefer to take a more cautious and complete approach to removing their breast implants. Most often, en bloc capsulectomy is recommended instead of a total capsulectomy or a traditional explant procedure for patients who are concerned about or are experiencing health consequences from their breast implants. En bloc capsulectomy helps to ensure the complete removal of scar tissue, while also preventing any fluid, ruptured silicone, or other pathogens from leaking outside of the capsule and into the body during surgery.

BIA-ALCL & En Bloc Capsulectomy

In July, 2019 the U.S. Food and Drug Administration officially announced 573 confirmed cases of BIA-ALCL worldwide, and while this number can seem alarming for patients with breast implants, it is important to keep in mind that the likelihood of developing BIA-ALCL is extremely rare and primarily attributed to textured-surface breast implants. When examining the available information on BIA-ALCL, which is surprisingly limited, it is believed that the interaction between the scar tissue capsule and the textured surface of a breast implant is a contributing factor to developing BIA-ALCL. For this reason, many doctors and plastic surgeons theorize that completely removing the breast implant and surrounding scar tissue with the en bloc capsulectomy procedure may be the best way to prevent and/or eliminate BIA-ALCL. In cases where BIA-ALCL is diagnosed in the advanced stages, patients should be advised to seek treatment guidance from an oncologist. In order to accurately diagnose BIA-ALCL, Dr. Petti may recommend that patients who are experiencing symptoms of the condition undergo an MRI and/or fluid aspiration testing. As one of the foremost breast surgeons in the area, Dr. Petti is trusted by her patients to recommend the best diagnostic protocol and treatment recommendations to meet their medical needs and concerns about BIA-ALCL.

Guidance on BIA-SCC

BIA-SCC, often simply referred to as “SCC,” is a very rare squamous cell cancer that has appeared to originate in the breast implant capsules of certain breast implants. The acronym stands for “Breast Implant-Associated Squamous Cell Carcinoma,” a condition currently being evaluated by the FDA in collaboration with the American Society of Plastic Surgeons (ASPS) and The Plastic Surgery Foundation (PSF). As of May 2023, the FDA has only found 19 cases of SCC in breast implant capsules — which refers to the shell of scar tissue surrounding an implant — making it impossible to determine risk factors for SCC.

Dr. Petti is committed to ensuring all women considering breast augmentation are aware of the potential safety risks associated with their procedure, and acts as an advocate for patients before, during, and after surgery. She is passionate about providing safe and effective breast augmentation procedures and always discusses both BIA-ALCL and BIA-SCC with patients during their consultation. At the time of your appointment, Dr. Petti invites you to ask questions and raise any concerns you may have about either condition. If you have breast implants, she also encourages you to remain vigilant to potentially concerning symptoms, such as pain in the breasts, swelling, and hard scar tissue formation.

En Bloc Capsulectomy Breast Implant Removal with Breast Lift

There are multiple reasons why a patient may choose to remove their breast implants, including the desire or need to rid themselves of older implants, the development of capsular contracture or other type of complication or potential complication, or they may simply want a change in their appearance. For some patients, a breast lift is an ideal next step following removal.

Breast explantation with a breast lift can be accomplished with or without new implants. If a patient opts for new breast implants, they can receive the shape and size they prefer, along with an elevated breast position. New implants paired with a breast lift can also add firmness to the breast tissue, enhance breast symmetry, and reduce the appearance of excess skin and a “sagging” appearance. If a breast lift with implants is not preferred, a breast lift without implants can still be an ideal option. Breast lift surgery can remove excess tissue and tighten the remaining skin, ultimately repositioning the breasts to a higher and more youthful projection on the chest wall. This can be particularly beneficial if the breasts have a more pronounced “drooping” appearance after the implants have been removed.

Not every patient chooses to pursue a lift following the removal of their breast implants. Dr. Petti will talk with you about your needs and goals and help you determine whether breast lift surgery may be recommended.

What Happens During En Bloc Breast Implant Removal?

En bloc explant surgery is performed under general anesthesia and considered to be a technically demanding procedure that is best performed by an experienced plastic surgeon like Dr. Petti. Surgery begins with an incision made along the inframammary fold, which is the crease on the underside of the breast. Through this incision, the scar tissue capsule containing the breast implant is carefully dissected from the breast. Once the scar tissue has been removed in one piece, it is extracted from the breast through the inframammary incision and the breast pocket is sterilized. If you have decided to replace your old breast implants with new ones, or plan to undergo a breast lift to create a natural-looking breast shape once the implants have been removed, this portion of your surgical plan can be completed once the breast pocket has been cleansed.