Implant Removal (En Bloc Capsulectomy)
The decision to remove your breast implants is a highly personal one. Implants may be removed on their own or along with the capsule. Capsulectomy is the surgical removal of the capsule. This may be performed for patients who have capsule contracture (hard, thick scar tissue) or evidence of implant rupture to prevent spillage of the free silicone. En Bloc Capsulectomy is a term derived from cancer surgery and refers to the complete removal of the breast implant capsule containing the implant and any associated fluid or ruptured implant material. It is recommended for any patient suspected of having a malignancy such as Breast Implant Associated- Anaplastic Large Cell Lymphoma (BIA-ALCL).
A conclusive link between breast implants and autoimmune diseases has not been demonstrated, despite extensive study by plastic surgeons and the FDA. There is, however, a large group of patients with breast implants who describe a constellation of symptoms often referred to as “breast implant illness”. En Bloc Capsulectomy has been advocated by patients suffering from breast implant illness with the goal being the complete removal of all the components of the implant, along with inflammatory reaction in the capsule. Dr. Feiner has extensive experience with this surgical procedure as a dedicated breast cancer reconstructive microsurgeon. He is sympathetic to the concerns being voiced by the BII community and is committed to studying the outcomes of explantation in this group.
During en bloc capsulectomy, the capsule is removed in one piece. This includes all previous scar tissue, sutures and foreign material. This often requires peeling the pectoralis muscle off the capsule in patients whose implants are under the muscle and returning/repairing the muscle to its anatomic position. The back side of the capsule must be carefully peeled off the chest wall. This requires meticulous dissection technique and patience. The capsule and implants are evaluated by a pathologist. Patients who have a clinical presentation concerning for BIA-ALCL will have fluid tested for CD-30 and ALK (Anaplastic Lymphocyte Kinase).
Surgical Options Include:
- En Bloc Capsulectomy- Complete and intact removal of implant and capsule
- En Bloc Capsulectomy, +/-Lift, +/-Fat Grafting- Improves the shape and volume of the breast following implant removal. Some procedures may require a staged approach to achieve optimal outcomes