What is an “en bloc” implant removal and do I need this procedure if I have my implants removed or replaced?

Many of our patients are asking us about removing their implants and an “en bloc” capsulectomy. This has become a popular term on social media and is often incorrectly interpreted. An en bloc resection is not always indicated and can cause additional complications not associated with implant removal.

“En bloc” is a surgical term that means removing organs or tissue in continuity or as a whole and is often a procedure performed when removing a malignant tumor. In the context of breast implant surgery, it would mean removing the implant and complete excision of the capsule (the scar tissue that forms around the implant). This is a meticulous surgical procedure that often involves removing the capsule off of the chest wall and ribs, which may require a much larger incision as the implant has to be removed with the capsule as a unit.

Whenever a capsulectomy is performed, an attempt is usually made to remove the majority of the capsule. It is often more dangerous to attempt to remove all of the capsule versus just removing the majority of the capsule and leaving the adherent portion in place. Frequently, it is not necessary to remove the capsule if it is thin, as the space will collapse after the implant is removed. If there is a capsular contracture (abnormal tightening of the capsule), most surgeons will remove a portion or all of the capsule. It is frequently not possible or very difficult to remove the entire capsule without removing the implant first. In this case, the capsule is dissected away from the surrounding tissue as much as possible and the capsule is opened allowing removal of the implant, or implant material if the implant is ruptured, followed by removal of the remaining capsule as indicated. This can usually be done through a smaller incision.

If a patient has BIA-ALCL (breast implant associated anaplastic large cell lymphoma), then an en bloc resection is indicated to completely remove the implant and capsule.

Many patients feel that an en bloc resection is required if they feel that they have BII (breast implant implant illness). BII is poorly understood and there is no data to suggest that a radical en bloc resection is necessary. Simple implant removal and capsulectomy (partial or complete) should be adequate. If there is any suggestion that the capsule is abnormal, your plastic surgeon my send your capsule to be evaluated by a pathologist.

While the internet can be a valuable resource, you should always discuss your options with a Board Certified Plastic Surgeon. Your treatment should be tailored to meet your own specific requirements.

Allergan Implant Recall

Allergan recently announced the recall of all of their Biocell textured breast implants. What does that mean if you have breast implants?

It is important to be educated on why these implants are being recalled. A rare form of lymphoma called BIA-ALCL (breast implant associated anaplastic large cell lymphoma) is a rare lymphoma. It is primarily associated with textured breast implants and most commonly with Allergan textured implants, although not exclusively.

If you have smooth implants you don’t need to worry. If you have textured implants but don’t have any symptoms, there is no reason to remove or replace your implants. If you have swelling, hardening or new masses, you should be seen by your plastic surgeon. If you are still concerned, you might consider replacing your implants with smooth implants.

We have primarily used smooth implants over the years but have used textured implants in breast reconstruction or for patients with a history of capsular contracture. All shaped implants are textured.

It is important to continue getting mammograms and monthly self breast exams. We like to see our breast implant patients (cosmetic and reconstructive) yearly or more often as needed.

We are always available if you have any questions about your implants.

My Implants Are Out-Now What?

Many of our patients ask about removing their breast implants but it is very important to have a discussion about what we will do after your implants are removed. Let’s go thru some of the options.

1. Do nothing. This is the simplest option. Some patients are perfectly happy with this option. You will be flat or indented and may have some loose skin or sagging. If there is a large amount of skin, you may want to have some of the skin removed. Some patients choose this option but decide to replace their implants later if they are unhappy with their appearance.

2. Breast lift (mastopexy). The breast tissue that is left can be rearranged to improve the shape of the breast and remove excess skin. This is a good option if you don’t mind smaller breasts and have adequate tissue to rearrange. There will be additional scars with a lift.

3. Replace implants. While most patients that want their implants out do not want them back in, you still have the option of replacing them with a newer device. For example, a textured implant can be replace with a smooth implant.

4. Autologous reconstruction. Tissue can be taken from another part of your body (e.g. abdomen, back or buttock) to replace the volume lost after implant removal. This is usually done in breast reconstruction and there can be problems with the area the tissue is taken from.

5. Autologous fat. Fat can be taken from other parts of the body and placed into the breast. This can be a good option in patients who need a small volume replacement, have contour deformities or don’t want implants replaced.