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.