En Bloc Breast Implant Removal | Newport Beach | La Jolla, San Diego | Tim Sayed, MD, FACS
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En Bloc Breast Implant Removal

Breast Implant Removal – San Diego

It happens rarely, but when a patient wants her breast implants removed, it’s essential to find the right surgeon who offers the safest techniques possible. One such technique is the En Bloc breast implant removal method, a special technique that’s known for its high margin of safety and effectiveness.

In most breast augmentations, some tissue forms around the implant creating what is known as a “capsule.” While this is a typical body response whenever a foreign object is inserted into the body (it happens with hip replacements and pacemakers too!), sometimes the capsule can cause complications with the breast implant. A technique like the en bloc breast implant removal may be required to remove the implant and the capsule entirely, allowing the surgeon to create a new, healthier pocket for a new implant.

Not every surgeon is skilled in performing en bloc breast implant removal, but Dr. Sayed specializes in breast surgery, and has performed breast surgeries in plastic surgery-oriented areas. Dr. Sayed performs en bloc breast implant removal because more than anything, he strives to give patients the safest techniques possible.

PHOTO GALLERY

View real patient before & after results in our photo gallery.

En Bloc Breast Implant Removal 101

In the case of an implant rupture, the breasts changing in size, the implants changing position, or a patient simply wanting to exchange implants, an en bloc breast implant removal might be warranted. Essentially meaning “as a whole,” the en bloc breast implant removal technique removes the implant and the capsule as an entire unit, making sure no residue is left behind and that the breasts can essentially heal and recover without contamination.

Bacteria and materials from the capsule or a leaking implant may cause certain symptoms like pain or distortion of the result. One of the risk factors for capsular contracture is something known as “biofilm,” a complex mixture of skin cells, proteins, and bacteria that can lead to an excessive inflammatory response. When the en bloc removal procedure is done, the surgeon removes the whole implant and capsule together to avoid leaving behind any biofilm material, so a new implant is less likely to develop a capsular contracture if the patient chooses to have another breast augmentation in the future.

An en bloc breast implant removal usually will require the creation of an inframammary incision, but these incisions are easy to hide. Of course, if the patient already has an inframammary scar, Dr. Sayed will try to use the original incision to minimize placing new scars whenever possible. Once the implant has been removed, the breasts’ tissue, muscle, or both will be able to revert back to its original position in the chest. Oftentimes, Dr. Sayed will place a drain in the breast to prevent fluid accumulation.

To combat sagging, Dr. Sayed can stage procedures and pair the removal with a breast lift and/or a new breast implant.

What is Capsular Contracture?

Capsular contracture is when the capsule around the implant starts to get thicker and thicker, eventually squeezing the implant and causing the breasts to harden, become misshapen, or making the implants change position.  No one’s quite sure why capsular contracture occurs, but the capsules may contain substances like silicone gel, silicone gel fragments, bacteria, calcified tissue, and inflammatory cells—all substances that cause further complications. It’s why en bloc breast implant removal is so necessary—by removing the capsule and implant as a unit, the contaminants will be self-contained and less likely to be left behind.

Contact us today!

If you’re in the San Diego or Newport Beach areas and have any questions about Implant Removal or wish to schedule a consultation on implant removal with Dr. Sayed, please contact our office.

FAQs About En Bloc Breast Implant Removal

  • A patient experiencing pain from previous breast implants
  • A patient who is symptomatic from a silicone breast implant rupture
  • A patient who wants to remove implants because of hardening, malposition, or asymmetry
  • A patient concerned that her implants may be causing other symptoms in her body
  • A patient with certain textured implants who may be concerned about rare risks of ALCL cancer

As the swelling dissipates, it’s normal to see some shrinkage in volume. Obviously, your implants are gone, but changes of the breast due to aging and stretching from the implants will lead to further change in shape and sagging. When removing an implant and the capsule, you might experience a longer recovery time than a regular breast augmentation: about a week longer than the typical 2 weeks of abstaining from any strenuous activity. After that, you can return to light fitness activity, and it’s advised that you take about a week from social activities and refrain from driving from at least 10 days or as long as you’re taking any prescription medication. You will be asked to wear a surgical bra for a few weeks.

This will be dependent on a few factors, so if you would like an accurate quote we encourage you to contact us for a consultation. You can also contact us for a pre-consultation if you want to learn more, or you can visit our Zwivel page for a virtual consultation.

With a total capsulectomy, the capsule is removed from the breast. The breast implant may be removed first before completing the capsule removal if necessary for exposure or safe conduct of the procedure. The implant may be reinserted into the breast pocket or completely replaced. An en bloc breast implant removal includes removal of both the total capsule and the implant contained inside the capsule. This is most commonly done for ruptured older generation silicone implants, where it is important to try to leave no residue of the original implant and capsule behind. Sometimes en bloc removal includes a small cuff of breast tissue that may have become hardened or inflamed over time. 

The en bloc procedure is also offered for patients who may be concerned that they have “Breast Implant Illness,” a nonspecific set of symptoms that can include joint pain, fatigue, vision changes, anxiety, gastrointestinal or other symptoms. While there is no proven causal relationship between implants and the development of these symptoms in a small percentage of patients, symptoms are often debilitating enough to prompt patients to seek removal of the implants and capsules in an effort to try to improve how they feel. In March 2019, the US FDA met to discuss concerns regarding breast implant illness, textured implants and other considerations.  Continued monitoring of approved implant devices was advised. Breast implants are foreign bodies and it is possible a small percentage of patients do not react well to them, but currently we have no scientific way to validate or predict the development of symptoms in relation to the placement of the implants. For now, we feel it appropriate to offer patients an effort at en bloc capsulectomy with explantation of the implants to help patients with these concerns move forward in their lives.

The en bloc procedure is attempted in most cases where capsulectomy is desired. Keeping the implant in the capsule while dissecting the capsule from normal tissue provides a roadmap and a three-dimensional structure to follow. However, in some cases, it becomes difficult to safely complete the procedure if the implant obscures the surgeon’s ability to see around the surgical site fully. Additionally, in some patients, the capsule may be stuck down to the chest wall and removing the back wall of the capsule may place the patient at risk for entry into the chest cavity. This is called a pneumothorax (if air enters) or hemothorax (if blood does). The treatment for this complication is usually straightforward with placement of a chest tube, but the surgeon would always prefer to avoid the complication if possible. Most surgeons will continue the effort at en bloc removal for as long as the surgical dissection appears safe and feasible with the implant remaining in the capsule. In cases where the implant may need to be removed during the procedure, the surgeon will work to avoid contamination of any ruptured silicone or other material in the breast tissues. Additionally, if any capsule can not be safely removed, it is usually cauterized.

The best analogy is removing a sticker from a windshield: sometimes it easily comes off in one piece; in other cases, the sticker may tear partly, and in order to remove the sticker completely, one has to start peeling it from another direction. This is the process by which the surgeon works to peel the capsule off the rib cage and surrounding breast tissue. There is currently no scientific literature of which we are aware to suggest a risk of fungus (mold) or bacterial contamination if incidental entry into the capsule occurs during removal. 

Yes, this is commonly recommended. A patient having implants removed may have extra loose skin that can be reduced, in order to improve the aesthetic appearance of the breast at the time of device removal. Many patients may also have sagging breasts due to pregnancy/breastfeeding, weight changes, aging and other factors. In some cases, breast lifting can help mask any contour irregularities (indentations, bulges, creases, etc.) that can occur with capsule removal, while also enhancing the “perkiness” of the remaining breast tissue.

This can be hard to fully predict, but most patients can expect the breast to return to about the size it was before implants were placed (assuming there has not been significant change in the underlying breast tissue from pregnancy, weight gain or other factors). Patients who had implants placed through an incision around the nipple (periareolar incision) may develop creasing in the scar when the breast is deflated by removal of the implant. This is one reason why fat grafting to the breast may make sense for you. Fat grafting can return some of the volume lost with implant removal as well as help minimize contour defects. The fat is usually placed in the layer of the breast tissue and breast fat, as opposed to the space under the muscle or in muscle. Fat for grafting is usually taken from the abdomen and/or love handle (flank) areas, creating some cosmetic improvement in the donor site in the process.

Yes, we routinely use drains to evacuate fluid from the space where the implant and capsule used to sit. This also helps the remaining tissues heal back together more rapidly. 

In selected cases, Dr. Sayed will repair the pectoralis major muscle down to the rib cage if it will help the healing process or aesthetic result. This maneuver is not necessary in most cases, however.

Yes, we routinely send the capsule for pathology testing. The pathologist will send a report, typically around a week after surgery, describing the tissues. It is rare to find anything other than expected capsular scar tissue, with perhaps some attached muscle or breast tissue. If cancer or anything else suspicious is noted, the pathologist will report on that and make further recommendations if appropriate.