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.

Breast implant removal cost 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.

If en bloc breast implant removal isn’t the best option for your case, Dr. Sayed can also use other methods. There are a number of issues that can be treated through breast augmentation revision, including capsular contracture, symmastia, assymetry, changing implant size, scarring, and contour irregularities. Dr. Sayed also offers breast reduction and nipple surgery. Meeting with Dr. Sayed in a consultation is the best way to determine which procedure is right for you.