Breast Explant Archives | La Jolla, San Diego | Tim Sayed, MD, FACS

En Bloc Breast Implant Removal Technique Compared to Others

With over 190,000 operations performed annually, breast augmentation with implants is one of the top cosmetic surgeries in the U.S. Nonetheless, approximately 35,000 patients a year opt for breast implant removal. 

There are three primary techniques available to surgeons when removing breast implants: simple device removal (just taking out the implants), capsulectomy (removing the implants and either part or all of the capsule of tissue formed around them), and en bloc capsulectomy (removing the implant and capsule together as a unit).

Here, Dr. Sayed discusses the En Bloc technique compared to other breast implant removal procedures. 

What happens during breast implant removal?

Breast implant removal is the process of removing the implants from the breast. However, there are several vital considerations surgeons and patients must take into account in order for this procedure to be successful.

First, depending on the length of time the implants have been in the patient, scar tissue, which forms naturally, will now be surrounding the implants. Second, different insertion procedures , implant sizes, and incision types mean that implant removal surgeons must consider the best way to remove the implants, which will depend on whether the surgeon is trying to remove the capsule tissue at all, and whether the surgeon is aiming to remove all the capsule tissue in one piece on each breast. The incision(s), length of surgery, and other factors that may influence recovery will depend on the operative approach and patient goals.

En Bloc Implant Removal

The term En Bloc essentially means “as a whole.” En Bloc removal means removing the implant and capsule (scar tissue) as a single unit. In doing so, the surgeon must separate the capsule from the surrounding tissue and try to leave the capsule intact. It is common for small tears or perforations to occur in the capsule through the process of separating it from the surrounding tissues (like the muscles of the chest, or the rib cage), but in the en bloc method, the surgeon is making a concerted, deliberate effort to try to keep the capsule as intact as possible. This allows the surgeon to try to ensure no capsule tissue is left behind and to photograph the removed specimen for patient reassurance. It is also important to try to avoid directly opening the capsule in cases where there may be a known or suspected leaking silicone implant, in order to reduce the likelihood of spillage of silicone gel into the patient’s tissues.

In simple breast implant removal procedures, without a capsulectomy, the surgeon opens the capsule, removes the implant, and then leaves the capsule behind. The surgeon may “rough up” the inside surface of the capsule to get the tissue to stick to itself and obliterate the space where the implant sat. While some patients coming in for implant removal want this simpler procedure (which can be done through smaller incisions than a capsulectomy), most of Dr. Sayed’s patients specifically are seeking a complete capsule removal, preferably with the en bloc technique, due to concerns that capsules may harbor microbes or other biochemical factors that may contribute to what is called “Breast Implant Illness.” It is not clear from current studies that we need to be so thorough in removal of capsule tissue, but Dr. Sayed feels it is better not to leave capsule behind so that patients know they have a “clean slate.” It is also known that capsules can be contaminated with microbes in what is called “biofilm,” which is the current leading explanation for the phenomenon known as capsular contracture. Additionally, certain recalled implants (Textured Biocell implants, previously made by Allergan) have in some cases led to cancer development from the inside capsule surface, so Dr. Sayed feels the capsule is not necessary an “innocent bystander.” 

Removal of the capsule, especially with the en bloc method, is more complex and requires larger incisions than simple implant removal. However, since many patients undergoing removal will also need breast lifts or other forms of skin removal at the same time, the incision to access the capsule for removal will be designed based on the pattern of skin removal expected, so the net resulting scar is what would have been dictated by the loss of implant volume anyway. Simply removing the implants but not removing skin is more likely to result in strange folds, double and triple creases, indentations, nipple inversion, and other unaesthetic changes because the breast is a 3-dimensional structure and the skin draped over the breast should be downsized if the breast volume is being reduced.

Breast Implant Removal in Newport Beach, CA

Which type of implant removal technique is best for you depends on several unique factors. Because of this, it’s essential to consult with industry-leading breast implant removal (explant)  surgeons like  Dr. Tim Sayed.

Reach out to Tim Sayed MD Plastic Surgery in Newport Beach or La Jolla, CA on (858) 247-2933 or via this online form to arrange a virtual consultation to discover how we can help you look and feel your best.

The Top Reasons for Breast Explant Surgery

Breast augmentation is one of the most popular cosmetic procedures in the U.S., with over 310,000 surgeries performed yearly. However, another statistic is on the rise, which is the number of women seeking to remove their breast explants through breast explant surgery

Reasons compelling women to seek breast explant surgery vary between individuals. The most common reasons double board-certified plastic surgeon Dr. Tim Sayed encounters are:

  • Scar tissue (capsular contracture) that has changed the breasts’ appearance
  • Changes in breast shape due to age, pregnancy, or breastfeeding
  • Complications with the implants, such as rupturing
  • Breast implant illness

Some women’s self-image and lifestyle may have shifted to a point that it is more practical for them to have non-augmented breasts. Others might be dissatisfied with the changes that have happened to their breasts over time. One factor that is often a concern is the possibility of complications from an implant that has broken or ruptured and leaked toxic material into the body. In extreme cases, this tissue damage can lead to permanent deformities of surrounding tissues.

At Tim Sayed Plastic Surgery in La Jolla and Newport Beach, CA, we want to enlighten our patients as much as possible. Understanding why women might seek breast explant surgery can help you better understand your desires and needs and the comfort of knowing you’re not alone.  

No Longer Content With Your Breasts’ Appearance

After several years with implants, the natural aging process will inevitably affect your breasts. As a result, your skin will stretch, breasts will shift lower on your chest, and your nipples and areolas will begin to point downward. Removing the implants will significantly reverse these concerns, and you may also wish to consider adding a breast lift as part of the solution.

Lifestyle Changes

The most frequently cited reason for breast explant surgery is a lifestyle change. Younger women often concentrate on their appearance above all else, but your priorities might change as you get older.

Breast implants, particularly larger ones, can hinder active lifestyles by being uncomfortable or getting in the way.

Many women who take up pursuits such as running, swimming, or CrossFit in their mid-20s or 30s might find their implants prevent them from thoroughly enjoying their activities and encourage them to seek breast explant surgery.

Complications With the Implants

A less typical reason for breast explant surgery is complications with implants. As implants get older and remain in your body longer, a painful condition called capsular contraction may occur. One or both implants could also become damaged, necessitating their removal.

Breast Implant Illness

Breast implant illness is the most prevalent reason Dr. Tim Sayed removes breast implants. Still, it’s critical to note that this condition remains infrequent, with statistics indicating that between one in 2,000 and one in 86,000 breast implant patients will experience the condition.

While health professionals have yet to fully understand its causes, breast implant illness is a set of nonspecific physical symptoms some patients with breast implants experience.

Some reported BII symptoms include:

  • Constant fatigue and drowsiness
  • Chronic joint inflammation and pain
  • Unexplained respiratory complications
  • Skin blotching and hair loss
  • Mental health concerns such as depression and anxiety

As medical experts strive to better understand and quantify BII, doctors encourage any patient with breast implants experiencing these unexplained symptoms to consult a professional. Often, having the breast implants removed provides noticeable relief of many symptoms, and Dr. Sayed has personally noticed improvements in some of his breast removal patients.

Breast Explant Surgery in Newport Beach, CA

If your beauty standards have changed or your enhanced breasts have become a hindrance, breast explant surgery can significantly improve your quality of life. Reach out to Dr. Tim Sayed in Newport Beach or La Jolla, CA, by calling (858) 247-2933 or contacting us via this online form to arrange a quick virtual consultation to discover how we can help you look and feel your best.

How Do Breasts Look After Explant Surgery?

Breast explant surgery is the process of removing breast implants. 

While women might desire to remove their breast implants for any number of reasons, the most common we encounter are:

  • No longer content with the appearance of the breasts
  • Health concerns
  • Complications with the implants

Whatever the reason for removing implants, the breasts will, of course, look different after the surgery.

At Tim Sayed MD Plastic Surgery in La Jolla and Newport Beach, CA, we want to help you look and feel your best. Explant surgery is a significant milestone, which is why we’ve put together this article to help women know what to expect after breast explant surgery.  

What Happens During Breast Explant Surgery?

During breast explant surgery, also called breast implant removal, Tim Sayed removes the implants and typically removes the tissue layer, called a capsule, that forms around the implants. This technique is known as En Bloc breast implant removal when the capsule can be removed in one piece with the implant remaining inside the capsule. En bloc is a form of total capsulectomy – any method that removes all the capsule – and is the method of choice in almost all cases we see.

Incisions are usually made in the breast fold under the breast when an en bloc is planned, in order to give enough working space to safely remove all the capsule off the chest wall. To the extent feasible, and depending on what the patient elects in terms of additional procedures, efforts are made to achieve as aesthetic a result as the patient’s anatomy allows. It is easier, to be honest, to get a pleasing round breast mound in patients who have a B cup or larger of natural breast tissue, and it can be difficult to achieve as nice an aesthetic outcome in patients who are more flat chested naturally. Your in-person consultation in La Jolla or Newport Beach will allow us to assess your breast volume in order to manage expectations.

How Will Breast Explant Surgery Affect My Breasts?

Once implants are removed, the volume of the breasts reduces significantly. This can cause several aesthetic implications:

  • Breasts may appear deflated with a “sagging” appearance
  • Skin is loose and prone to extensive wrinkling
  • Nipples and areolas point downwards
  • Indentations and adherence to the muscle or rib cage may become evident

These issues tend to be greatest in patients with larger (more than 400cc) implants and/or smaller (less than B cup) natural breast tissue.

How Can I Improve the Appearance of My Breasts After Explant Surgery?

The best way to combat the aesthetic complications associated with breast explant surgery is to get a breast lift.

In a breast lift, Dr. Sayed removes excess skin that causes looseness and wrinkling, which positions the breasts higher on the chest wall. This makes the breasts firmer and also sets the nipples and areolas in a more youthful, forward-facing position.

Another option is fat grafting to add some volume back to the breasts. Typically this will be less than the amount of volume the implant provided and will not be quite as projecting and round as an implant, but fat grafting can be a helpful tool to giving patients a bit more breast volume and shape when the implant has been removed. There are pros and cons to performing fat grafting at the time of explant or delaying it to a later stage after some healing has occurred. Your decision will be personalized and based on your exam, photos and medical history during your consultation.

Breast Explant Surgery in Newport Beach, CA

Breast explant surgery can and likely will improve your quality of life if your breast implants are a hindrance. Reach out to Dr. Tim Sayed in Newport Beach or La Jolla, CA at 858 247 2933 or via this online form to arrange a consultation to discover how we can help you look and feel your best.