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.