En Bloc Capsulectomy
With the popularity of breast implants for nearly half a century, plastic surgeons are seeing some of the late effects of breast implants. The most common issue is capsule formation also known as capsular contracture.
This complication is not only one that can occur early on, but it also can occur later in the life of the implants. It is widely believed that early capsular contracture is due to contamination of the implant, however, late onset is often due to partial or complete rupture of the implants. Another issue that we see is the dissatisfaction with size.
Implants have a time and a place and often the allure of a larger volume is replaced by feeling matronly and heavy. Menopausal changes also contribute to the size increase of breasts, hence, compounding the feeling that there is a mismatch of size and disproportion of the previous beauty that was felt with implants. Finally, breasts can also change with age. The onset of droopiness (ptosis) and other life events such as pregnancy, weight gain and loss, and genetics lead to loss of shape of the breasts.
The culmination of onset of capsular contracture, dissatisfaction with size and loss of shape of breasts lead to a desire for removal of implants. In general, implants that are removed in older patients are not replaced and breasts are lifted. This has become a very common operation and one that carries a high level of patient satisfaction.
In smaller breast patient and some of the younger patients, there is still a desire for breast implants. In such cases, implants are replaced with or without a lift. Occasionally, an internal support material is used to support and stabilize the shape of the breast.
Regardless of the selected option, the implants are removed using a technique that has become known as en bloc capsulectomy. En bloc is a French term that signifies ‘whole’. En bloc capsulectomy is the removal of the entire capsule – in total.
This is an enticing and desirable method of “clean up”. The capsules are often thickened and occasionally marred with calcifications.
Some women continue to worry about breast implant illness despite the lack of any scientific proof of such consequence. For that group of patients en bloc capsulectomy is also desirable and relief from the removal of all elements associated with implants.