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.

Capsular Contracture of Breast Implants
Capsular Contracture of Breast Implants

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.

Large Breast Implants
Large Breast Implants

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.

Ptosis (droopiness) of Breasts
Ptosis (droopiness) of 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.

Before and After of Removal of Implants with a Breast Lift
Before and After of Removal of Implants with a Breast Lift

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.

Removal and Replacement of Breast Impants with Breast Lift Before and After Photo
Removal and Replacement of Breast Impants with Breast Lift

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.

En Bloc Capsulectomy
En Bloc Capsulectomy

This is an enticing and desirable method of “clean up”. The capsules are often thickened and occasionally marred with calcifications.

Calcified Capsule - Capsule Contracture - Breast Implants
Calcified Capsule

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.


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