Should You Have an En Bloc Capsulectomy?

Apr 28, 2023

Greer Plastic Surgery -  En Bloc Capsulectomy

If you’re asking this question, you are most likely researching the different methods for breast implant removal, a common occurrence for those who’ve had implants. Types of implant removal methods include simply removing the implant, removing some or all of the capsule around the implant, or removing the implant and the entire layer of scar tissue surrounding the implant, all in a single unit (i.e. en bloc capsulectomy). Keep reading to learn when en bloc capsulectomy is recommended, what the process involves, and what the recovery is like!

What is a Capsulectomy?

Let’s start from the very beginning: whenever a foreign body (that is, an object) is implanted internally, your body will form scar tissue around it. This applies to everything from artificial joints and pacemakers to breast implants. The layer of scar tissue around a breast implant is known as a capsule that can range in thickness and transparency. It can be as thin as a few cells and very transparent, or it can be dense, firm, and calcified. The word capsulectomy refers to removing some or all the capsule of scar tissue.

What is the Difference Between Capsulectomy and En Bloc?

There are three types of capsulectomy: en bloc, total capsulectomy, and partial capsulectomy. A partial capsulectomy is what it sounds like; a portion of the capsule is left behind in the breast. With a total capsulectomy, the entire capsule is removed, which can involve extracting it in pieces or after taking out the implant first.

An en bloc capsulectomy removes both the implant and the surrounding capsule in one piece, without opening the capsule. Both total and en bloc capsulectomy are done through an incision in the crease under the breast, but this incision is longer than one typically used to place breast implants.

En Bloc Capsulectomy is a Proposed Treatment for Breast Implant Illness

En bloc capsulectomy has long been touted as the most effective treatment for breast implant illness, and any discussion of en bloc capsulectomy should include a brief discussion of this condition and its symptoms.

What is Breast Implant Illness (BII)?

The term “breast implant illness” refers to a wide constellation of symptoms that may include thinning hair, brain fog, fatigue, rash, joint pain, and even memory loss. At this time, it is a diagnosis of exclusion, meaning symptoms may be linked to breast implant illness when no other underlying cause can be found. Some patients seek removal of their breast implants hoping to improve their symptoms, which raises the question: which implant removal technique is most effective?

What Type of Capsulectomy Do You Need?

Capsulectomy is done for a variety of reasons. If the capsule is slightly thickened and we are removing breast implants without replacing them, removing at least part of the capsule allows the tissue to heal together. This process eliminates any potential space for fluid to collect. If surgery is being done for breast implant-associated anaplastic large cell lymphoma (BI-ALCL), then the entire capsule needs to be removed. But until recently, we had no scientific data regarding which type of capsulectomy is best for breast implant illness.

What is the Risk of En Bloc?

Over the past several years there has been an increased number of patients requesting en bloc capsulectomy, and an increased number of surgeons touting its effectiveness. But en bloc capsulectomy carries increased risks compared to partial capsulectomy, especially if the implants are placed under the muscle. Peeling capsule off the ribs and costal cartilages is difficult, and risks injuring the intercostal muscles. There is even a risk of injury to the lungs. With these additional risks, we must ask the question: is en bloc capsulectomy even necessary?

Is En Bloc Capsulectomy Necessary?

Thanks to a new study published in the Aesthetic Surgery Journal, we finally have data to answer this question. A study published in 2002 looked at 150 patients having breast implant removal or mastopexy to determine whether patients’ saw an improvement in BII symptoms after partial, total, or en bloc capsulectomy. 50 of the women had self-reported symptoms consistent with BII and were having implants removed or replaced. Fifty of the women had no symptoms and were having implants removed or replaced. And the final group of 50 women were having a breast lift and had no history of implants, to act as a control group.

The study results found that women who had symptoms of BII and had their implants removed had an improvement in symptoms regardless of which type of capsulectomy they had.

How Much Does En Bloc Capsulectomy Cost?

Although there is no proven medical reason to perform an en bloc capsulectomy, it may still be necessary to remove some or all of the capsule when having your breast implants taken out depending upon your unique case. The total cost of en bloc capsulectomy includes the surgical fee, anesthesia, and the facility fee. Cost may increase if there are additional procedures done, such as a mastopexy. You can expect to pay somewhere around $7,500 to $10,000 for implant removal and capsulectomy.

How Long Does En Bloc Capsulectomy Take?

Doing a strict en bloc capsulectomy is more time consuming than doing a total capsulectomy because leaving the implant within the capsule makes surgical dissection much more difficult. Fortunately, en bloc capsulectomy is not necessary, and symptoms of breast implant illness will improve with a total or partial capsulectomy. The time for these procedures ranges somewhere around two to three hours. Patients go home the same day, and you may or may not have drains placed afterward.

Do Breasts Fill Out After Explant?

Unless you had significant tissue laxity before surgery (think of the slightly deflated appearance breasts may have after pregnancy and breastfeeding) your breast tissue will have stretched out a bit to accommodate the implants. Immediately after surgery, breasts may lack fullness over the upper pole. Fortunately, the tissue does retract a bit after removing implants, so the breast tissue will look a bit fuller after a few months.

What is the Recovery Like After En Bloc?

After any type of breast implant removal that includes partial or total capsulectomy, most patients will need about a week off work. Plan to avoid any strenuous cardio, like running or spinning, and you’ll also need to avoid lifting more than 15 pounds for four weeks after surgery.

As mentioned, it will take breast tissue several months to shrink up after removing your implants. It can also take a year or more for scars to fade completely. Until then, they will appear light pink or slightly darker than the surrounding skin.