Breast implants have improved the lives of countless women, both medically and cosmetically. But we must acknowledge that some women have encountered problems with their implants, up to and including conditions classified as “ breast implant illness” or BII.
Dr. Alexis Parcells of Parcells Plastic Surgery in Eatontown, NJ, is a board-certified plastic surgeon who has earned a reputation as one of the country’s top breast surgeons and breast surgery educators.
Once a woman and her doctor have decided that breast implant removal is necessary, advisable, or desired, surgical options must be weighed and chosen. Those decisions must always be based on the patient’s health and safety. Two prominent techniques are often misunderstood, misdefined and have caused significant frustration and confusion among patients. So let’s try to sort this out.
“En bloc” is a surgical term that refers to the modular removal of organs, tissues, and implants in one intact piece or “bloc.” This technique is often employed as a surgical treatment for removing a malignant tumor. With respect to breast implant surgery, “en bloc” means removing the implant together with the complete excision of the “capsule,” which is the scar tissue that forms around and encases the implant. To be clear, any object not naturally found inside the body, such as any surgical implant (or even a splinter!), will form a layer of scar tissue. Your capsule may contain silicone gel, silicone fragments, bacteria, and calcification. In the “en bloc” technique, the implant and capsule are removed in one piece, with the implant still inside the capsule. Think of it like a baby being delivered still encased in an intact placenta.
“En bloc” can be a complicated surgery, particularly if implants have been placed under the pectoralis muscle in a patient’s chest. In this case, because the backside of the capsule is attached to ribs and muscles, surgical risks include damage to the underlying ribcage and even the lungs. In cases where an “en bloc” removal is deemed unsafe, a “total capsulectomy” can become the procedure of choice.
In a total capsulectomy, the implant and the capsule material are removed but as separate pieces rather than in one intact unit. The capsular material is removed after the removal of the implant. Typically, the superficial surface of the capsule is dissected, allowing removal of the implant. That is followed by dissection of the remainder of the capsule, including its deep surface. The capsule may be removed in one piece or in several pieces. To extend our “birth” analogy, think of total capsulectomy as delivering a baby after the placenta has been broken, then delivering the placenta after the delivery of the baby.
Be aware that sometimes complete removal of the capsule is not possible if it could compromise the viability of breast skin.
Breast implant illness is not well understood. There is no data suggesting that “en bloc” surgery is necessary, absent any malignancy. Nevertheless, some women are concerned about breast implant illness. Others may want to address cosmetic and lifestyle issues, and still, others may want to avoid future implant “maintenance.” Regardless, there is no question there is considerable public confusion about these surgical terms and techniques for breast implant removal or “explant” surgery.
There are few agreed-upon surgical indications for removing breast implants and capsules unless a patient suffers from severe capsular contraction or lymphoma that can be associated with a textured implant. While some breast implant illness support groups strongly advocate implant removal as the treatment of choice, The American Society of Plastic Surgeons advises patients to beware of en bloc or total capsulectomy surgery unless there are clear surgical indications.
Both plastic surgery organizations and patient support groups agree that there is no guarantee that implant removal with or without capsule removal will “cure” symptoms commonly associated with breast implant illness.
You should always discuss your options with a board-certified plastic surgeon such as Dr. Alexis Parcells of Parcells Plastic Surgery in Eatontown, NJ. Dr. Parcells has authored numerous textbooks and professional journal articles on breast surgery. She will make sure you are fully and accurately educated on the subject and completely comfortable with your surgical plan. You are warmly invited to schedule a consultation.
Parcells Plastic Surgery offers the most advanced surgical and cosmetic medical spa treatments to women in New Jersey.
Board-certified plastic surgeon Dr. Alexis Parcells is here to educate and empower you to celebrate your natural beauty.4 Industrial Way West #101, Eatontown, New Jersey 07724