A woman’s decision to have her breast implants removed is deeply personal and often years in the making. With more information emerging about BIA-ALCL, and online forums dedicated to “breast implant illness,” plastic surgeons are receiving more inquiries about explantation for health reasons vs. aesthetic reasons, or to treat a specific complication such as capsular contracture. This trend has stoked debate over the most appropriate explantation technique to use: total capsulectomy or en bloc removal.
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Breast implant illness – a broad term describing inflammatory symptoms some women are attributing to their breast implants – is a hot topic on social media and in online forums. As women experience unexplainable symptoms, they turn to the internet to learn more and share their stories. While such a community does help these women feel heard and understood, the unfortunate side effect is the rapid spread of misinformation.
A perfect example is advice circulating on websites devoted to breast implant illness that en bloc capsulectomy is the only effective way to reduce symptoms, and that patients should only opt for this technique. While there are many qualified plastic surgeons who are experienced with en bloc capsulectomy and may recommend it, I fear patients are focusing on a procedure rather than their individual circumstances or the surgeon’s qualifications and experience – all based on advice from non-physicians.
En bloc capsulectomy requires a 10 to 15 cm long incision spanning most of the inframammary fold so the capsule can be separated from the breast tissue and chest wall, and removed intact with the breast implant inside, as one piece. Unless we are treating an implant rupture or BIA-ALCL, the size of the resulting scars, complexity of procedure and potential for additional risks make en bloc capsulectomy an unnecessary and inappropriate procedure for most patients.
Why I favor total capsulectomy
Many surgeons think removing the capsule is unnecessary. I believe all tissue associated with the implants should be removed. In the case of breast implant illness, the implants can then be ruled in or ruled out as the cause of symptoms. It also gives the patient peace of mind knowing everything has been removed.
Like en bloc capsulectomy, total capsulectomy completely removes both the breast implant and the surrounding capsule from the body. However, a total capsulectomy requires only a 5 to 6 cm incision in the inframammary fold. Through this incision, the anterior capsule is released from the breast tissue while the posterior capsule is elevated off the chest wall to the mid-implant point to provide the surgeon full vision of the superior portion of the implant. The capsule is then opened to remove the implant, clamped closed and removed from the body.
En bloc capsulectomy vs. total capsulectomy are similar explantation procedures with different indications, similar to an open vs. laparoscopic appendectomy. Educating patients on all of their options and choosing the correct one for them can reduce unnecessary surgical trauma and avoid an extensive recovery.
About the author
Christopher L. Hess, M.D., F.A.C.S.
Based in Fairfax, Virginia, Dr. Hess is a board certified plastic surgeon, Fellow of the American College of Surgeons, and a member of both the Medical Society of Virginia and Virginia Society of Plastic Surgeons. Known for his experience, patient-first care philosophy, and commitment to providing natural results safely, Dr. Hess helps patients from all over the country through expertly performed cosmetic procedures. Hess Plastic Surgery is located at 3930 Pender Drive, Suite 120, Fairfax, Virginia 22030; (703) 752-6608. For more information, visit www.hessplasticsurgery.com.
