Breast augmentation remains the most popular cosmetic surgery procedure in the United States—and the vast majority of our LJCSC patients are so happy with their results that they cannot imagine not having their breast implants. All the same, a small percentage of patients each year decide to have their breast implants removed, either due to a complication or simply personal preference.

Our board certified plastic surgeons are highly experienced in explantation, or breast implant removal. And, just as they personalize breast augmentation to each patient’s needs, they personalize breast implant removal to ensure a safe surgery and aesthetically pleasing result. One technique an increasing number of patients are asking about is en bloc breast implant removal, or en bloc explantation.

What is en bloc breast implant removal?

En bloc explantation is a breast implant removal technique that takes out the old breast implant and the surrounding scar tissue capsule as one unit (the term “en bloc” means “all together”). After breast augmentation, the body responds by forming a layer of scar tissue around the implant—this is called a capsule. You’ve probably heard of the capsule in relation to a complication called “capsular contracture”—abnormal contraction of the capsule—but every single patient with breast implants has capsules. The difference is that a normal, healthy capsule cannot be felt and does not cause problems.

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Is there a benefit to en bloc removal?

En bloc explantation has not been shown to produce any results different or better than a total capsulectomy and removal of the implant. It is a procedure based on the belief that keeping the implant inside the capsule reduces the risk of any contaminants from the implant getting into the body.

Why en bloc removal isn’t always the right option

More and more of our San Diego breast implant removal patients are asking about en bloc explantation. There are certain situations in which en bloc removal either cannot be safely performed, or is not in the patient’s best interest:

  • The capsule is thin (very common in healthy patients). A healthy capsule is quite thin and tears easily. It may be impossible to keep it totally intact during removal. In this case, our surgeons will free as much of the capsule as possible with the implant inside. Then, they will carefully open the capsule and remove the implant; this causes the capsule to collapse, which makes it much easier for the surgeon to free the capsule from the top and back of the breast. Most capsules are tightly adherent to the ribs if the implant was placed in a subpectoral position. When the capsule is very thin, it is like shaving wet tissue paper off the ribs.dr-saltz-breast-augmentation-revision
  • The breast tissue and skin are very thin. If there is very little tissue between the skin and the capsule, removing the capsule could risk tissue damage or even tissue loss. In this case, it may actually be safer to leave the capsule intact and remove only the implant.
  • The capsule and implant are too large to remove en bloc through a reasonable incision size. In this case, rather than create a wider scar, your surgeon may carefully open the capsule after separating it from the surrounding tissue and then remove the implant through a small incision in the capsule.

How is en bloc capsulectomy performed?

En bloc explantation requires at least an incision along the entire length of the inframammary fold. If the implants are very small, the incision could be shorter. If the breasts and/or implants are large, a vertical incision from the fold to the edge of the areola may be needed.

Video 1: Making the incision for en bloc capsulectomy

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Video 2: Separating the capsule

To perform en bloc capsulectomy, a plastic surgeon carefully separates the capsule from the breast tissue, keeping the breast implant inside.

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Video 3: Removing the capsule & implant en bloc

Once the capsule is completely released from the breast tissue, the capsule and implant are removed together.

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The resulting breast cavity is irrigated with saline, Betadine, and a triple antibiotic solution. A drain is inserted and the incisions are closed.

LJCSC en bloc capsulectomy procedure after implant removal
View of inside of breast after en bloc capsulectomy procedure

A breast lift may be advised to address any stretched or sagging skin and ensure a beautiful result. We will be sure to discuss this option with you before surgery and help you understand how a breast lift may help.

Since 1988, more than 32,000 patients have had safe, successful procedures at La Jolla Cosmetic Surgery Centre.

What is the recovery like?

Recovery after en bloc breast implant removal is typically quicker than the initial breast augmentation recovery. Most patients return to office jobs within one week, and can resume exercise gradually after a couple of weeks. If you are having a breast lift at the same time, your recovery may be a little longer. Of course, your plastic surgeon and their nurse will go over the details of your surgery and expected recovery during your consultation.

Contact us for more information about en bloc breast implant removal

If you are considering having your breast implants removed, or you are interested in learning more about the en bloc removal technique from our San Diego plastic surgeons, please call our office at 858-452-1981 or contact us using the form on this page.