En Bloc Excision of Breast Implants

Many patients are asking Dr. Ennis to "take out my implants" due to complications from previous breast implant surgery. To accomplish this, Dr. Ennis may perform an en bloc excision or the breast implant which may or may not remove the implant. The procedure type is determined by the individual issues of the patient and results. This guide to En Bloc Breast Implant Excision was written by Dr. Ennis to help patients understand their options and the process. Please click a table of contents link to go directly to that section or scroll to begin reading.

En Bloc means the surgeon leaves the capsule tissue intact on the breast implant and cuts around this intact unit without disrupting either the capsule or the implant so as to avoid contamination to the body.

En bloc removal of the breast implants (also known as a complete capsulectomy) is the removal of the entire breast implant as well as the surrounding tissue or capsule as one piece or in its entirety.  

Many women have suffered from different illnesses such as fibromyalgias, arthritis, unexplained allergies and have not concluded a reason or source for their illnesses. As a last resort, women look to have their implants removed in an effort to get better in hopes this might be the source for their troubles. Most surgeons and doctors recommend En Bloc removal of the implant which means to remove the implant and the capsule and any tissue that was in contact with the implant to remove any possible nidus for the allergen

As a last resort, women look to have their implants removed in an effort to get better in hopes this might be the source for their troubles.

This procedure can be performed on anyone who has breast implants, saline or silicone. Depending on your reasons to have the implant removed will determine if a simple implant removal will suffice or if a full capsulectomy with En Bloc resection of the surrounding tissues.

During your consult, your surgeon will ask about your medical history and examine you. The surgeon will then make suggestions and a plan for implant removal which will likely include En Bloc removal which removes the entire capsule. Make sure to discuss this procedure with your surgeon in detail, as simple implant removal is very different than a complete capsulectomy and/or En Bloc removal of the surrounding tissue. This procedure is often more expensive as it takes considerably more time in the operating room which equates to cost. Discuss with your surgeon which procedure is best for you.

There are several matters to consider when looking at having breast implants removed or undergoing an En Bloc removal of implants.

Most En Bloc excisions / capsulectomies will be performed through an inframammary incision under the fold of your breast as this gives the surgeon the best access to the implant and capsule.  Keep in mind the incision may be slightly longer than the existing original scar from having the implant placed or just a simple implant removal. Removing the implant through the underarm is an option but the capsule cannot be removed and therefore this incision is not an option for performing an En Bloc resection or capsulectomy. Removing the implant and the capsules through the nipple incision is often difficult as well as visibility is very limited so this incision is not recommended by most surgeons.

This is a personal decision. Most women who are concerned that the implant might be the cause of their illness will opt not to replace the implant with either saline or silicone. The shell of both the saline and silicone implant is made of silicone, so if the concern is silicone itself, then the saline implant may not be a good option either as the shell of the saline implant is also made of silicone.

Fat grafting or fat transfer (also known as lipo-infiltration of the breast) may be an option to restore volume to the breast once the implant is removed.

There must be enough fat existing elsewhere on the body to harvest the fat to put back in the breast.

There must be enough breast tissue (or thickness of tissue) to reinject the fat into. The fat must have a place to live or in essence, enough healthy breast tissue to support it. The fat cannot be reinjected into the old capsule or location of the old implant as the fat will not survive here.

En Bloc resection or Capsulectomies is an outpatient procedure, meaning you will be discharged home the same day. Surgery time can vary depending on the complexity of your case. On average, the surgery will take 2-3 hours.

Anticipate seven to ten days off work for office work but discuss your case with your surgeon as recovery may vary depending on your individual case. Limitations on heavy lifting and exercises such as running, and chest workouts will be longer.

Results will vary depending on your starting point and the complexity of your situation. The appearance of your breast prior to the procedure will also significantly affect the end result of your procedure.  Keep in mind that although all surgeons will strive to get you the best result, this is not considered a cosmetic procedure but rather a salvage procedure in an attempt to improve your overall health after all other modalities have failed.

 It is preferred to consult with a surgeon board certified and who is a member of both the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery. Dr L. Scott Ennis is a member of both of these societies and is also a member of the prestigious International society of Aesthetic Plastic Surgeons.