En Bloc Breast Implant Removal
En Bloc Breast Implant Removal
Dr. Daniel Krochmal demonstrates removal of a breast implant for capsular contracture. When possible, Dr. Krochmal tries to remove the implant and capsule “en bloc”, or as a single unit. He carefully frees the capsule in such a way that as much of the breast tissue is preserved as possible. This technique can also be used for patients with symptoms attributed to the breast implants, also known as Breast Implant Illness.
What is En Bloc Breast Implant Removal?
“En Bloc” breast implant removal is a technique where the breast implant is removed along with the protective scar surrounding the implant (called the “capsule”). The body naturally forms a scar shell around almost every foreign object placed in the body (joint replacements, pacemakers, etc.) to try and “wall it off”, and breast implants are no exception. Normally this capsule is thin, soft, and flimsy. However, sometimes this capsule can be thickened and hardened/calcified, and can contract in such a way where the breast implant is distorted (called a “capsular contracture”). If the capsular contracture becomes significant, then sometimes it’s necessary to remove the capsule along with the breast implant.
When the entire capsule is removed along with the implant in one piece, this is called “en bloc” breast implant removal. Some patients may not have capsular contracture, but may want their implant removed along with the capsule. This scenario is becoming more common with patient concerns regarding Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), and if patients feel their body is reacting to the implants and causing symptoms (referred to as “Breast Implant Illness”, or “BII”).
How is En Bloc Breast Implant Removal Done?
Who is a Good Candidate for En Bloc Breast Implant Removal?
A good candidate for en bloc breast implant removal is a patient with a significant capsular contracture, a patient that has BIA-ALCL or is concerned about it developing, or a patient who believes they have BII/Breast Implant Illness. It should be noted that at this time there is significant research being conducted into the nature of BII, and which symptoms may improve or not improve with en bloc breast implant removal (for example, if there is actually something else causing the symptoms, then removing the breast implants wouldn’t improve those symptoms the patients are having).
Of course, a patient may just wish to have their implants removed for any reason. If a patient has smooth-walled implants, and isn’t having concerns for BIA-ALCL or BII, then many doctors (including Dr. Krochmal) will simply remove the implant and leave the harmless capsule in place, as removing the capsule is unnecessary and can possibly lead to more surgical complications or breast shape distortion.
What is the Recovery for En Bloc Breast Implant Removal?
En bloc breast implant removal recovery is pretty straightforward. You’ll be a bit sore for a few days, but many times patients report the discomfort is less than the initial augmentation procedure when the implants were placed. You’ll get pain medication to help with the discomfort. Most patients are out to dinner the following day, and driving after several days. You can shower the next day, but no soaking in water, heavy lifting, or strenuous activity for 1 month to allow for the tissue on the inside to heal properly. You may have a surgical drain placed to reduce the fluid build-up and swelling, and these are typically removed within 1 week of surgery if they are used.
What About BIA-ALCL and BII?
If there is concern about your implants or the capsule (for BIA-ALCL), then some of the tissue may be sent to the lab for testing. If the tests come back positive for BIA-ALCL, then your doctor will talk to you about next steps. The good news is that en bloc breast implant removal for BIA-ALCL is curative in the vast majority of cases! You may still be referred to an oncologist as a safety measure. If one breast has BIA-ALCL, many doctors will recommend en bloc breast implant removal on the other breast as well.
For Breast Implant Illness (BII), there are no labs to check at this point in time to document success. There is no guarantee that the symptoms patients are experiencing will go away with en bloc breast implant removal.