En Bloc Capsulectomies
A new term has become popular on the internet – en bloc capsulectomies. There is even a website, “enblocsurgeons.com,” advertising surgeons who know how to “properly” treat breast implant illness. There are a few surgeons who do hundreds a year. One plastic surgeon has devoted his entire practice to it!
First, breast implant illness is not really understood, despite even scientific publications that include the words “Understanding breast implant illness…”
Almost any physical or psychological problem that has occurred in a woman with breast implants may be considered Breast Implant Illness. The problem of course is the lack of a control group.
One plastic surgeon in her late fifties who spoke at the FDA Hearing in 2019 mentioned that her identical twin sister with breast implants was having many problems such as headaches, joint pains, and mild memory loss. But so was she, despite not having breast implants.
This is not to say that there is not a problem, but rather that the physical basis for the problem has not been found. A scientific vacuum is never a good thing, because nonscience fills the gap.
Many plastic surgeons recommend that not only the breast implants be removed in the setting of Breast Implant Illness, but the capsule as well. At the “enblocsurgeons.com” you can look up an “en bloc” surgeon, who is committed to removing every piece of the capsule along with the implant.
If a capsulectomy were easy and harmless, why not? Well, it is not easy and harmless, and it is expensive for patients. It is often a difficult dissection with a high complication rate. It can leave the breasts looking scarred and deformed, much worse that they appeared before the breast implants were inserted. Plus, there is no scientific basis for capsule removal in a woman who has normal breast capsules. An en bloc capsulectomy is unnecessarily aggressive. The only woman who should receive an en bloc resection is a woman with diagnosed BIA-ALCL who has a capsular mass.
A much better option for the woman who has textured implants but no sign of capsular disease or BIA-ALCL, is simply to have her implants exchanged for new smooth implants, leaving the capsule alone. This is a quick, safe, and inexpensive procedure. Patients have minimal discomfort and are back to their usual activities within a day or two.
So, my patients that are concerned about BII either undergo no surgery, or breast implant removal without potentially harmful capsulectomies. Patients who have textured implants without any sign of BIA-ALCL often have their implants replaced with smooth implants, without capsulectomy.
Today, there is no reason for women to have textured implants. Both cosmetic augmentation and reconstruction may be performed with smooth implants, avoiding the risk of BIA-ALCL.
- Swanson E. Evaluating the necessity of capsulectomy in cases of textured breast implant replacement. Ann Plast Surg. 2020;85:691–698.
- Swanson E. The case for breast implant removal or replacement without capsulectomy. Aesthetic Plast Surg. 2021;45:1338-1341.