Explant Surgery Options — En Bloc vs. Total Capsulectomy: Which Is Right for You?

One of the most common questions Dr. Hakimi hears from explant patients is, “Do I need en bloc capsulectomy?” The short answer is: probably not. While en bloc removal sounds more thorough, it’s typically reserved for specific medical situations, not routine explant surgery. The confusion around these terms can make an already overwhelming decision even more stressful. Let’s break down what these procedures actually involve and when each is appropriate.

First — What Is a Capsule, and Why Does It Form?

When you get breast implants, your body recognizes them as foreign objects. In response, it forms a protective layer of scar tissue around the implant. This isn’t a bad thing. It’s a normal part of the healing process that all women with breast implants experience. The capsule “walls off” implants from the rest of the body and provides stability. 

For most women, the capsules remain thin, flexible and barely noticeable. You might not even know they’re there. However, sometimes capsules can become problematic. They may become unusually hard and “squeeze” the implant, a condition known as capsular contracture. In severe cases, this can lead to pain, firmness and a distortion of breast shape.

Recent research suggests that capsules might also play a role in breast implant illness. The theory is that chronic inflammation within the capsule, possibly triggered by bacteria or implant materials, could contribute to the systemic symptoms some women experience. While this connection is still being studied, it’s one reason why complete capsule removal is often recommended during explant surgery for women with BII symptoms.

What Is En Bloc Capsulectomy?

“En bloc capsulectomy” is a surgical technique that is often confused with total capsulectomy. It involves removing the breast implant and capsule (the surrounding scar tissue) in one piece, along with a small amount of healthy tissue. True en bloc procedures are usually reserved for tumor resection, and in most cases, are overkill when it comes to breast implant removal. 

According to the Breast Surgery Collaborative Community (BSCC), en bloc capsulectomy is only indicated for established or suspected cases of implant-related cancers, such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This rare type of non-Hodgkin’s lymphoma can develop in the fluid or scar tissue surrounding an implant, making it important to remove both implant and capsule as a single, unbroken unit. 

What Is Total Capsulectomy? 

What many people refer to as “en bloc capsulectomy” can be more accurately described as total capsulectomy in the absence of malignancy. Total capsulectomy involves taking out the breast implant and capsule, as a single unit whenever possible, but with the end goal of removing all safely resectable scar tissue. Some capsules may be too thin or too close to the ribs, lungs, muscles or other structures for intact removal. 

The BSCC consensus statement defines four different types of capsulectomy: 

• Total intact capsulectomy: Complete removal as a single unit
• Total capsulectomy: Complete removal, not necessarily as a single unit
• Partial capsulectomy: Removal with some capsule left behind
• En bloc capsulectomy: Complete removal as a single unit with a margin of normal tissue 

The right approach for you depends on several factors, such as your symptoms, implant placement, reasons for seeking explant surgery and intraoperative findings. Dr. Hakimi will assess all of these factors to determine the safest, most appropriate removal technique. 

Is Total Capsule Removal Always Necessary?

In practice, the goal is always complete capsule removal, but your surgeon’s primary responsibility is your safety. If removing every bit of capsule tissue would put you at risk for complications like pneumothorax (a collapsed lung) or damage to chest wall muscles, a skilled surgeon will prioritize your well-being over achieving “perfect” results.

It’s worth noting that residual capsule tissue doesn’t necessarily mean your symptoms will persist. Many women experience significant relief even when small amounts of the capsule remain, particularly if the bulk of the inflammatory tissue has been removed. The key is working with an experienced surgeon who can make these decisions during your procedure.

Dr. Hakimi’s experience with explantation means he can adapt his technique based on what he finds during surgery. He’ll always aim for the most complete removal possible without compromising your safety. During your consultation, he’ll explain which approach is likely to be most appropriate for your specific case and what factors might influence your surgical plan.

Do I Need My Implants Removed? 

The decision to remove breast implants is personal and depends on your individual circumstances. There’s no universal guideline that says implants must come out after a certain number of years, though the FDA recommends regular monitoring and acknowledges that most women with breast implants will need to consider replacement or removal at some point.

Several factors that might lead you to consider explant surgery may include:

Cosmetic Concerns

Over time, breast implants can change in appearance, and so can your natural breast tissue. You might notice that your breasts look different from how they did right after surgery, or perhaps your implants no longer suit your lifestyle. Other women consider explantation due to issues like shifting of the breast implant, visible rippling, asymmetry or dissatisfaction with size. 

Implant Complications

Medical complications are another common reason for implant removal. Capsular contracture, where the scar tissue hardens, can affect both your appearance and comfort. Other complications might include infection, implant malposition or chronic pain. These issues don’t always resolve on their own and may require surgical intervention. Sometimes the best solution is implant removal rather than replacement, especially if you’ve experienced recurring problems.

BII Symptoms

Breast implant illness has become an increasingly recognized reason for explant surgery. Women experiencing BII often report a wide range of symptoms that can affect multiple body systems, including chronic fatigue, joint pain, brain fog, mood swings and skin rashes. While the medical community continues to study the relationship between breast implants and these symptoms, many women find significant relief after explantation. As symptoms resolve, many women report feeling like themselves again, with improved health and overall quality of life. 

How Dr. Hakimi Helps You Decide

Dr. Hakimi evaluates each patient individually, carefully considering their concerns and goals. Beyond selecting a surgical technique, you need guidance on whether implant removal makes the most sense for your situation. During your consultation, he’ll review your medical history thoroughly and discuss your specific concerns in detail. This might include questions about when issues started, how they’ve progressed and why you’re considering implant removal now.

Dr. Hakimi provides honest information about what explantation can accomplish, acknowledging that outcomes vary from person to person. He may suggest alternatives like implant replacement or revision, depending on how you want your breasts to look after surgery. His goal is to help you weigh all these factors to make the choice that feels right for you.

Make an Informed Decision About Your Explant Surgery

Whether you’re dealing with BII symptoms or simply want to return to your natural appearance, Dr. Hakimi is here to help you explore your options. His experience with explant surgery, combined with his commitment to patient education and safety, ensures you’ll receive honest guidance tailored to your unique situation.

To learn more about explant surgery and which technique might be right for you, schedule a consultation with Beverly Hills’ most trusted plastic surgeon. Get started by calling Hakimi Plastic Surgery at 424-239-5201 or by requesting a virtual consultation.