Total Capsulectomy | En Bloc Implant Removal
Part of your body’s natural healing response is for scar tissue to form around a medical device, including a breast implant. In most cases, this “capsule” of scar tissue remains thin and flexible and can even help hold the implant in place. However, sometimes the tissue thickens and hardens into a condition known as capsular contracture, putting pressure on the implant.
Capsular contracture can distort the affected breast, causing pain. Capsulectomy is surgery to remove the problematic breast implant and scar tissue, restoring comfort and an attractive appearance. I can also use this procedure to correct other problems, including ruptured silicone implants or those struggling with issues related to their implants including breast implant illness.
I have 27 years of experience performing capsulectomy procedures. I have treated countless patients who have had ruptured silicone implants, experienced capsular contracture, and had issues with their implant size and shape, correcting the problems with partial or total capsulectomies. I also have years of experience with performing en bloc implant removals, which is a routine surgery that takes the capsulectomy one step further for women who suspect that their implants may be causing systemic issues in their bodies (also known as breast implant illness). If you are experiencing discomfort or complications with your implants, I can help treat your concerns.
To learn more about how a New Jersey breast implant removal can help you, call (973) 736-5907 or contact us today.
Breast Implant Illness Treatment by Dr. Spiro
Dr. Spiro’s podcast episode below describes how he manages complex cases, including those related to breast implant illness, capsulectomy, and reconstruction options. Dr. Spiro brings a wealth of knowledge and a unique approach to treating this condition, emphasizing the importance of thorough and individualized care for each patient. His innovative techniques, such as the total capsulectomy and non-implant auto augmentation, have set him apart in the field, providing patients with options that aim for both health improvement and aesthetic restoration. Schedule your personalized consultation with Dr. Spiro in New Jersey today by calling us at (973) 736-5907 or contacting us online.
Implant Removal gallery
Please review our capsulectomy and implant removal before and after pictures to see our patients’ amazing results after surgery.
Why You Might Consider or Require Capsulectomy and Implant Removal
You might desire explant surgery – with or without replacement – to change your breasts’ size or shape or switch to a different implant material. You might require capsulectomy as part of your implant removal procedure if problems with the original implants have affected or might affect the surrounding tissue or if tissue removal is necessary to ensure a successful implant replacement.
I can solve problems like these with capsulectomy and implant removal.
- Rupture or leakage of a silicone implant: Capsulectomy removes tissue the silicone has leaked into, preventing further spread.
- Capsular contracture: Capsulectomy addresses the thickened, hardened scar tissue, relieving your discomfort and restoring an attractive form and feel to the breasts.
I can also perform capsulectomy and implant removal to address any concerns about implant-related illnesses. Removing the implant and surrounding tissue (en bloc removal) further reduces the low risk of Breast Implant-Associated Illness (BLL), restoring your peace of mind.
In capsulectomy with implant removal, I can replace implants as part of the procedure or remove them entirely. If you opt to have an explant procedure without getting new implants, I can perform an auto-augmentation breast lift that repositions tissue to create an attractive shape and fullness.
Meet Scott SpiRo, M.D., F.A.C.S.
SURGEON BY TRADE
I am a board-certified plastic surgeon specializing in deep plane facelifts and neck lifts, breast procedures including breast reduction, reconstruction and breast augmentation. I’m also an expert in body contouring including mommy makeovers, liposuction, tummy tucks, and more. To me, every patient is unique and deserves exceptional, natural-looking results. You can understand my approach to care by reviewing the testimonials and before and after galleries on this site and learning more about why I’ve been named a top plastic surgeon in my field.
ARTIST AT HEART
Art is my other passion, and my artist’s vision guides my work as a surgeon. I have done technical illustrations for many journal articles, book chapters, and patient resource pamphlets for national societies. I am also an accomplished painter, sculptor, and photographer. When you visit our office, you’ll see a gallery of reproductions of many of my pieces in oil, graphite, and photography.
Capsulectomy and Implant Removal Candidates
Capsulectomy and implant removal involves removing the breast implants and scar tissue that has formed around an implant. Women whose breasts feel firm, hard, and painful are good candidates for this surgery, as they are potentially suffering from capsular contracture. Ideal candidates for this procedure also have realistic outcomes for their results after surgery and are in overall good general health.
What to Expect During Your Consultation for Capsulectomy and Implant Removal
During your consultation, I will talk to you about your medical history, current medications, and surgical goals. I will also evaluate and examine your breasts based on your concerns with your implants. My staff and I will review the procedure with you and explain possible risks, complications, and surgical outcomes.
Types of Capsule Removal Surgery | Explant Surgery
If you are a good candidate for capsulectomy, I will choose and explain the safest and most effective approach during your consultation.
- Total capsulectomy: In a total capsulectomy, I’ll remove all the scar tissue after taking the implant out. Depending on your unique surgical plan, I’ll then replace the implant or reshape the breast without an implant.
- Partial or subtotal capsulectomy: In a partial capsulectomy, sometimes called a capsulotomy, I remove a portion of the capsule scar tissue. In some cases, this is sufficient to release tension around the implant. If you choose not to have your implant replaced, the surrounding breast tissue typically absorbs the remaining scar tissue after a partial capsulectomy.
- En bloc capsulectomy: In an en bloc capsulectomy, I remove the implant and its capsule as a single unit. En bloc capsulectomy may be the option when a silicone implant has ruptured or when there is a risk of implant rupture during the procedure.
How to Prepare for Capsulectomy and Implant Removal
Before having capsulectomy and implant removal surgery, you will need to stop taking certain medications that may slow your body’s ability to heal. If you smoke, vape, or use any nicotine, cannabinoid, and/or ADHD medication, you must be willing to stop for several weeks before and after your surgery.
As part of your planning for the day of the surgery, you should also arrange to have a family member or friend drive you to and from the hospital.
Capsulectomy and Breast Implant Removal Surgery in New Jersey
I perform capsulectomy and implant removal surgery while patients are under general anesthesia. Based on my recommendations during your initial consultation, I will remove all the capsule scar tissue by performing a total capsulectomy or an en bloc capsulectomy, or I will remove only a portion of the capsule scar tissue in a partial capsulectomy. It is up to you to determine whether you prefer to have a breast implant replacement as part of your procedure.
If you have chosen not to have an implant replaced after removal, I may repair your pectoralis muscle and reattach it back to the chest wall. This process diminishes the possibility of post-operative seroma, which is a fluid accumulation in the space previously occupied by the implant. I generally propose combining a breast lift procedure with capsulectomy and implant removal if it is feasible. An auto-augmentation breast lift uses the tissue that I would otherwise remove in a breast lift or reduction, to add fullness to the breast.
Capsulectomy and implant removal can also manage suspected anaplastic large cell lymphoma (a rare type of non-Hodgkin’s lymphoma) and other suspected illnesses associated with breast implants; I have developed a comprehensive protocol in our outpatient hospitals for evaluating the tissue specimen after surgery. These processes include pathology and microbiology assessments, including testing for BIA-ALCL, standard tissue pathology, anaerobic and aerobic culture with gram stain, and acid-fast bacteria and fungi to test for ALCL or breast implant illness. Additional markers for BIAALC and squamous cell cancer will be tested. We take patients’ health concerns seriously, which is why we subject the tissues to comprehensive testing.
What to Expect in Recovery after Capsulectomy and Implant Removal
After surgery, I will place drainage tubes in the area to help reduce swelling. I will also give you a compression bra to wear for several days. Your breasts may feel sore, but the full recovery for capsulectomy and implant removal is only two weeks. You can also return to work within 4-7 days after surgery and resume fitness activities in about a month. The overall procedural outcome is extremely satisfying to patients from a cosmetic standpoint and for relief from discomfort.
Trust the expert in breast explant surgery
Dr. Scott Spiro is a board-certified plastic surgeon at Spiro Plastic Surgery in West Orange, NJ, specializing in capsulectomy and implant removal procedures to help women experiencing capsular contracture and other problems with breast implants including breast implant illness. Call us at (973) 736-5907 or reach out online to learn more about your options for treatment with a beautiful outcome.
Breast Implant Illness FAQs
Breast Implant illness prevalence is very difficult and controversial to pinpoint the actual percentages. It depends on if one is asking about registered indications for revision implant breast surgery (and this varies from 2.7-4.2% of cases) versus the tens of thousands of women who participate in online communities that center around the diagnosis
Signs and symptoms vary from patient to patient and there are not necessarily any first signs or symptoms.
Many symptoms include…
- Joint or muscle pain
- Chronic fatigue
- Memory and concentration problems (brain fog)
- Breathing issues
- Sleep disturbances
- Rashes and other skin conditions
- Dry eye and dry mouth
- Anxiety
- Depression
- Headaches
- Hair loss
- Gastrointestinal disorders
The surgical management for Breast Implant Illness is controversial. There are some surgeons who believe simple implant removal (explanation) alone is enough. Others believe that total capsulectomy (complete removal of the scar layer that forms around an implant), is a more thorough method of treatment. My extensive experience has shown that bacteria cultured from the recesses of the inside of the removed capsule contributes significantly to Breast Implant illness symptoms.
If the cultures come back positive, additional oral antibiotics are continued for another three weeks.
It seems that the vast majority of positive cultures are for Cutibacter Acnes. A bacteria prevalent in skin. The issue is that Cutibacter can take up to 10 or more days and in rare circumstances take weeks to culture out positive. Most surgeons either do not thoroughly culture the capsule or the labs they use are unwilling to be persistent in holding on to cultures that have not tested positive at a week to ten days.
That is just it, the word “en bloc” is being pushed in social media circles, not in the medical community. In actuality, “en bloc” is a term generally reserved for a cancer procedure designed to intentionally remove anticipated normal tissue surrounding cancerous tissue in order to obtain a recommended margin for cure or local control. En bloc is not a treatment applicable to breast implant illness as the illness is not a cancer. The treatment is actually a form of total capsulectomy known as a TOTAL INTACT CAPSULECTOMY. In this operation the entire scar layer surrounding an implant is removed together with the implant in unison. In some cases, total capsulectomy cannot possibly be executed as a total intact and that the entire capsule is removed, but in segments with the entire implant. Some reasons for this approach may be safety as determined at surgery where scar capsules may be fused to ribs and rib muscles.
Lesser complete capsulectomies are known as segmental, partial, or incomplete capsulectomies.
In suspected breast Implant Illness, the implants are generally not replaced at that time. This is the general request by patients who have been suffering.
Total capsulecomy can potentially be deformational; yielding obvious voids and absence of tissue in some circumstances. This has led me to develop a special type of procedure to aid in camouflage the tissue loss and deformity of absence. I call this NON IMPLANT AUTOAUGMENTATION. In this procedure I creatively use tissue flaps (called DERMOGLANDULAR FLAPS) from the remaining breast to fill in voids left behind from the absence of the implant and capsule layer.
For simple implant removal, the answer is yes. Since no capsule is removed in simple implant removal, there is a better more reliable place for the fat to be placed into. However, as I stated previously, simple implant removal is not an ideal or thorough treatment for Breast Implant Illness. But if total capsulectomy has truly been done, and especially if some type of tissue flap reconstruction has also been done, then it is difficult to get the fat to “take’ at the same time as these other definitive treatment procedures and it is best held off until the patient heals from the definitive initial surgery.
These are complex surgeries that are routine for me in my practice but are next level complex especially when combined with various attempts at local tissue reconstruction simultaneously. So, my advice to patients is to seek experienced Plastic Surgeons who are Board Eligible or Board Certified by the American Board of Plastic Surgery. Do your own research, don’t just go by what you see online (like in a Facebook group). Look at the surgeon’s website and read their Google reviews. Make an informed decision because it is an important one!
