The scar tissue which forms around an implant is called a capsule. This is the body’s natural reaction to a foreign object, in the same way as a capsule will form around a splinter in your toe. In most cases, the capsule will not change the way your implants look or feel. When removing breast implants, the capsule should be taken into consideration. If the breast implants are being removed permanently, there is no good reason to remove the capsule unless it is very hard or has obvious disease, such as ALCL.

` En bloc’ is a French term that translates as `all together’ or `as a whole’. It is a term that is used in cancer surgery to describe the technique of removing a tumour and a cuff of normal tissue around it in one piece, such that the tumour cells are less likely to leak into the circulation. The application of ‘en bloc’ resection to breast implant removal with the capsule in one piece is misleading, and not based on any studies or research. 

Generally, if you wish to have your breast implants removed you do not require any sort of capsulectomy, let alone an ‘en bloc’ procedure. There has never been a single clinical or scientific study which has demonstrated any benefit of ‘en bloc’ resection of a breast implant with a capsule. It is hazardous, and can result in a punctured lung. ‘En bloc’ resections require longer scars, and prolonged surgical time. It frequently leads to deformities of the breast, given that additional tissue is removed with the capsule and implant.

There are many medical inaccuracies perpetuated by the internet in relation to an `en bloc’ procedure. Some women who believe themselves to be suffering breast implant illness (BII) feel that a total capsulectomy is necessary to remove all causative agents and hence seek an `en bloc’ implant removal. There is no evidence that ‘en bloc’ resection has any long-term effect on reducing the symptoms of BII.

The procedure is not recommended by any surgical association or group which deals with implant removal, as it has demonstrable risks and no demonstrable benefits. The only circumstances under which I will undertake the procedure is when a patient has been diagnosed with anaplastic large cell lymphoma (ALCL).

Removing breast implants changes the shape of a patient’s breast in an unpredictable way, although I can provide you with some idea of how they will look. Once you’ve had the breast implants removed, your breasts will initially look deflated. It can take up to 12 weeks for the breasts to regain their volume. Your breasts will not look the same as they did before you had the breast implant surgery, as the weight of the implants will have stretched the tissue. Given time, the position of the nipple, crease under the breast and lowest point on the breast will all lift to a degree. If a patient does not want new implants but wants to have an improved breast shape, the implant removal surgery can be combined with a breast lift (mastopexy). 

From your pre-surgical measurements, I will be able to provide you with an indication of whether this surgery is likely to be beneficial, or whether it is worth waiting to see how your breasts recover after removing the implant before making any decisions on additional surgery. Frequently, simply removing the implants and allowing time is sufficient.

This procedure is performed as a day case
The surgery takes approximately 30 minutes, unless a capsulectomy is performed
Once both implants (and their capsules, if applicable) are removed, the incisions are closed with dissolving sutures
If you are in good health and a non-smoker, you will usually heal quickly and only need approximately 1 week of downtime
Normal daily activities like showering, eating and light activity such as walking can be resumed within 24 hours after surgery