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Finally, after all these many years, the venerable but publicity shy en bloc capsulectomy has hit it big time.

Yes, indeed!

And it largely has social media to thank for it.

This seems to be the case at least judging by the countless social media articles, discussions and threads focusing on this procedure. In fact, certain recent Google searches using the term en bloc in relation to capsulectomy yielded more than 100,000 results.

That is quite a significant number!

Part of this recent “fame” is also driven by substantial of marketing by plastic surgeons and others wanting to be involved in this latest “trend”.

Let’s look into this en bloc capsulectomy a little further and see what it is all about and whether this publicity is warranted or not.

What is an En Bloc Capsulectomy?

An en bloc capsulectomy is the surgical technique involving the complete removal of an implant and any free silicone (if the implant is ruptured) along with an intact surrounding capsule (scar tissue that forms around implants). This is a type of total capsulectomy in which the capsule is removed completely intact – as one whole unit.

En Bloc Capsulectomy Example 1

En Bloc Capsulectomy Example 2

This can be performed as part of an explantation or an implant exchange.

What is the difference between an En Bloc Capsulectomy and a Total Capsulectomy?

A total capsulectomy involved the complete removal of the scar tissue that naturally forms around the implant. The capsule can be removed either piecemeal, which is most commonly done, or as one intact unit – which is what an en bloc capsulectomy is.

It is important also to realize that there are situations where it is physically impossible to have an en bloc capsulectomy and one of these is where the capsule is extremely thin.

Is an En Bloc Capsulectomy Superior to the Standard Total Capsulectomy?

Ideally, there is an intuitive attractiveness of removing an intact capsule along with the implant, particularly in certain clinical or pathological situations. Examples of these can include where the implant is ruptured exposing free silicone, where there is substantial calcifications of the capsule and in situations where an infective process may be at work or is conjectured to be occurring. A purported example of the latter is BII (breast implant illness) where certain self-appointed experts have made claims that performing anything less than an en bloc capsulectomy is tantamount to inappropriate, poor care – or worse.

Regardless of whether the total capsulectomy involves either the piecemeal or en bloc removal of the capsule, there are further actions that are subsequently taken during the procedure itself to help ensure the most ideal situation prior to wound closure.

Is there any irrefutable scientific evidence that the results of an en bloc resection are superior to those of the standard total capsulectomy?

Absolutely not!

What Then is Truly Behind This Recent En Bloc Publicity?

In my opinion, the driving force right now behind publicity associated with the en bloc capsulectomy is largely marketing in nature rather than being based on real scientific evidence. More than a few of the surgeons loudly touting this technique are either overtly (or less than subtly) indicating that THEY (in contrast to others) possess the skills that are required to perform this more technically challenging approach. This position can drive more patients to them and, therefore, generate more revenue.

Whether or not this en bloc technique will be shown in the future to be superior or not to the “standard” approach remains to be seen. On the other side of the coin, it is a variation of technique of an accepted procedure so that its usage is not wrong as long as it can be performed just as safely as the generic total capsulectomy.

 

If you are in need of a capsulectomy or are just considering either an implant exchange or explantation, you can contact my office to schedule a thorough consultation with me.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

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