Does Dr. Sarah Mess Offer En Bloc Breast Implant Removal?
Dr. Mess offers total capsulectomy as an option for breast implant surgery removal. She uses the technique when removing breast implants with capsular contracture, suspected rupture, and per patient preference. While En bloc removal has received a lot of attention in recent years, the procedure comes with its own set of risks.
En bloc breast implant surgery removal involves a careful separation of the scar capsule containing the implant away from the breast tissue, pectoralis muscle, and ribs. Once isolated; the intact capsule containing the implant and possibly free silicone, biofilm, and fluid; is slipped through the incision without contaminating the breast tissue. Unfortunately, many implant capsules are thin and break apart even under careful dissection. Other times the capsule is scarred tight to the ribs and other structures where removal risks exposing the patient to unacceptable bleeding risks. Lastly, a true En bloc removal often requires extremely long excision lines to access the implant resulting in long scars.
Dr. Sarah Mess has settled on total capsulectomy as her preferred option for patients looking to have their implant capsules removed. She uses electrocautery and a lighted retractor for a meticulous dissection under direct vision. The patient has general anesthesia (‘twilight’ sedation possible in certain cases), IV antibiotic protocol, and a rinse of the pocket with an antibiotic solution prior to closure.
Recovery is generally much easier than the initial augmentation with patients returning to work in a week or less.
Patients may opt to have implant removal alone or followed by:
- Revision augmentation with implant
- Tightening of the skin/lifting with mastopexy
- Fat transfer to the breast to replace the implant (and be implant-free)
The body forms a layer of scar tissue around any implant whether breast implant, total knee replacement, mediport for chemotherapy, or decorative stud. The body seals off foreign body from the surrounding tissue, a natural defense even to sterile, inert objects.
Capsular contracture is an over-zealous scar formation around the breast implant by the body where the scar thickens, tightens and possibly calcifies. When the scar calcifies, an eggshell of calcium is seen on mammogram, the patient has pain, and the capsule appears as chalky layers of scar upon removal.
When capsular contracture occurs with breast implants, they feel hard, look high on the chest wall, and sometimes cause pain. Capsular contracture is the most common reason for reoperation after breast augmentation throughout a patient’s lifetime. Lifetime data is not available in the United States, but capsular contracture is probably in the 20-25% range. Despite surgical correction with removal of the scar capsule and replacement of the breast implant, capsular contracture recurrence is not uncommon.
With breast implants greater than 25 years old, the gel is more liquid and permeable and passes through the scar capsule into the breast tissue. The free silicone gel ends up residing in the breast tissue toward the axilla as the body will try to cart off movable-foreign-body from the breast into the axilla, the main lymphatic drainage basin.
The silicone is inert and does not cause cancer or illness, but palpable, firm nodules disturb the peace of mind of the patient and their physician. MRI and biopsy could confirm that the nodules are silicone and not a breast cancer.
Newer breast implants have more cohesive gel and do not permeate through the shell and stay put in the scar capsule when ruptured. Implant ruptures are typically caused by fracture of the implant shell from wear and tear; medical devices cannot be expected to last forever.
