Enbloc, capsulectomy vs leaving the capsules in…

It is a subject matter that is always arising on the support group.

  • What is the difference between enbloc and capsulectomy?
  • What will happen if the capsules are left in?
  • Why won’t my surgeon commit to removing 100% of the capsules?

Lets answers these questions, so that you are fully informed, can make the right decision for your situation and also walk into your surgeons office with a really clear understanding to get the best out of your consultation.

WHAT IS A CAPSULE?

A capsule is the scar tissue that forms around the implant within the body. It is the body’s natural defence mechanism to protect itself from the introduction of a foreign object. It can be referred to as scar tissue, scar capsule or just capsule.

WHAT IS THE DIFFERENCE BETWEEN ENBLOC & CAPSULECTOMY?

Enbloc is actually a french term used to describe a surgical excision of a cancer. This is why some surgeons may not fully understand what you are requesting. Enbloc terminology for the removal of implants has come across the pond from the USA group and the reason it is now widely used within the UK explant community.

There are two types of capsulectomy…

Partial Capsulectomy:  This is where some of the scar tissue could only be removed.

Total Capsulectomy:  This is where the all the capsule is fully removed in either sections/pieces or completely as a whole unit, with the implant still contained inside.

So for clarity on terminology here in the UK;

TOTAL CAPSULECTOMY is actually the correct term to use when speaking with a surgeon if you want all the capsule removed. It is a type of enbloc capsulectomy.

The procedure of a full total capsulectomy (as a whole unit) was originally performed when the surgeon knew that the implants were ruptured. This is to prevent any silicone leaching into the cavity (the area where the implant was placed).

However many women now seeking explantation, request this specific technique as they are concerned their health issues are down to a possible biofilm (a mucusy film containing bacteria and microorganisms) that can develop in between the implant and capsule, silicone leaking from the implants or even in the case of saline implants, mould that has formed within the implant. They want to make sure that if there is anything nasty lurking, that it is contained within the capsule during the operation and doesn’t get the chance to seep into their bodies. This gives them peace of mind that they have the best chance of regaining their health and eradicating any illnesses and symptoms they are suffering with.

WHY A SURGEON MAY REFUSE OR NOT COMMIT TO REMOVING THE SCAR TISSUE/CAPSULE

This topic has recently been debated by surgeons at the BAAPS meeting last month  (October 2019). During the lecture on Breast Implant Illness (BII), theatre surgeons questioned why a capsulectomy was justifiable due to there currently being no scientific evidence for a patient to undergo this procedure, unless they have proven Breast Implant Associated – Anaplastic Large Cell Lymphoma (BIA-ALCL).

The surgeons concerns are that there are possible risks involved, such as atelectasis (partially collapsed) or pneumothorax (fully collapsed), where the lung collapses after being accidentally punctured during the removal of the scar tissue due to it being stuck to the ribs. This particular risk is more likely to happen to patients that have their implants under the muscle than over the muscle.  Obviously these complications can be dealt with. However if a surgeon happened to be taken to court, they would have to clarify why they felt the need to perform a capsulectomy when there currently isn’t any scientific evidence stating that it is medically essential for the general removal of implants. It basically leaves them wide open to litigation.

THIS is why some surgeons may tell you they are not willing to commit to removing the scar tissue.

In my opinion a GREAT SURGEON is a one that is completely honest with you about what they are able to achieve, by informing you that even though they will do their best to remove the capsule they cannot make any decisions on this until they have actually started the operation and can see exactly where the scar tissue has attached itself and if it is safe to remove it.

SHOULD I REMOVE OR LEAVE THE SCAR CAPSULE IN?

This is a very personal choice, but one where understanding the pros and cons are essential.

As we are all aware there has been a lot of press surrounding highly textured silicone breast implants and their connection to a rare form of non-hodgkins lymphoma. So removal of the capsule lowers the risk of BIA-ALCL occurring post explant.

If you are concerned about the risks of BIA- ALCL and want peace of mind to be able to move on after explant, there are tests that can be done on the scar tissue after explant. Simply ask your surgeon if they can send your capsule off to histopathology to be tested for CD-30 to put your mind at rest.  This must be requested and discussed with your surgeon prior to the explant.

If you want to know more or are worried you are having any symptoms of BIA- ALCL please click on this link for more information.

Also many explanted ladies (including myself) have found that their histopathology results report silicone debris within the capsule causing chronic inflammation. This shows that removing the capsules at the same time as the implants helps reduce the immune response and inflammation, thus allowing the body to heal. Otherwise this inflammation continues post surgery as the issue is still embedded within the capsule.

More evidence is definitely needed in this area. As noted above, some surgeons agree with this recommendation and feel happy to offer the possibility of removal, whereas others feel more research is needed and until this can be achieved are being more cautious and will not perform it at all.

If this is a procedure you definitely want then my advice would be to email their secretary prior to booking a consultation, to find out which side of the fence they are on. That way you won’t feel like the consultation is a waste of time and money.

Anecdotally, we have found that women whom have left their capsules in ended up paying for a second surgery to remove them at a later date, due to the fact they were still struggling with symptoms and illnesses. Most found that once the capsules were  removed their health started to improve.

 

 

 

 

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