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What is a capsulectomy?

A capsule refers to the growth of scar tissue around the breast implant. It is natural for the body to develop scar tissue around an implant and has the advantage of holding the implant in place. However, this capsule of scar tissue can harden and cause discomfort, called capsular contracture. Therefore, a capsulectomy is the surgical procedure wherein this scar tissue is removed to relieve pain and discomfort and restore a natural look to the breast.

What is an en bloc capsulectomy?

An en bloc capsulectomy is the removal of the capsule and scar tissue surrounding along with the implant, or “en bloc.” The procedure may be necessary in cases of a ruptured implant, capsular contracture, or other problems affecting the look or comfort of breast implants.

A total capsulectomy is the removal of the implant and the surrounding scar tissue or capsule. It does not necessarily mean the surgeon will remove the breast implant within the capsule in an “en bloc” procedure.

What is the procedure for implant removal?

Breast implants may be removed, or explanted, in a similar manner as they were placed, in reverse. In most cases, the procedure is performed while you are under intravenous sedation. Your surgeon will make an incision in the areola or the crease beneath the breast (inframammary) to remove the implants. If you are having an en bloc capsulectomy, your surgeon will most likely make an inframammary incision to remove the entire implant and scar tissue.

You may choose to undergo a breast lift after the implants and scar tissue have been removed to help tighten any loose skin. The procedure takes from one to three hours, and most patients can return home following surgery.

Will I have scars?

As with most surgeries requiring incisions, you will have scars. However, Dr. Rottman is exceptionally skilled at hiding and closing incisions for minimal scarring, which will fade over time.

How long is the recovery from breast implant removal?

The recovery from breast implant removal or en bloc capsulectomy is similar to that of breast augmentation. In the case of simple breast implant removal, it may be an easier recovery you’re your initial breast augmentation, while en bloc procedures may take a bit longer. You may have drains that Dr. Rottman will advise you on how to care for and you will need to take a week off from work to heal.

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The Allergan textured implant recall

In late July of this year, Allergan voluntarily recalled their BIOCELL textured implants and tissue expanders under the name Natrelle after receiving a request for recall from the FDA. The recall is not a cause for alarm. Macro-textured implants of the recalled style are not common in the United States, making up only 5% of implants.

What are textured implants?

Textured implants are saline or silicone implants with a textured, granular, or rough surface to adhere to the tissue around the implant. This adherence to the surrounding tissue keeps implants from rotating or moving after implantation, which is especially helpful for teardrop-shaped implants.

Macro-textured implants, such as those recalled by Allergan, have rougher, more textured surface than other textured implants. The particular implants and tissue expanders recalled are as follows:

  • Natrelle Saline-Filled breast implants
  • Natrelle Silicone-Filled breast implants
  • Natrelle Inspira Silicone-Filled breast implants
  • Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Filled breast implants
  • Natrelle 133 Plus Tissue Expander
  • Natrelle 133 Tissue Expander with Suture Tabs

Why were Allergan BIOCELL textured implants recalled?

Allergan BIOCELL textured implants were recalled as it was found that these particular implants have a slightly higher chance of leading to the development of BIA-ALCL (breast implant-associated anaplastic large cell lymphoma).

What is BIA-ALCL?

BIA-ALCL is a rare non-Hodgkin’s form of lymphoma that grows very slowly, making it easy to catch as well as treat. The symptoms of BIA-ALCL are a persistent swelling, fluid developing around the implant, pain, or a firm or hard lump in the breast area.

While the likelihood of developing BIA-ALCL is slightly higher with these textured implants, it is still infrequent, and highly unlikely to occur. However, if you have noticed any of the above symptoms, you should speak with your doctor immediately so that testing can be performed.

One theory is that macro-textured implants can lead to a higher probability of BIA-ALCL due to inflammation or bacteria. The rough texture and crevices in these implants may create an environment where bacteria can thrive and spread. To date, it is uncertain why some women develop BIA-ALCL, and further studies are needed.

Should I remove my Allergan implants?

The FDA does not recommend the removal of recalled implants unless you are experiencing the symptoms of BIA-ALCL. While there is a higher likelihood of developing BIA-ALCL from macro-textured implants, it is still very rare. However, it is advised that you speak with your surgeon to discuss what route will be best for you.

If you are already thinking of breast implant removal or replacement, or the need to remove scar tissue from around your implants, this could be the time to look at scheduling a consultation. Please reach out to Dr. Rottman and his team to schedule a consultation to learn more about your options.