With more information on BIA-ALCL and online forums devoted to “breast implant disease”, plastic surgeons are receiving more and more information on explantation for health reasons, as opposed to aesthetic reasons, or to treat a specific complication such as capsular contracture. This trend has fueled the debate over the most appropriate implantation technique to use: total capsulectomy or bulk removal.
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Breast prosthesis disease – a general term describing the inflammatory symptoms attributed by some women to their breast implants – is a hot topic on social media and online discussion forums. Women experiencing inexplicable symptoms, they turn to the Internet to learn more and share their stories. Even if such a community helps these women feel heard and understood, the unfortunate side effect is the rapid spread of misinformation.
A perfect example is the advice circulating on websites dedicated to breast implant disease, according to which block capsulectomy is the only effective way to reduce symptoms and that patients should not opt than for this technique. Although many qualified plastic surgeons have experience and can recommend block capsulectomy, I fear that patients will focus on a procedure rather than their personal circumstances or their qualifications and experience – all based on advice from non-doctors.
Bulk capsulectomy requires an incision 10 to 15 cm long covering most of the inframammary fold so that the capsule can be separated from the breast tissue and chest wall and removed intact with the breast implant inside, in one piece. Except in the event of an implant or BIA-ALCL rupture, the size of the scars, the complexity of the procedure and the risk of additional risks make block capsulectomy an unnecessary and inappropriate procedure for most patients.
Why I favor total capsulectomy
Many surgeons think that it is useless to remove the capsule. I believe that all of the tissue associated with the implants should be removed. In the case of breast implant disease, the implants can then be considered the cause of the symptoms. It also gives the patient peace of mind knowing that everything has been deleted.
Like block capsulectomy, total capsulectomy completely removes both the breast implant and the surrounding capsule from the body. However, a total capsulectomy only requires a 5 to 6 cm incision in the inframammary fold. Thanks to this incision, the anterior capsule is released from the breast tissue while the posterior capsule is raised above the chest wall to the central point of the implant to give the surgeon a complete vision of the upper part of the implant. The capsule is then opened to remove the implant, tightened and removed from the body.
Bulk capsulectomy and total capsulectomy are similar implantation procedures with different indications, similar to open appendectomy compared to laparoscopy. Informing patients of all of their options and choosing the one that works best for them can reduce unnecessary surgical trauma and prevent prolonged recovery.