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    Implant removal en-bloc

    Every patient who decides to have breast augmentation with implants should be aware that another operation will be necessary later in life. Whether implants are changed or removed, an additional breast lift and/or autologous fat treatment is performed should be discussed at the appropriate time. This is completely independent of whether the procedure is intended for medical or aesthetic reasons. The many sources of information on the Internet cannot replace a consultation with an experienced specialist in plastic and aesthetic surgery. We will be happy to assist you!

    What is the life expectancy of breast implants?

    The durability of breast implants is limited: There is no lifetime guarantee or lifetime durability, this also applies to modern breast implants. However, they are designed to last a long time. Implants are constantly being further developed, especially the resistance of the usually multi-layered outer shell and the dimensionally stable filling material. A rupture (synonym for tear) can occur with a probability of about one percent per year. This means that after about ten years the implants show a defect in ten percent of the women. Consequently, the implants inserted must be removed or replaced for medical reasons at the latest after their service life has expired. You can find more information about the different modern implants on the page breast augmentation with implants. There you can also find out more about the designs. Round implants tend to shape a plump breast while ergonomic breast implants are recommended for a natural breast. On the mentioned page, the characteristics and the quality of the products of the different manufacturers (among others B-Lite) are also discussed.

    What is an implant removal en-bloc?

    An en-bloc resection is a surgical technique. The French term en-bloc means “in one piece”. In the case of an implant removal, this means the removal of the capsule tissue. Therefore, this operation is called “capsulectomy” in English (“-ektomia” in ancient Greek for cutting out). The technique originates from tumour surgery. When removing tumours, the surgeon must work with the greatest precision in order to leave non-malignant cells in the body. A similar procedure is used in the surgical treatment of infected wounds. Here, too, the surgeon must very carefully separate infected tissue and the associated instruments from healthy tissue. Good sensitivity and experience is required to show the boundaries between the altered scar tissue and the healthy tissue.

    What are the advantages of implant removal en-bloc?

    By removing a calcified capsule, the shape of the breast improves and the breast feels softer. If BIA-ALCL is suspected, the capsule should be removed because of the malignant white blood cells suspected in it (Clemens MW, et al., 2016, J Clin Oncol). For many patients it is a comforting feeling to know that everything has been done to remove the implant and possible residues. It is our task to inform you comprehensively. We are here to advise our patients, both on breast augmentation and on the removal of breast implants. In each case, we will of course thoroughly examine the professional justifiability of the jointly made decision.

    In which persons is an en-bloc implant removal useful?

    After ten years, a regular check and, if necessary, replacement of the implants is recommended. Experience shows that implants are replaced earlier in women who have undergone breast cancer surgery. The en-bloc implant removal should be weighed separately. This applies in particular to patients in whom:

    • advanced capsular contracture or calcification of the capsule,
    • suspicion of a breast implant associated anaplastic large cell lymphoma (BIA-ALCL) was raised,
    • the magnetic resonance examination suggests a defective breast implant, or
    • there is a high level of suffering when Breast Implant Illness (BII) is suspected.

    A capsular contracture is detected by palpation of the breast. Indications of an implant rupture result from newly occurring pain and deformation of the breast. Finally, a magnetic resonance tomography is required to substantiate the suspicion of implant rupture. However, a residual uncertainty remains, despite a magnetic resonance tomography. The suspicion of BIA-ALCL results from an increase in the size of the breast, usually several years after breast augmentation. The diagnosis of BIA-ALCL is confirmed by an ultrasound-assisted removal of fluid that has accumulated around the implant. Intensive research is being carried out on examination methods for determining Breast Implant Illness (BII). There are laboratory tests to detect certain autoimmune diseases. For patients with Breast Implant Illness (BII), both autoimmune disease testing and all other blood tests may be normal.

    What does an en-bloc implant removal in Saarbrücken cost?

    If you would like to find out in advance about the price of the procedure to remove silicone implants, please try our price calculator.

    Why an implant removal en-bloc in Saarbrücken?

    Over the years, Dr. Stahl has continued to develop the techniques of en-bloc resection. Various fellowships have taken him to outstanding plastic surgeons in Brazil, New York, Atlanta and Salt Lake City. PD Dr. Stahl became a senior consultant and permanent deputy of the medical director at the University Hospital of Tübingen in 2015. From 2016 to 2018, he moved to Lüdenscheid as clinic director. PD Dr. Stahl has refined his microsurgical techniques over the course of his university career, so that today he enjoys a reputation in specialist circles as a particularly gentle and precise surgeon.

    For more information on the expertise and extensive experience of specialist plastic aesthetic surgeons in breast surgery, click here.

    How is an en-bloc implant removal performed?

    Before every operation, a meticulous check is made several times to ensure the highest possible patient safety. Only when all requirements have been met according to the checklist, the operation is started.

    Before the operation, the breasts and the regions from which the fat cells are removed are marked in a standing position. If the operation is carried out in twilight sleep, you will be given medication to take away your fear and reduce your sensitivity to pain. If you are not in a deep sleep anyway, you will at best feel that something is going on on the surface of your body.

    In order to operate more gently and to prevent the formation of bruises, an adrenaline solution is injected in the area of the planned skin incision (“tumescence technique”). In order to be able to work with the greatest precision, the operation is performed with magnifying glasses. The capsule is exposed through a small skin incision of five to six centimetres. The scalpel and dissecting scissors are used to remove the capsular tissue from the pectoral muscle without coming into contact with the implant. Whether new scars appear when the implant is removed depends on several factors. This will be clarified during the personal consultation and examination.

    The following steps depend on the patient’s wishes. Depending on this, a new implant can be inserted, the breast can be tightened and/or an autologous fat treatment can be carried out. Depending on the findings, drainage tubes are inserted into the wound. However, these can be removed again after only a short time. The wound is closed with fine sutures. These dissolve again after about three weeks. In the operating room, you will be placed in a seated position before the procedure is completed. This is done while you are still asleep and serves to check whether the shape of the breast in sitting as well as in lying position reflects the desired result. Finally, a bandage and a special support bra are applied. The removed implants and the capsule are photographed. The implant remains the property of the patient even after the operation.

    The operating time of the outpatient procedure is approximately 60 to 180 minutes. Immediately after the operation you will be monitored continuously for a longer period of time in a so-called recovery room. When you are fully awake again, you can have a drink and, if desired, something to eat. Before leaving the practice, control appointments are made and behavioural measures are discussed together. You will be given a comprehensive written report. In addition, you will be given a telephone number for the post-operative period where you can reach the plastic aesthetic surgeon 24 hours a day in case of an emergency.

    Before, after and even during the operation you can watch movies or your favourite series with virtual reality glasses. This is not only entertaining, but the distraction has been proven to reduce pain sensitivity.

    Can an en-bloc implant removal be combined with a breast lift?

    Health concerns are driving many women to inquire about en-bloc implant removal. When breast implants feel like a foreign body, patients often ask for removal first. Not only the implants but also the breasts themselves change over time. Weight fluctuations, pregnancies, hormonal changes, changes in skin elasticity and mammary gland tissue can lead to sagging breasts. Similar to a flabby belly after pregnancy, sagging skin must be expected after the removal of an implant. In contrast to pregnancy, implants are removed or changed on average after eight to nine years (Auclair E., et al., 2020, Aesthet Surg J). A regression of the skin is therefore unlikely. The larger the breast implant, the weaker the connective tissue after removal. For many women beautiful full breasts are the reason for breast augmentation with implants. If only the implants are removed later, it is very likely that the patients are dissatisfied with the appearance of their breasts. A combination with a breast lift and/or an own fat treatment is possible and recommended. We are happy to advise you.

    What can you expect during a consultation for an implant removal en-bloc?

    On our Breast Surgery FAQ page you will find these and many other answers to frequently asked questions about breast surgery. This information also applies to the complete removal of breast implants en-bloc.

    What can you expect at a consultation on an en-bloc implant removal?

    Bitte besuchen Sie unsere Seite Brustoperationen – FAQ , um weitere Details zu erfahren, was in der Regel zur OP-Vorbereitung und Nachsorge zu beachten und zu vermeiden ist. Dort wird u.a. auch auf die Nutzung eines Kompressions-BHs in den ersten Wochen eingegangen.

    Before and after pictures of an implant removal en-bloc.

    The publication of before-and-after photos of aesthetic treatments is not allowed to be published on the internet according to § 1 paragraph 1 No. 2 of the Heilmittelwerbegesetz. However, patients expect such images in order to determine the desired result with the attending physician. In addition, patients want to convince themselves of the surgeon’s competence by viewing such photographs. It is possible to view such before and after photos during the consultation, as many patients agree to release the images taken during the procedure to educate other patients of the practice. In accordance with the data protection regulations, these will of course only be shown during the consultation for the purpose described above. They are particularly informative because we naturally select the before and after pictures of implant removal en-bloc according to specific criteria: Only images of patients with the same initial situation in terms of factors such as age, skin type, smoker or non-smoker, etc. can be classified as particularly relevant and can show you a realistic picture of the result. These images therefore have much more significance than arbitrary search results in an image search in search engines without taking individual factors into account.

    Field reports with an implant removal en-bloc at CenterPlast Saarbrücken.

    You will find online in the menu category “About us” on our page “Testimonials” bundled patient testimonials and reviews about our high quality treatments with high quality implants as well as experiences regarding the removal of the old or insertion of the new breast implants.

    What is capsule tissue?

    Capsule tissue is the body tissue that is in contact with the surface of the implants. The tissue reacts to the implant and changes over time. The capsule tissue consists of scavenger cells (macrophages), giant cells, cells of connective tissue (fibroblasts) and white blood cells (lymphocytes). In implants with a rough surface, small silicone particles have been found in the space between the cells and in the macrophages. These particles were not found in implants with smooth surface (Copeland M, et al, 1994, Plast Reconstr Surg).

    What is yellow bleeding?

    The spread of fine silicone particles into the body tissue around a breast implant is called silicone bleeding or gel bleeding. The phenomenon of gel bleeding was already described in 1978 [1]. In this process, minute amounts of silicone of the contents penetrate the outer shell of an implant [2]. The dispersion of silicone particles is influenced by the nature of the shell and the cross-linking of the silicone. In this context, silicone particles were detected in the lymph nodes of several patients [3]. Silicone particles could also be detected in other body regions in a case report [4]. This problem also occurs after tattoos of the skin. It is known that the pigments are transported by blood and lymphatic vessels and accumulate in lymph nodes and other organs [5]. Gel bleeding is to be distinguished from implant rupture. If the silicone implant ruptures, the silicone remains bonded. An implant rupture can be detected with magnetic resonance imaging. Detection of jaundice requires examination of a tissue sample under a microscope [6]. The health risks posed by the rough surface of certain implants should be considered separately. The rough surface of breast implants is suspected to be associated with BIA-ALCL. Thus, it is assumed that this is triggered by the textured surface or the probability is increased. The BIA-ALCL is also discussed on this page.

    What are the risks of removing the capsule tissue?

    The removal of the capsule tissue requires a skin incision in the crease under the breast. The removal of the capsule tissue is accompanied by a larger scar. The removal or replacement of an implant is often combined with a breast lift using the “T-incision technique”. In these cases the removal of the capsule tissue does not cause a larger scar.

    When removing the capsule tissue, there is a risk of secondary bleeding, injury to the lung skin, damage to the nerve plexus and the vessels of the armpit. The risks of removing the capsule tissue are greater if the implant is inserted under the pectoral muscle. The removal of the capsule tissue in the area of the ribs can cause permanent pain. Removal of the capsule tissue reduces the breast volume.

    The risks of breast surgery without removal of the capsule tissue are low (Swanson E., 2020, Ann Plast Surg). The duration of surgery is shorter. Less pain occurs in the days following the operation. Patients often return to work within a few days.

    In principle, the general surgical risks such as inflammation or thrombosis are increased in smokers. After breast reconstruction as a result of breast cancer, the overall risks are greater. In principle, there is always the possibility of extending the operation and performing a capsule removal. A noticeable capsule or accumulation of fluid will prompt the plastic surgery expert to perform a capsule removal. Revision breast augmentation is a demanding procedure, and an optimal result is never achieved as easily as during the initial surgery.

    Does en-bloc implant removal protect against BIA-ALCL?

    A single case is described in which BIA-ALCL was detected after implant removal without capsule removal. Everything indicates that in this single case the BIA-ALCL was overlooked during implant removal (Chacko A. et al., 2018, Insights Imaging). There are also four known cases in which BIA-ALCL was detected after en-bloc implant replacement. In these cases, the implants were replaced and the capsules removed due to capsular contracture. In these patients the implants were exchanged for smooth implants (Clemens MW, 2019, Meeting of the American Society of Plastic Surgeons).

    The risk-benefit ratio should be carefully considered in a preventive surgery. Prevention makes sense if the risk of falling ill and the severity of the disease is greater than the risk of the operation. Removal of a capsule at least theoretically increases the risk of removal or replacement of an implant. There are no fact-based figures from meaningful studies. Removing an implant or replacing it with smooth implants without removing the capsule reduces the risk of BIA-ALCL. The risk of capsule removal is greater if the implant is below the pectoral muscle than if the implant is above the pectoral muscle. If BIA-ALCL has been detected on one side, implant removal en-bloc on both sides is recommended (Mark W Clemens M.W., et al., 2019 Aesthet Surg J).

    Do Breast Implant Illness (BII) symptoms improve after implant removal en-bloc?

    Retrospective studies indicate that 50 to 74 percent experience an improvement (Melmed E.P., et al., 1998, Plast Reconstr Surg). In 30 to 35 percent the complaints after an operation are unchanged. In 10 to 15 percent a worsening was reported (Bridges AJ., et al., 1993, Ann Intern Med).

    Does the tissue need to be examined after en-bloc implant removal?

    When examining the removed capsule under the microscope, silicone particles are often detected (Melmed E.P., et al., 1998, Plast Reconstr Surg. 1998). However, this detection does not have any consequences. In more than 82 percent of the cases no further abnormalities are found. In 0.36 percent of the cases, breast cancer is detected without prior suspicion (Lapid O, et al., 2014, Aesthet Surg J). In case of doubt, we always send the tissue for examination.

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    The author

    Dr. med. Stéphane Stahl

    “We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

    Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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