Choosing the safest and most appropriate method for implant removal begins with understanding the differences between en bloc and intact capsulectomy—two terms that patients often encounter when researching explant surgery.
At Lampert MD Plastic Surgery, these distinctions are part of a comprehensive, educational consultation process led by Dr. Joshua Lampert, a board-certified plastic and reconstructive surgeon. With a background in craniofacial surgery and complex breast surgery, he possesses unique expertise in managing capsules. Since scar tissue behaves differently in each patient, selecting the right approach requires advanced surgical judgment, a deep understanding of breast anatomy, and a facility that supports meticulous, high-precision procedures.
In this blog, we will clarify the meanings of en bloc and intact capsulectomy, explaining when each technique is appropriate. We will discuss the medical considerations that influence these decisions and describe how Dr. Lampert safely carries out these procedures in his AHCA-certified Ambulatory Surgery Center. By the end, you will have a better understanding of the surgical terminology and the science behind capsule removal. Additionally, you'll know which questions to ask during your consultation, empowering you to make an informed and confident decision about your health.
What is Explant Surgery?
Explant surgery involves removing breast implants and, when appropriate, the surrounding scar tissue capsule. This procedure is often recommended for patients experiencing issues such as:
- Breast Implant Illness (BII) symptoms
- Capsular contracture
- Implant malposition
- Concerns about implant rupture or integrity
When thoughtfully planned, a capsulectomy can help restore comfort, improve quality of life, and address both aesthetic and health-related concerns.
Breast Implant Illness (BII) is a patient-driven term describing a wide range of systemic symptoms that some women associate with their implants. Commonly reported symptoms include:
- Fatigue or chronic fatigue
- Joint or muscle pain
- Cognitive issues such as “brain fog”
- Dry eyes or dry mouth
- Rashes or skin changes
- Hair loss
- Flu-like or inflammatory symptoms
Although BII is not an officially defined medical diagnosis, the FDA has acknowledged that some patients experience systemic symptoms following breast implantation and may see improvement after implant removal.
En Bloc Capsulectomy
An en bloc capsulectomy removes the implant and its surrounding scar capsule as a single unit, without opening or disrupting the capsule. This approach is especially valuable in situations where:
- A silicone implant has experienced a silent rupture, and keeping the leaked gel contained is safest
- There are concerns about inflammatory reactions or systemic symptoms
- A textured implant is present, particularly when evaluating risk for Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)—a rare immune system cancer associated primarily with textured implants
By removing the implant and capsule together, the surgeon minimizes the risk of silicone leakage into surrounding tissues. This technique can often be performed with a relatively small incision, allowing the tissue “ball” to be delivered intact.
Intact Capsulectomy
An intact capsulectomy also removes the capsule in one piece, but differs in that the surgeon may separate the capsule from the implant before removal. The capsule itself remains whole, but the implant is not removed simultaneously inside it.
This method may be appropriate when:
- The capsule is thin, fragile, or densely adherent to the chest wall
- The patient has concerns, but does not require en bloc removal for safety
- The surgeon determines that separating the implant and capsule increases the protection of critical structures
In both approaches, the goal is the same: to achieve a safe and complete removal of implant-related tissue while protecting the patient’s chest wall, muscle, and surrounding anatomy.
En Bloc vs. Intact: Key Differences
| Feature | En Bloc Capsulectomy | Intact Capsulectomy |
|---|---|---|
| Implant and capsule removed together? | Yes | Capsule removed whole, implant removed separately |
| Best for silent rupture? | Yes | Typically not ideal |
| Useful for BIA-ALCL concerns? | Yes, often preferred | Sometimes appropriate, depending on capsule condition |
| Capsule remains unbroken? | Always | Yes, but implant separation may require careful manipulation |
| Typical incision size | Often small | Variable |
| Determining factor | Safety and implant condition | Capsule strength and anatomy |
Which Technique is Best for You?
You may be a candidate for en bloc capsulectomy if you:
- Have a ruptured silicone implant
- Experience systemic symptoms consistent with BII
- Have textured implants and are concerned about BIA-ALCL
- Prefer complete capsule removal without disturbing the implant
However, you may be a candidate for intact capsulectomy if:
- Your capsule is thin or adherent to vital structures, making en bloc unsafe
- You do not require en bloc for cancer, rupture, or pathology reasons
- Your surgeon determines that intact removal protects your anatomy more effectively in your case
Patient safety—not ideology—must drive the surgical plan. Surgical management should be tailored to match each patient’s diagnosis, clinical risk, and anatomic findings.
Dr. Joshua Lampert is Here to Help You Decide
Because every capsule forms differently, the optimal approach must be guided by a surgeon with advanced training, precise anatomical understanding, and a facility designed to support the highest standards of care.
At Lampert MD Plastic Surgery, patients undergoing explant surgery benefit from Dr. Joshua Lampert’s uncommon depth of expertise. His background includes a competitive, integrated plastic surgery residency in Manhattan, followed by an ACGME-accredited craniofacial fellowship, training that provides rare insight into complex breast and soft-tissue anatomy. This knowledge is paired with an AHCA-certified Ambulatory Surgery Center, equipped with hospital-grade safety features, including HEPA filtration, antibacterial surfaces, stringent sterile processing protocols, board-certified anesthesia, and infection-prevention systems that exceed those found in typical outpatient environments.
These elements—technical mastery, anatomical precision, safety-driven infrastructure, and relationship-centered care—make Dr. Lampert one of Miami’s most trusted surgeons for implant removal and capsule management. Schedule a private consultation with Dr. Lampert today to discuss the safest and most appropriate capsulectomy approach for you.
