What is "En Bloc"
This term is widely used among patients, however many surgeons refer to the procedure as a capsulectomy. En bloc and capsulectomy having the same meaning. For suffers of breast implant illness it is very important the capsule is removed in its entirety with the implant. The capsule and implant is kept in-tact so as not to further contaminate the body. The "capsule" is referring to scar tissue surrounding the implant, this is normal. When any foreign body enters our body, the natural defense mechanisms are triggered. From day one of the implant being inserted the body begins to produce scar tissue, over time this scar tissue increases and forms a capsule surrounding the implant.
If the implant is contaminated, ruptured or causing illness it is believed by patients the capsule is contaminated by the silicone. Research is currently underway in regard to bacteria living on and around the implant. This bacteria lives in what is referred to as a bio-film. The bio-film lives independently without a blood supply.
Having an "En Bloc" procedure is sought after by patients as they want reassurance the implant, any bio-film and any possible silicone is removed entirely. Women suffering breast implant illness want to move on with their lives and rightfully so. This debilitating illness destroys lives. Some surgeons are empathetic and appreciate the patients high anxiety levels as a result of their implant journey. However others refuse to acknowledge the illness until scientific evidence proves the disease is in fact real. However we believe remaining non-bias and supporting women is imperative. Not so long ago Chronic Fatigue was not a recognized illness. Let's also mention the stomach ulcer which was believed to be from stress, until a doctor induced the bacteria and proved the stomach ulcer was curable and in fact as a result of bacteria.
According to the American Society of Plastic Surgeons, there were 307,190 breast augmentations procedures in the USA in 2011, as well as 22,271 breast implant removals. Please keep in mind these figures are for the USA only.
Women who have explanted have reported the following
What happens during the explant/breast implant removal procedure?
The patient will be given either a general or twilight sedation (local anesthesia) depending on the complexity of the surgery. Under twilight anesthesia the patient is semi awake and only the surgical area is numbed. However, in most cases the procedure is done under general anesthesia.
The procedure is most often conducted in an outpatient setting and takes an average of two hours, sometimes longer if a Mastopexy/Breast Lift is required. Some surgeries require an overnight stay or longer if infection or reconstructive surgery is involved.
The explant surgeon and patient should discuss incision options. The explant surgeon will explain which are most suitable for the patient and her desired outcome. Most times the explant surgeon will perform your explant via the original incisions.
After the aesthetic is administered, your surgeon will place a small incision along the scar created during the original Breast Augmentation procedure. The implant will then be removed, (deflated first if made of saline).
At this time (a new Breast Implant will be inserted if you are re-implanting) if not your Surgeon may or may not perform a Capsulectomy and or a Mastopexy/Breast Lift.
The following incision options are possible:
The choice of which incision to use depends on several factors, including the size of the breast implants that are to be removed, the patient’s anatomy, the type of implant, and surgeon-patient preference.
The incisions are closed
The surgeon closes the incisions with layered sutures (stitches) in the breast tissue, and with skin adhesives, sutures and surgical tape to close the skin and keep it closed. You will be wrapped in compression bandages or have a tight surgical bra to wear for a time determined by your explant surgeon. Each one has different views on compression.
Initially, there will be evident incision lines. These will fade with time.
View the results
Explant surgery results are visibly evident straight away, due to loss of fullness. BUT the final results will take weeks if not months to be fully evident. There will be some swelling caused by the surgery, which will resolve within a couple of weeks. As the swelling dies down and the incision lines fade, you will have a better idea of whether the procedure met your expectations.
Capsulectomies are very useful in removing thickened, hard scar tissue that forms what is referred to as a capsule around a prosthetic device such as a breast implant. The capsule is made of three components, fibroblast, collagen and blood vessels. The reason of the capsular contracture and the increased capsular scar tissue is not specifically known. However, it may be associated with the possibility of a micro infection of staph, epidermis staph aureus or some other type of bacterium.
There’s normal lining called the capsule that develops after augmentation, and if this capsule stays enlarged there’s never a problem and the implant freely flows throughout the implant pocket. However, sometimes the capsule itself can shrink wrap and that shrink wrapping cause the implant to feel firmer or look higher or have an abnormal shape. “Capsular Contracture” A capsulectomy therefore is just the actual incision and removal of that scar tissue. In any case, whenever a capsulectomy is performed, the word “ectomy” means to remove the scar tissue.
Mastopexy (breast lift surgery) may also be conducted in order to help alleviate any changes in appearance caused by removing the breast implant.
There are three types of breast droopiness, also known as breast ptosis. Breast lift surgery is effective in treating mild, moderate, and severe instances of ptosis:
Most patients can return to non-strenuous work after 10 days. Strenuous work or exercise should not be resumed until at least 3 to 4 weeks have passed, and sexual activity should be avoided for a minimum of 1 to 2 weeks. After that, you should continue to be extremely gentle with your breasts for at least the next several weeks. As with all surgery, it is important to understand that these guidelines can vary widely based on the patient’s personal health, the techniques used, and other variable factors surrounding the surgery. Any severe pain should be reported to your surgeon.
Ptosis of the breast refers to drooping or sagging of the female breast. The cause of ptosis was unknown until recently. Many women mistakenly believed that the breast itself offered insufficient support and that wearing a bra can prevent sagging. Many also believed that nursing increased sagging. Research has shown that ptosis is a natural consequence of aging, though the rate at which a woman develops ptosis depends on many factors.
Breast ptosis is influenced by heredity which determines skin elasticity, breast size, and the balance of adipose and glandular tissue. Over a woman’s life, the primary influencing factors on sagging are cigarettesmoking, a woman’s body mass index (BMI), her number of pregnancies, her breast size before pregnancy. Ptosis can also be increased by weight gain because increased breast size contributes to ptosis.
Plastic surgeons categorize the severity of ptosis by evaluating the position of the nipple relative to the infra-mammary fold. In popular culture, this normal process is referred to as “sagging” or “drooping”, while plastic surgeons refer to it medically as ptosis.
We have constructed a list of the most Trusted Australian En Bloc surgeons;
Most Popular Trusted Surgeons
Dr Rodrigo Teixeira
Dr Jeremy Richardson
Dr Vlad Milovik
Dr Drew Cronin
Dr Terrence Scamp
Dr Scott Ingram
Dr Matthew Peters
Dr Adrian Brooks
Dr Tony Connell
Explant surgeons as per Australian NZ Support Group popularity
(top surgeons in order of popularity based on 6600 members)
*Dr Gavin Sandercoe
*Dr Ellis Choy
*Dr Chaitham Reddy
*Dr Ellis Choy
*Dr Nicholas Moncrieff
*Dr Gary Avery
*Dr David Littlejohn
*Dr Mansoor Mirkazemi
*Dr Allan Kalus
*Dr Broughton Snell
*Dr Edmund Ek
*Dr Ben Green
*Dr Justin Perron
*Dr Gerald Bayley
*Dr Scott Ingram
*Dr Raymond Goh
*Dr Matthew Peters
*Dr Peter Widdowson
*Dr Drew Cronin
*Dr Dilip Gahankari
*Dr Mark Doyle
*Dr Quoc Lam
*Dr Marcus Wagstaf
Perth (based on Perth support group 950 members)
*Dr Mark Lee
*Dr Rohan Page
*Dr Tony Connell
*Dr David Colbert
*Dr Adrian Brooks
*Dr Tim Cooper
*Dr Ian Timms
Tasmania: Not enough research as yet
Northern Territory: only two Specialist Plastic Surgeons reside in NT
*** YOU CANNOT PAY TO BE ON THIS LIST***THE LIST IS CHOSEN ON EXPERTISE, EXPERIENCE & ETHICAL PRACTICE STANDARDS***
Where can you get help and support?
Facebook Group by Ricci Jess @biiconcierge
Australian support group (which I do not admin)
Please contact us if you would like more help finding a En Bloc breast explant surgeon you can trust.
*There is no financial incentive or affiliation with any of the above surgeons. This list has been created from our independent research and as a guide only. We encourage all patients to seek a second opinion whenever considering an invasive procedure. *
If after a lot of careful self evaluation and soul searching - you have decided to have enbloc breast explant surgery, then you will need to be prepared to make the next important step which is finding a enbloc breast explant surgeon. Most surgery involves serious operations that can never be guaranteed to work perfectly but the chances of them going wrong are much less if your surgeon is qualified, ethical and trustworthy. That is why searching for a surgeon becomes a much clearer and easier task if you know what to look for and where.
It is important to point out at the early stages of your search for a enbloc breast explant surgeon, that many kinds of doctors perform enbloc breast explant surgery, even though they may have no specific training in plastic surgery. Certain laws allow them to advertise a certification in another field of surgery without actually specifying which the field, because of limited consumer protection, such doctors are allowed to perform enbloc breast explant surgery in an office based surgery setting regardless of whether they are actually specialized in cosmetic and plastic surgery.
Advertising by such doctors can be confusing and even misleading, it is advisable that you shortlist enbloc breast explant surgeons that are specially trained, certified, and experienced in the procedure that you want.
Why place yourself in the hands of a doctor or surgeon that isn't actually trained and experienced in the field of enbloc breast explant surgery?
That is why we have a directory of fully qualified, empathetic Trusted Surgeons for you to choose from.
Here is a check list that can help you define your search criteria
Ideally Your Enbloc Breast Explant Surgeon should have the following credentials
I have put together the following tips for making life easier both before and after your explant surgery.
Things you will need to purchase in advance:
Organise the following in advance:
* Things for your bedside table –
Remember all of are different and there are no hard and fast rules in what you will need. The items and hints listed here are suggestions I have made over the years and other women have found them useful or wished they had known these things in advance.
Let your body do its job in healing itself, your job is to be loving and kind to yourself and keep hydrated while the healing takes place ?
LIFE AFTER SURGERY
After surgery you will be taken to a recovery area to be monitored. Your breasts will be wrapped in gauze, compression garment, bandages or a surgical bra.
Your surgeon should describe the usual after surgery (postoperative) recovery process, the possible complications that may occur, and the recovery period. Following the operation, as with any surgery, you can expect some pain, swelling, bruising and tenderness. These effects may last for a month or longer, but should disappear with time. Scarring is a natural result of surgery. Prior to surgery, ask your surgeon to describe the location, size and appearance of any expected scars. For most women, scars will fade over time into thin lines.
Your surgeon may prescribe medications for pain and/or nausea. If you experience bleeding, fever, warmth, redness of the breast, or other symptoms of infection, you should immediately report these symptoms to your surgeon. Your surgeon should tell you about wound healing and how to care for your wound.
You may need a postoperative bra, compression bandage or jogging bra for extra support as you heal. At your surgeon’s recommendation you will most likely be able to return to work within a few days, but you should avoid any strenuous activities that could raise your pulse and blood pressure for at least two weeks.
Ask your surgeon about a schedule for follow-up visits, limits on your activities, precautions you should take, and when you can return to your normal activities, including exercising.
Help at home
Depending on the complexity of your en bloc breast explant surgery, you may need help with household chores, dressings, transportation etc. If you have concerns in any of these areas, please talk with your surgeon or family doctor before your enbloc breast explant surgery.
Increase in rare cancer linked to breast implants
Increase in Australian cancer cases linked to breast implants
What to know about the FDA warning about breast implants
Associated Medical Association – Breast implants linked to cancer
Link found between textured breast implants and rare cancer
The Medical Journal of Australia – Improving the safety of breast implants – implant associated lymphoedema
Textured breast implants pose greater risk of infection than smooth breast implants
Medical Press – Research reveals which breast implants pose the greatest risk of implant-associated cancer
ABC News Contaminated breast implants linked to rare cancer, plastic surgeons warn
New Macquarie University Health Sciences Centre research links rare cancer to breast implant infection
Australian Society of Aesthetic Surgeons – Breast Augmentation 14 Point Plan
14 Point Plan – Professor Anand Deva
Safer Breast Implants