En Bloc Total Capsulectomy

Plastic Surgery Update by Dr. Allan Kalus:

Often we are asked when an En Bloc Total Capsulectomy required. Well this is a case in point. The lady had her smooth walled, silicone implants inserted in front of the muscle about twenty year ago and for many years she had noticed that her breasts had become rock hard, and in fact looking at her it was as if she had two tennis balls on her chest.

An En Bloc Total Capsulectomy requires a wide exposure and when we came down through the breast tissue onto the wall of the capsule we could immediately see a very thick walled capsule. This has to then be dissected out all the way around and, in this case had to be peeled off the muscle in this back wall. When we removed the capsule with the remains of the silicone which had obviously leaked, you could see it was a thick-walled capsule actually lined with calcium it had become rock hard. So, in this type of situation obviously one cannot leave this capsule behind, one has to remove all of the capsule and all of the silicone. Of course, the capsule has a lot of pressure effects and often the rib cage is distorted as well as the overlying breast.

So, the next question is what sort of reconstruction do we do? We used to put in another implant, but these days much more often we reconstruct this by Autologous Fat Transfer where we take the fat from the tummy, hips or thighs and with careful preparation graft it into the breasts. In this way we can replace a very abnormal looking breast with a very natural looking breast with a beautiful cleavage.