Capsulectomy Explained – Explant Procedures Like Total Intact Capsulectomy & En Bloc
Learn More About Capsulectomy, En Bloc, and Other Key Terms
We often use terms like “en bloc capsulectomy,” “total intact capsulectomy,” and others when talking in forums, with surgeons, and with BII-sisters.
If you’ve recently discovered Breast implant illness and are searching for information on explant surgery, recovery, scarring, and everything else along with it, the medical terminology can become overwhelming. That’s why this page exists.
Here, you will find a detailed explanation of what a capsulectomy is, what the different terms mean, and what you should know. Keep reading to learn more.
What is a Capsulectomy?
The word capsulectomy means “surgical removal of a capsule,” referring to the procedure in which a surgeon removes the scar tissue (capsule) that naturally forms around an implanted medical device, such as a breast implant. The scar capsule is the body’s response to any foreign object implanted inside it and consists of connective tissue. This process occurs regardless of where in the body the implant is placed. The capsule begins to form soon after implantation, as the body tries to protect itself from the foreign object.
Different Capsulectomy Procedures
There are several techniques a plastic surgeon can use to perform a capsulectomy — the surgical removal of the capsule surrounding a breast implant. The approach is typically planned ahead of time and thoroughly discussed between the patient and the surgeon. However, in some cases, the surgical method may need to be adjusted during the procedure if unexpected findings or complications arise.
Recently, the Breast Surgery Collaborative Community (BSCC) introduced guidelines to clarify terminology regarding the surgical removal of capsule tissue. The term “en bloc” has sometimes been misused within the BII community, though it has helped patients communicate their wishes about the type of procedure they wish to undergo. These guidelines and terminology are intended to support both patients and surgeons by promoting clearer communication and better decision-making.
Capsulectomy Procedures
👉🏼 En Bloc Capsulectomy
Removal of the breast implant and capsule in one piece, along with a margin of healthy tissue. This method is typically used in confirmed or suspected cases of breast implant-associated cancer following medical diagnosis.
👉🏼 Total Intact Capsulectomy
Complete removal of the entire implant capsule in one single, intact piece. This is the most commonly requested procedure among BII patients.
👉🏼 Total Capsulectomy (Total Precise Capsulectomy)
Complete removal of the entire capsule surrounding the breast implant, but not necessarily in one intact unit.
👉🏼 Partial Capsulectomy
Only parts of the capsule is removed, leaving some of the capsule residue inside the body.
En Bloc Capsulectomy
If you’ve been reading this site, browsing U.S.-based resources, or following how American explant surgeons operate (with very few exceptions), you’ve likely come across the term en bloc capsulectomy. The phrase “en bloc” is French for “in one piece” — meaning that the breast implant, the surrounding capsule, and a margin of healthy tissue are removed together as a single unit.
That said, the term “en bloc capsulectomy” is often used in cases where the procedure is technically a Total intact capsulectomy. Until recently, the later of theese terms didn’t exist in formal medical terminology, which is why “en bloc” became the go-to descriptor — even when it wasn’t strictly accurate.
When the capsule tissue is thick, this procedure is generally easier to perform. If the capsule is thin, it demands greater surgical precision — though experienced surgeons are often still able to complete it successfully. En bloc capsulectomy becomes especially important in cases of implant rupture, as removing the implant and capsule in one piece helps minimize the risk of silicone leakage into the chest cavity during surgery.
An en bloc capsulectomy generally leads to a slightly longer incision below the breast since the entire capsule needs to be carefully separated from the surrounding breast tissue and chest wall.
Total Intact Capsulectomy
One of the most comprehensive and frequently requested explant methods is called a total intact capsulectomy, which is often referred to — sometimes mistakenly — as “en bloc.” A total intact capsulectomy involves removing both the breast implant and the entire surrounding capsule as one single, unbroken unit — without cutting into or damaging the capsule during surgery.
During this procedure, the surgeon carefully separates the capsule from the surrounding tissue. The goal is to extract the implant and capsule completely intact, which requires precision, patience, and surgical experience. Since the capsule is often attached to the chest wall, muscles, or ribs, this is a technically demanding procedure that takes longer than simpler explant techniques.
By removing the capsule as a sealed “sac” — without rupture — there’s less risk of leaking any residual materials such as silicone, biofilm, or toxins into the body. This can be especially important if you’re experiencing symptoms of Breast Implant Illness or have concerns about capsule-related inflammation etc.
Total Capsulectomy
If you and your surgeon have agreed on a total capsulectomy, it typically means that the surgeon will first remove the implants, followed by the surgical removal of the entire capsule tissue surrounding them. The goal is to ensure that all capsule tissue is removed during the procedure. Most women who choose explant surgery opt for full capsule removal to maximize their chances of recovery from Breast Implant Illness and reduce the risk of future symptoms or complications.
However, it’s important to note that, as of today, there are no scientific studies that definitively prove the benefits of removing the capsule during explant surgery. On the other hand, there are no studies disproving it. This shows an obvious need for additional research in this area, as with many other aspects of BII.
Partial Capsulectomy
In some cases, surgeons may recommend leaving part of the capsule behind — most commonly the portion attached to the chest wall. This means that roughly 50% or more of the capsule tissue remains in the body. There can be a variety of reasons for choosing this approach, such as underlying health conditions, surgical risk factors, or the patient’s own preferences.
In Some Cases, Residual Capsule Tissue May Remain
In some cases, it may not be possible to remove the entire capsule during explant surgery. This can occur when the capsule tissue is tightly adhering to the chest wall or surrounding structures, and attempting a full capsulectomy could increase the risk of serious complications, such as pneumothorax (lung puncture) or tissue damage. In some cases, an experienced surgeon may choose to leave small portions of the capsule for your safety.
This is why having an open conversation with your surgeon before the surgery is essential. Discuss your goals, concerns, and potential outcomes ahead of time. It’s also crucial to keep in mind that even if some capsule tissue remains, many women report considerable improvements in their BII symptoms and overall health post explant.
Photos of Total Capsulectomy and En Bloc Explant Surgery
This image gallery features photos of breast implants that have been removed via total capsulectomy or en bloc capsulectomy. These pictures are submitted with permission by women who undergone explant surgery, particularly in Sweden but also in other Nordic countries.
Please note: Some of the images may be graphic or difficult to view.
A heartfelt thank you to the women in the Nordic support group on Facebook who kindly sharing their photographs to help others going through the similar journey.
Can Residual Capsules Be Surgically Removed Post Explant?
Yes, it is possible. However, not all plastic surgeons perform this kind of surgery. If the breast implants have already been surgically removed and you wish to remove the remaining capsules, the procedure is commonly referred to as a total capsulectomy — as long as the goal is to remove all capsule tissue.
❗️ It’s important to note that capsules are not reabsorbed by the body. If you’ve had more than one set of implants — such as one set placed over the muscle and another under — it’s likely that you have two separate capsules on each side. That’s because each time an implant is placed, the body forms a new capsule around it.
💸 The financial cost of removing capsules later on varies, but it is usually comparable to what a capsulectomy would cost if performed during explant surgery, since the procedure is essentially the same.
Image note:
The photo shown is of a capsule removed more than two years after the breast implants had been explanted. The patient chose to remove the capsules due to ongoing autoimmune symptoms and elevated blood markers (CRP and ESR) that she had for over a year. Remarkably, her bloodwork normalized within three weeks post-op — and today, she reports feeling significantly better.
The U.S. Is Leading the Way
In the United States, some surgeons report a 100% success rate in explant surgeries where the entire capsule is always removed. These surgeons often dedicate their entire practice to explant procedures and have completely stopped performing breast augmentations—after witnessing firsthand the complications and side effects implants can cause in certain patients.
Many of these surgeons have performed hundreds (or even thousands) of explants and fully recognize that Breast implant illness (BII) is a very real condition. They’ve made a conscious choice not to contribute to the problem, but to be part of the solution by helping women heal, and advocate for them. Some U.S.-based surgeons, like Dr. Lu-Jean Feng, have also conducted clinical studies to help educate fellow surgeons about BII and the importance of total capsule removal. Are you looking for a surgeon in the US, this site has a great global list of explant surgeons.
In Sweden, one of the closest clinics with a similar philosophy is Strandkliniken, led by Dr. Oya.
If you’re considering explant surgery, be sure to visit our page on Research where you can explore up-to-date studies. This information is essential for making an informed decision about your health and healing journey.