Finding a plastic surgeon to perform your explant surgery is tricky because it can be a more complicated procedure than placing implants. If you have already had a negative experience with your breast implants, it is very important to find a surgeon that can remove your implants carefully. Your surgeon needs to be able to minimize any silicone leakage or other problems during the surgery.
You should start by looking for a surgeon who understands that breast implants can cause serious health problems, because those surgeons will be more careful when removing your implants. It is also important that your plastic surgeon be board-certified by the American Board of Plastic Surgery. Any doctor can call themselves a plastic surgeon, but only those who are board-certified have extensive training. The ABPS website lists all board-certified surgeons.
En Bloc Removal
Your explant surgeon should be experienced in en bloc removal, whenever possible. En bloc removal is when the surgeon removes the scar tissue (or capsule) and implant at the same time, with the implant still inside the intact scar tissue capsule. This is especially important if your implants are filled with silicone gel, are ruptured, or are very old. En bloc removal allows the silicone and other chemicals to stay inside the intact scar tissue capsule as it is removed. En bloc removal prevents silicone, other chemicals, and bacteria from leaking into the woman’s body during surgery. It requires a larger incision (which can mean a larger scar), but it is worth it because it prevents leakage that can cause health problems.
Keep in mind that en bloc removal may not be possible in all cases, and your surgeon may not know if an en bloc procedure is possible until you are in surgery. For example, if your scar tissue capsule is very thin or tightly attached to the chest wall, en bloc removal may not be possible.
Total Capsulectomy
En bloc removal is also sometimes referred to as a total capsulectomy, but they are not exactly the same. A total capsulectomy is not always performed using the specific en bloc technique. A total capsulectomy is the removal of the breast implants and all the scar tissue, or capsule, that forms around a breast implant. However, during a total capsulectomy, the implant is not necessarily removed while still inside the intact scar capsule (en bloc method). Most surgeons use the term total capsulectomy to mean that they will cut the scar tissue capsule, remove the implants first, and then go back and remove all of the scar tissue capsule.
What if en bloc removal is not possible?
Let your plastic surgeon know in advance that if en bloc removal is not possible, you want the surgeon to remove as much of the scar tissue capsule as possible. Surgeons who are experienced in en bloc removal will know how to remove your implants and scar capsule material as carefully as possible.
Unfortunately, there are not many surgeons experienced in en bloc removal and most do not take insurance. If you cannot find a surgeon near you that performs en bloc removal, or you are required to see a surgeon inside your insurance network, you should select a surgeon who can perform a total capsulectomy.
If you are paying for the surgery yourself, keep in mind that the most important factor to consider is the expertise of the surgeon in performing en bloc removal. In some cases, women have traveled to experienced surgeons in the U.S. and still spent less than their local, less experienced plastic surgeon.
Your Decision
Once you have selected a board-certified plastic surgeon experienced in explantation, there are several questions you should ask to ensure your surgeon understands your wishes. You should ask the surgeon how many en bloc or total capsulectomy procedures he or she has performed to gauge skill and experience. You can also ask to speak with one of your surgeon’s patients who has had en bloc explantation to hear about their experiences. Finally, you may ask for before and after pictures of the plastic surgeon’s own patients. Here is a one-page resource that lists all the questions you should ask your surgeon at your next consultation. Click here to print this one-page list of questions to take with you to your next consultation.
It is also important that you and your surgeon are on the same page about your priorities for the surgery. In order to help make sure that your surgeon knows how strongly you feel about the surgery, we have created a short acknowledgement form that you can print and take with you to your consultation. This form will be signed by you and your doctor and acknowledges that your doctor understands your desire for an en bloc explant whenever possible. Click here to print the acknowledgement form to take with you to your next consultation.
Insurance Coverage
If you want health insurance coverage for your surgery, you can find out if there are plastic surgeons who participate in your health insurance plan, are board-certified, and experienced in the en bloc or total capsulectomy removal. You can start by contacting your insurance company’s member service line to speak with an insurance representative. Many insurance company websites provide online databases of participating physicians.
As mentioned previously, many plastic surgeons experienced in en bloc or total capsulectomies do not accept or work with insurance. If your plan is likely to cover your breast implant removal, you will need to determine if your plan allows you to see out-of-network surgeons and seek reimbursement. If your plan requires you to see in-network surgeons, you will need to decide how important it is for you to have your surgery done en bloc and how you will raise the funds to pay for the procedure up-front.
Once you find participating surgeons, you can call their offices to ask about their experience with en bloc removal or total capsulectomy. If the surgeon meets the above criteria, you should request an in-person consultation before scheduling your surgery.