Orange County Plastic Surgeon

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Breast Implant Removal Surgery – Breast Revision – En Bloc Capsulectomy (Orange County, CA)

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About En Bloc Capsulectomy

Dr. Domanskis feels an obligation as a medical practitioner to provide certain facts to help educate those considering plastic surgery. He and his staff are dedicated to making sure patients have all the information they need before undergoing a surgical procedure. The following information about the en bloc capsulectomy is intended purely as patient and potential patient education.

What is an en bloc capsulectomy?

An en bloc capsulectomy is when the silicone or saline breast implant and its surrounding fibrous capsule is removed together “en bloc.” This differs from another technique, which involves cutting into the capsule, removing the breast implant, and then, after this, removing the capsule.

Why would I want to have an en bloc capsulectomy?

An en bloc breast capsulectomy, when performed properly, will cause the least amount of contamination of the breast with the silicone implant if it is ruptured or not. Also, it is your best chance of removing all the silicone which is microscopically embedded in the surrounding capsule of the silicone and or saline breast implants.

Procedure Details

Who performs en bloc capsulectomy?

An en bloc capsulectomy should only be performed by a plastic surgeon certified by the American Board of Plastic Surgery and who has vast experience with breast surgery — breast implants in particular like Dr. Domanskis has. Dr. Domanskis focus for last 25 years has been on breast surgery and implants in particular.

Where is an en bloc capsulectomy performed?

Dr. Domanskis usually performs this surgery in an accredited outpatient surgical facility or hospital, whichever the patient wishes.

Do I need a general anesthetic?

Dr. Domanskis usually recommends a general anesthetic, but it can be performed under intravenous sedation.

How long does an en bloc capsulectomy take?

An en bloc capsulectomy usually takes Dr. Domanskis about two hours depending on how much scar tissue is present and the complexity of removing the breast implant and capsule en bloc.

What do you do with the capsule and implant that is removed en bloc?

Dr. Domanskis sends the specimen that is removed to the pathologist to be examined.

What is the pathologist looking for?

The pathologist is looking for any abnormalities that are in the capsule.

Abnormalities – Lymphoma

What types of abnormalities can be found in the capsules?

The most serious is an unusual type of lymphoma called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), or BIA-ALCL. BIA-ALCL is not breast cancer — it is a type of non-Hodgkin's lymphoma (cancer of the immune system). To date, it has been found in about 500 patients who have breast implants, almost entirely in those breast implants that are textured or have a fuzzy coating. The reason that the implants were coated was the possibility of decreasing capsular contracture. As you may have heard, the FDA has requested that the manufacturers of the Biocell textured implants (Allergan) remove them from the market(“recall them”) and not manufacture them.

What causes this lymphoma?

No one knows what causes this type of lymphoma. However, it has p;rimarily been associated so far with textured breast implants, both silicone and saline.

Tell me more about this lymphoma.

BIA-ALCL is a rare and highly treatable type of lymphoma that can develop around breast implants. BIA-ALCL occurs most frequently in patients who have breast implants with textured surfaces. This is a cancer of the immune system, not a type of breast cancer. The current lifetime risk of BIA-ALCL is estimated to be 1:3817 – 1:30,000 for women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades. When caught early, BIA-ALCL is usually curable.

Common symptoms include breast enlargement, pain, asymmetry, lumps in the breast or armpit, overlying skin rash, hardening of the breast, or a large fluid collection. These symptoms typically develop at least more than one year after receiving an implant, and on average, after 8 to 10 years. For any patient experiencing these or any symptoms, they should see their doctor for evaluation.

BIA-ALCL has been found with both silicone and saline implants and both breast cancer reconstruction and cosmetic patients. BIA-ALCL patients seem to have an allergic reaction to textured devices over many years. Currently, it is not possible to test for who is at risk of this disease.

How is lymphoma diagnosed besides by the pathologist examining the capsule? What signs do I look for?

The most common symptoms are unexplained breast enlargement, asymmetry, fluid buildup, or a lump in the breast or armpit. However, rarely, symptoms may be more subtle, such as overlying skin rash and hardening of the breast. Women who develop these symptoms should see their physician to be evaluated with a physical exam and further testing.

  1. Schedule a follow-up appointment with your treating physician to discuss any concerns you may have about your breast health.
  2. Following a physical examination, patients with BIA-ALCL symptoms may receive an ultrasound or a magnetic resonance imaging (MRI) of the symptomatic breast to evaluate for fluid or lumps around the implant and in the lymph nodes.
  3. If fluid or a mass is found, patients will require a needle biopsy with drainage of the fluid to test for BIA-ALCL. This fluid will be tested by a pathologist for CD30 immune staining (CD30IHC). Testing for CD30IHC is required to confirm a diagnosis or rule out BIA-ALCL. Fluid collections ruled out by CD30IHC for BIA-ALCL will be treated as typical seromas by a physician. Specimens not tested for CD30 may miss the diagnosis of BIA-ALCL.


What other reasons are there for having an en bloc capsulectomy?

Many women have had health issues, commonly referred to as breast implant illness, that may be caused by breast implants. Many have felt much improvement after their removal with some or even all of the symptoms disappearing. We cannot say that it will help get rid of any or all of your breast implant illness symptoms but it unquestionably has helped. However,the response from removal of the silicone or saline implants with an en bloc capsulectomy varies from person to person.

Will I possibly need any other procedure at the same time?

Dr.Domanskis will discuss the various options available to you from just small adjustments to re-shaping of your breasts to improve the look of your breasts once the total capsulectomy with en bloc removal of your breast implants is done. In most cases this would be done at the same operation.

Does Dr. Domanskis use drains when he performs an en bloc capsulectomy?

In most cases, Dr. Domanskis places a drain for the seepage that occurs. This is left until the drainage is minimal(less than about 20cc in a 24 hour period) which is usually within several days after surgery. Unfortunately, no showering is possible until the drain is removed.

Can I receive photo verification that the en bloc has been performed?

Yes, Dr. Domanskis will take photos after removal of the total capsule with the implant within the capsule(en bloc specimen) and take a photo for verification as well as insurance billing purposes.

Can I get an operative report?

Yes, we can provide an operative report of what exactly was done.

Can I get my implants returned to me that are removed?

Yes, you will be able to get your implants back to you.

Are there any negatives to getting an en bloc capsulectomy?

Sometimes, the incision to do an en bloc capsulectomy needs to be longer to have good visualization to remove everything en bloc. This results in a longer scar.

How long is the recovery from an en bloc capsulectomy?

The recovery from an en bloc capsulectomy usually requires several days of abstaining from light activity and a full two to three weeks before resuming heavy activity. Heavy activity includes anything that would raise your blood pressure and possibly cause you to bleed. The healing process with swelling continues after this for quite some time during which time your breast will feel hard.

Is an en bloc capsulectomy painful?

Yes, it can be painful, especially if the breast implant has been placed under the pectoralis muscle.

Do I get pain pills?

Yes, we do give patients pain pills.

Are other complications possible?

Yes. Other complications can include bleeding, which may require another surgery; infection, which would be treated with antibiotics; loss of sensation; unevenness of the breasts; scarring; and a feeling of hardness, which usually goes away. Possible serious complications include pulmonary embolus, or a blood clot, that forms in the leg and travels to the lungs among other things.

How can I prevent these complications?

You can limit these complications by refraining from aspirin or compounds that contain aspirin, as well as herbals. Also, it is critical to limit your activity after the surgery for a minimum of two to three weeks. You should follow the post-op instructions that we give to our patients and keep your appointments. Finally, you should move around, at least your legs, to prevent clots from forming. You should also tell Dr. Domanskis if you have had any problems with bleeding in the past or are taking any medications and/or drugs.

What is the cost of an en bloic capsulectomy?

An en bloc capsulectomy price is $7,500 for this procedure only.

Will my insurance cover an en bloc capsulectomy?

Your insurance may cover an en bloc capsulectomy, but you would need to contact them. We do provide you the information, like an operative report, to submit to your carrier as well as codes to use.

Can I have other cosmetic procedures done at the same time?

Yes, other cosmetic procedures can be done during the same operation.

Do you offer financing?

Yes, we have several financing companies that offer excellent financing options. If our patient does not qualify, we offer in-house financing.

Where is your office?

Our main office is in Newport Beach, CA, but we also have a satellite offics in Miami and Dr. Domanskis operates in San Francisco, as well as Anguilla, Nassau, and the EU(Italy/Lithuania).

How long do I need to be there?

It would be preferable to be in the area for two weeks, but in most cases, that is not possible. Some of Dr. Domanskis's patients have returned home after just a couple of days.

Can you help with travel arrangements?

Yes, we can help with all travel arrangements.

How can I arrange a consultation if I am far away from your offices?

Dr. Domanskis does offer FaceTime, Skype, and What'sApp complimentary consultations.

Do you have patients that have had an en bloc capsulectomy that I could talk to?

Yes, we have satisfied patients throughout the US and overseas that Dr. Domanskis has performed an en bloc capsulectomy that are willing to talk with you regarding their experiences.

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The Right revision for you

If you believe you are experiencing capsular contracture, an evaluation with Dr. Domanskis can help determine whether you need traditional breast revision or en bloc capsulectomy. Dr. Domanskis has extensive experience with breast surgeries and has in-depth knowledge about the advantages and complications associated with each procedure. If he determines that you do require a removal, you can feel certain that he will choose the best option for your specific body and health.

*Individual results are not guaranteed and may vary from person to person. Images may contain models.