En bloc capsulectomy means removing the implant and the entire capsule around it in one piece, without opening the capsule. It is a real operation with a real indication — and it is also the most over-requested term in breast surgery, because online it is often presented as the only safe way to have implants removed.
It is not. What should be done with the capsule depends on what is found, and the technique that matters most is the one matched to your situation.
The terms, properly distinguished
| Term | What it means |
|---|---|
| Capsulotomy | The capsule is cut or released but left in place |
| Partial capsulectomy | Part of the capsule is removed, usually where it is thickened |
| Total capsulectomy | The whole capsule is removed, though it may come out in pieces |
| En bloc capsulectomy | Implant and capsule removed together as a single intact specimen |
The distinction that matters clinically is between leaving the capsule, removing it, and removing it intact. Only the last is en bloc.
When it is genuinely indicated
The situation en bloc removal was developed for is confirmed or suspected BIA-ALCL, where the disease sits in the capsule and the fluid around the implant, and keeping the specimen intact is part of the oncological treatment. It is also reasonable where a mass has been found in the capsule.
Outside those situations, an intact removal is a preference rather than a requirement, and it carries costs worth knowing about.
What it costs you surgically
- A longer incision. An intact specimen is bulky and has to come out whole, which usually means a longer scar than removal alone.
- More dissection. More bleeding, more bruising and a longer operation.
- Proximity to the chest wall. In thin patients the back of the capsule lies against the ribs and the pleura. Removing it intact there carries a risk of entering the chest cavity, which is uncommon but serious.
- It is not always possible. A thin or adherent capsule can tear whatever the intention. A surgeon who guarantees an intact specimen in advance is promising something not entirely within their control.
Dr Kumar will tell you before surgery what he intends to do with the capsule and why, and will tell you afterwards what was actually found.
Medicare
Item 45551 covers removal of a breast prosthesis with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. It is intended for capsular contracture, a mass within the capsule, or evidence of BIA-ALCL or other malignancy, and where claimed the capsule must be sent for histopathology.
Where the implant alone is removed, item 45548 applies. A capsulectomy requested without one of those indications does not meet the criteria set out for 45551.
The question worth asking instead
Rather than asking a surgeon whether they “do en bloc”, the more useful questions are: what do you expect to find in my capsule, what will you do if it is thin and healthy, what will you do if it is thickened, and what will you send for testing? Those answers tell you far more about how your operation will be conducted.
Common questions
Does leaving capsule behind cause problems? A thin, healthy capsule left in place generally settles and is reabsorbed. It is not a foreign body in the way the implant is.
Will it help my symptoms more than removal alone? There is no good evidence that intact removal improves systemic symptoms more than removal with appropriate capsule management. Breast implant illness.
Is the capsule always tested? Where item 45551 is claimed it must go to histopathology. Dr Kumar will tell you what is being sent and why.
Are drains used? Often, where the dissection has been extensive.
Is recovery longer? Yes, compared with removing the implant alone. See explant surgery.
Next step
Bring a GP referral — it is required to see Dr Kumar — your implant cards and any imaging. You will get a straight explanation of what he plans to do with your capsule and why. Call 1300 267 726. More about implant removal and revision.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
