A consensus statement on the terminology and management of breast implant capsules issued by the Breast Surgery Collaborative Community (BSCC), a consortium of patient advocates, board-certified plastic surgeons and others with a vested interest in enhancing breast surgery safety, offers clarity for women seeking guidance on removal of breast implants related to health concerns.
In particular, the BSCC, which includes physician representatives of the American Society of Plastic Surgeons (ASPS) and The Aesthetic Society, notes that an en bloc capsulectomy — a lengthy, complex, and expensive procedure — is only necessary for patients with an established or suspected breast implant-associated cancer after appropriate medical workup.
“It’s unfortunate, but there are surgeons who will capitalize on a patient’s trust or fear to urge them toward the more costly and riskier procedure,” says The Plastic Surgery Foundation (PSF) President Scot Bradley Glasberg, MD, who is a co-founder of the BSCC. “In actuality, the en bloc is only necessary in very specific cases and it can leave patients with significant breast deformities, and be prone to complications. Ultimately, it should be the science and clinical data that dictates clinical care and guidelines.”
The BSCC consensus statement points out that it is currently unknown whether the removal of breast implants with or without a capsulectomy will prevent the future development of a breast implant-associated cancer. It also says there is a rare subset of patients who have still developed breast implant-associated cancer after capsulectomy.
The BSCC statement adds that patients who decide to undergo a capsulectomy, particularly those with textured implants, must continue standard clinical monitoring and imaging surveillance after that surgery.
“It’s absolutely vital that patients be made aware of all options and the risks associated with any surgical procedure during the informed consent process,” says William P. Adams, Jr. MD, a past president of The Aesthetic Society, The Aesthetic Foundation, and a co-founder of BSCC. “It is always a patient’s choice to elect to undergo a procedure such as a capsulectomy, provided the risks of such a surgery are clearly understood. However, it is our responsibility as plastic surgeons to ensure that patients get the best evidence-based information developed through high-level science, and right now many patients are being given a lot of misinformation on the internet and social media sites.”
The BSCC consensus statement defines four types of capsulectomy:
- Total intact capsulectomy: Complete removal of the breast implant capsule as a single unit.
- Total capsulectomy (total precise capsulectomy): Complete removal of the breast implant capsule, not necessarily done as a single unit or in one piece.
- Partial capsulectomy: Removal of the breast implant capsule where some capsule is left behind.
- En bloc capsulectomy: Removal of the breast implant capsule with a margin of uninvolved tissue for treatment of suspected or established breast implant-associated cancers after appropriate medical workup.
Further, the BSCC consensus statement explicitly states, “the absolute and only indication for an en bloc capsulectomy is for an established or suspected breast implant-associated cancer after appropriate medical workup.”
The BSCC notes that the informed-consent process for patients considering a capsulectomy should be a shared decision-making process with their surgeon, including a discussion of potential benefits and risks. This should include patient concerns regarding systemic symptoms, often referred to as Breast Implant Illness (BII), the risk of breast implant-associated cancers involving the capsule (such as BIA-ALCL, BIA-SCC, etc.), and any potential future risks, especially resulting from textured implants and tissue expanders. Importantly, the risk of the capsulectomy procedure itself, including the patient’s medical history, must also be weighed against those risks noted.
