En bloc capsulectomy of saline implants

This 57 year old woman had saline implants placed 15 years ago by another surgeon. Several years later she had a mastopexy done by a different surgeon who apparently kept her same implants in place. She was never pleased with her outcome and developed bottoming out and easily palpable implants. She began having health concerns including fatigue and unexplained swelling. She researched on line and found information on a social media based support group that made her suspicious that she may have breast implant illness. She did not have extensive testing but decided to have her implants removed and believed she needed "en bloc " capuslectomy. During her consultation she indeed had breasts with easily palpable implants. Dr. Lyle diagnosed a ruptured implant on the left which was a surprise to the patient who thought they were intact. She did not desire a mastopexy. Dr. Lyle performed enbloc removal of her left implant which was confirmed to be ruptured and total capsulectomy of the right intact smooth walled saline implant. He did remove some excess inferior skin to improve shape although not a formal mastopexy. En bloc capsulectomy entails removal of the implant within its capsule. It is not always possible to do with intact saline implants -especially under the muscle. The capsule has to be well established and separable from normal tissue without causing undue injury to normal structures. In many cases it is not necessary- in the absence of proper indications