Summary: The Breast Surgery Collaborative Community (BSCC) states that an en bloc capsulectomy is only necessary for confirmed or suspected breast implant-associated cancer after thorough evaluation, emphasizing informed consent, evidence-based care, and the need for continued monitoring, while warning against unnecessary procedures driven by patient fears.

Key Takeaways:

  • The Breast Surgery Collaborative Community (BSCC) states that en bloc capsulectomy is only necessary for patients with confirmed or suspected breast implant-associated cancer after thorough medical evaluation, emphasizing that this complex and costly procedure should not be recommended based on patient fears alone.
  • The BSCC highlights that it is unknown whether removing breast implants, with or without capsulectomy, prevents future breast implant-associated cancer and stresses the importance of continued clinical monitoring and imaging surveillance for patients undergoing capsulectomy, particularly those with textured implants.
  • Informed consent and shared decision-making are crucial, with plastic surgeons responsible for providing patients with evidence-based information and ensuring they understand all options and associated risks, especially given the prevalence of misinformation online.

A consensus statement from the Breast Surgery Collaborative Community (BSCC), which includes patient advocates, board-certified plastic surgeons, and other stakeholders, provides clear guidance on managing breast implant capsules.

Experts Warn Against Unnecessary Capsulectomies

The BSCC, with representatives from the American Society of Plastic Surgeons (ASPS) and The Aesthetic Society, emphasizes that an en bloc capsulectomy—a lengthy, complex, and costly procedure—is only necessary for patients with confirmed or suspected breast implant-associated cancer after a thorough medical evaluation.

“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,” Adams adds. “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.”

Four Types of Capsulectomy Procedures

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.”

Shared Decision-Making Essential for Capsulectomy

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.