En Bloc Capsulectomy for Breast Implant Related Illness or BII


Many women wish to have appropriate breast surgery that includes EN BLOC capsulectomy for BREAST IMPLANT RELATED ILLNESS or BII. This en bloc capsulectomy is not a new concept. This flattened term, en bloc, refers historically to surgical procedures to remove cancers and other tumors in its entirety with a margin of normal tissue around it. The intent of an en bloc removal of the cancer was to consensually remove cancer without cancer touching any other part of the normal tissue surrounding it. This is still a legitimate technique for removing cancers today. This has since been extrapolated into the removal of the capsule of the breast implant after previous breast surgery.

Affordable Breast Augmentation Phoenix

The en bloc removal means that the implant and the capsule removed as one large element with a cuff of normal tissue around it.

This can be surgically done of course by Dr. Jacobsen. It is important to realize however that the most important element of effective breast surgery for ladies is to remove the capsule the gel of the implant and the shell of the implant in its entirety. Dr. Jacobsen has been doing this for 25 years.

Dr. Jacobsen always sends the capsule along with the implant that is sometimes ruptured to the laboratory for pathologic review and screening for cancer. If there is fluid around the implant this is also sent to the laboratory. The capsule is always removed in its entirety. Sometimes in rare instances unfortunate ladies that had radiation or previous breast cancer some of the capsule were attached intimately to the ribs and cannot be removed practically or safely. But the capsule and the implant are always entirely removed.

On another page on my website, you will see there is reference to breast implant-related lymphoma. So far none of the capsules that Dr. Jacobsen has this removed have shown any element of this cancer or any other cancers. This will likely be the case for you as well.

In order to respect the pure nature of the surgical technique of en bloc removal the incision will have to be quite considerably large so that the surgical instruments and Dr. Jacobsen’s hands can reach from the bottom of the breast across the top of the breast all the way up to the superior aspect of the breast and still be able to surgically remove this through the incision as one piece. This often is impractical as it can if done properly entirely deconstruct the breast and render this poor woman with an unreasonable a large incision. So oftentimes removal of the breast implant and the capsule is sometimes done in parts for the safety of the woman and the overall effectiveness of the operation. But everything is removed including the capsule the implant shell and all the gel.

Occasionally the implant is ruptured outside of the capsule. This requires the removal of the capsule the breast implant the gel and then in any of the breast tissue around the breast implant that has spanned affected by that silicone gel. The sometimes required in some ladies removal of a considerable portion of the breast.

It is quite important however for all women to have the entire capsule removed and all the elements of the breast implant where there is ruptured or not.

Dr. Jacobsen knows how to do this effectively safely and to ensure you have all the benefits of removing her implant for your recovery whether it is for pain or for breast implant-related illness.

The most common complication after this operation is bleeding. Although the incision may be relatively small the surface area inside your breast around the capsule is quite large and so we make sure that you have a compressive surgical bra and the limit your activity significantly for the first 48 hours after the surgery to prevent bleeding. Sometimes drains are utilized as well.

 

 

Breast Implant Illness – Frequently Asked Questions/Talking Points Q

[from www.surgery.org]

 What is Breast Implant Illness (BII)?

There are many women now with breast implants who self-identify and present with various systemic symptoms and deeply believe that these are related to their breast implants. They refer to these symptoms as Breast Implant Illness (BII). Breast Implant Illness (BII) is a term used by women who have breast implants and who self-identify and describe a variety of symptoms including (but not limited to) fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues that they feel are directly connected to their saline or silicone, textured or smooth breast implants.

The recent increase in patients reporting Breast Implant Illness (BII) symptoms appears to be related to social media. There is one Facebook group alone with more than 50,000 members, all of whom report Breast Implant Illness (BII) symptoms. This is not to say that social media is the cause of Breast Implant Illness (BII) however, it may account for the rapid increases in patient reporting.

BII is not an official medical diagnosis so far and there is no ICD-10 diagnostic code for this phenomenon.

Is there a link between medical grade silicone implants and any disease?

Silicone is an element that exists in nature as crystalline silica, which has been shown to activate the immune system in conditions such as systemic sclerosis which has been seen in stonemasons. The silicone used in breast implants is different. So far this silicone substance not been proven to cause any disease. This silicone does not exist in nature, it is created by hydroxylating silica to form polydimethylsiloxane. Medical grade silicone has had antioxidants, dyes, and plasticizers removed during processing.

There is medical grade silicone is nearly all implantable medical devices.

Examples:

Total knee joint

Total hip joint

Brain shunts

Some heart valves

IV catheters

Port-A-Caths

Nasal Splints

Chest tubes

Cardiac bypass tubing

Internal defibrillator devices

Prosthetic limbs

Facial masks for burn patients

Pacemakers

Spinal stimulators

Drains, internal in the body

Foley catheters

Feeding tubes

Syringes

Silicone sheets for scar management

None of these devices and the associated silicone within them have been associated with any disease or condition.

The reason this silicone is used in medical devices is that it is indeed inert to the human body just like glass or sand. These substances have been known to NOT cause any allergic reaction as there are for many other medical materials, drugs or substances. This why this material is used in medical devices.

It is interesting to note that the silicone used in nearly ALL other medical devices has not been implicated in any illness of any sort.

We have seen patients with a large “load” of silicone in their knees and hips from replacements but believe it is only the silicone in their breasts that are causing problems.

Are there any tests that would indicate a connection between breast implants and symptoms that are being labeled Breast Implant Illness (BII)?

There is no diagnostic testing specifically for Breast Implant Illness (BII). This is one of the current areas of focus for the Aesthetic Surgery Education and Research Foundation, the research arm of the American Society for Aesthetic Plastic Surgery. There are tests for autoimmune diseases that can be performed to evaluate for potential causes of a patient’s symptoms. There are patients who have symptoms they attribute to Breast Implant Illness (BII) with positive immune testing and others with all laboratory tests which show no abnormalities.

Is there any scientific data showing causation between implants and these symptoms or any disease entity?

In 1999, The Institute of Medicine Committee on the Safety of Silicone conducted an extensive review of the available literature and concluded there was no demonstrated clear link between silicone implants and any systemic illness. There have been studies of many different sizes and designs to look at the safety of breast implants themselves. These have looked at specific autoimmune disorders and diseases. In aggregate, these studies show little to no links between breast implants and any disease. Studies of patients who have symptoms that they have related to their breast implants have not shown consistent laboratory abnormalities to define a distinct syndrome. To date, there has been very little in the way of research into this entity that has been labeled Breast Implant Illness (BII) by women with breast implants.

BII is not new. Only the name is new. In the early 90s there was a great “scare” regarding breast implants and there was a moratorium on their use for years except for reconstructive purposes. Over the next 15 years the breast implant was the most studied medical device in the history of man! 100,000s of women all over the world were studies. Dr Jacobsen participated in the studies. NO connection between breast implant silicone and auto-immune diseases or other illnesses were discovered even remotely and as a result the FDA after exhaustive consideration re-approved the silicone implants for general use in 2006.

You can read this report here:

FDA Update on the Safety of Silicone Gel-Filled Breast Implants

https://www.fda.gov/media/80685/download

Does implant removal improve patient’s symptoms or cure a patient who has a medically diagnosed disease entity like an autoimmune disease?

Various studies show different degrees of improvement in patient symptoms after removal of their breast implants, some of which are temporary, and some showing permanent resolution of symptoms. There are no studies that specifically show which symptoms may or may not improve with implant removal with or without capsulectomy. There is no current definitive epidemiological evidence to support a direct link between breast implants and any specific disease process. However, this does not mean further research is not indicated. In rare and unusual disease processes, it can take years to come to a scientific conclusion. There are many factors that can affect the interaction between a patient and her breast implants. Further study is required to determine the best way to potentially screen patients prior to breast implant surgery and to determine which of the multitude of reported symptoms might improve with implant and capsule removal. A lack of a direct, proven scientific link does not mean that the symptoms experienced by these patients are not real. Some patients have legitimate concerns about a potential link between breast implants and symptoms, so it deserves our attention and further scientific research to better determine what symptoms may improve with explanation of implants.

What are ASAPS and ASERF doing to better understand this group of systemic symptoms being called Breast Implant Illness (BII)?

Because there are many women that self-identify as having Breast Implant Illness (BII), we are listening. ASAPS and ASERF are developing a new scientific study to examine this entity. We are also providing our members with a questionnaire to use to collect a record of complaints from patients with implants, as well as one to utilize for post-explantation. We cannot yet define BII and therefore cannot say with any certainty that it exists, because we do not have any tests we can run to prove or disprove its existence. However, we can listen to and partner with our patients to determine what is the best course of action to address their complaints, be it explantation or otherwise.

What should a physician do when a patient complains of Breast Implant Illness (BII) symptoms?

Do not ignore your patient’s concerns. Their symptoms are real and whether or not they can or cannot be attributed to their implants isn’t relevant since there is simply no existing way to prove nor disprove causation or association. Options can include further medical workup with or without the consultation of a rheumatologist, observation without medical workup, implant removal without capsulectomy, exchange with or without capsulectomy, removal with total capsulectomy, or removal with en bloc capsulectomy. Patients who present with concerns of Breast Implant Illness (BII) have real symptoms that often cannot be categorized into any specific know disease entity. This does not mean their symptoms are not real and they deserve a full evaluation. The various options need to be discussed and hopefully, with further research, we may be able to determine which patients may see symptom improvement or resolution with removal of their implants and which may not see any change.

What is the risk of developing Breast Implant Illness (BII)?

As there is no definitive link between the often subjective and divergent list of symptoms and no means for testing, there is no ‘known’ risk. Many of the symptoms described by breast implant patients are experienced by the general public on a regular basis with or without implants. That isn’t to write-off a potential connection, but no connection has been established to-date. Patients should, however, be informed of the risks that can be associated with breast implants, including (but not limited to) BIA-ALCL, a rare spectrum of disorders that can range from a benign accumulation of fluids around the breast (seroma) to an extremely rare lymphoma. They should know that BIA-ALCL is not a cancer of the breast tissue itself and that when caught early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required.

If after the discussion of risks and the possibility of no improvement of symptoms post explantation is discussed with a patient, what should be done if the patient demands an “en bloc” or “total” capsulectomy with their explantation?

There are many medical inaccuracies perpetuated on the internet. BII patients tend to believe that a total capsulectomy is necessary to remove all causative agents and they prefer it en bloc, oftentimes without having a full understanding of what size incision is necessary for en bloc. Rather than react, first discuss the reasons you would perform a total capsulectomy with any patient. Not all plastic surgeons routinely perform a capsulectomy with explants, but some do. If you wish to perform capsulectomy on a patient, it is important to explain that it is not always possible to remove all of the capsules. Sometimes a portion of the capsule must be left behind or is disintegrated with the use of electrocautery to prevent significant damage to muscle, rib or lung. Explain what size incision is necessary for an en bloc (as many may not be aware of how large an incision may be necessary). If they had an axillary approach or periareolar approach for breast implant placement, it must be explained to them that they cannot have the procedure done through those incisions. It is recommended to reinforce that there are increased surgical risks associated with en bloc capsulectomy which requires a complete dissection of all the tissues surrounding the breast implant and, that we do not have enough collective data to guarantee any improvement in their symptoms they have labeled Breast Implant Illness (BII).

Dr J and his staff look forward to understanding the details of your unique case, desires and aspirations, and to providing you with realistic, safe and attainable results that leave you looking beautiful, and truly feeling like yourself. Take the first step toward your healing or rejuvenating procedure with Dr J by filling out our contact form to request a consultation, or to inquire about any of the services we offer. We look forward to treating you!


4.9 Average Rating  |  Click to view over 377 reviews



4.8 Average Rating  |  Click to view over 171 reviews



4.7 Average Rating  |  Click to view over 154 reviews
  • review rating 5  Dr. J is seriously hands down the best plastic surgeon out there. Bonus, His staff is amazing as well! Amazing work and the best bedside manner there is!

    thumb Stephany Stuhmer
    7/24/2020
  • review rating 5  Dr. Jacobsen surgically treated my husband for a serious and complicated wound infection. It took a lot of determination on Dr. J's part to get him through this ordeal. We would email photos on a regular basis and Dr. J would always personally reply and see him asap if needed. We would definitely recommend him to anyone.

    thumb Judy Shewman
    7/16/2020
  • review rating 5  My beloved Bernie received such wonderful care from Dr Jacobsen. He was seen the very next week for a growth he had on his ankle. Both Dr. Jacobsen and his staff were very professional, warm, kind and compassionate. What impressed me the most about Dr J was his ability to be fully present and listen deliberately to our concerns and then communicated in a language we could understand about what Bernie needed. Bernie was in surgery the next day. Dr J listened to Bernie’s concerns and honored his choices, even though they were different than what Dr J recommended. Although the cancer spread through his body in the next several months and Bernie died, Dr J and his staff were always compassionate and understanding. They took the time to listen and they were especially kind to me, Bernie's beloved wife.

    thumb Victoria Benoit, Author
    7/16/2020
  • review rating 5  Dr Jacobson is the most competent and engaging surgeon I've known. A paralyzed Veteran for 25 years, I developed pressure wounds the VA were incapable to treat, finally the VA gave up completely and drugged me and put me on palliative care,telling nurses I'd be dead by 2015. Dr Jacobson changed all that and gave me new life. He is simply the best. Cosmetically or otherwise,one cannot do better than Dr William Jacobson .

    thumb Eddie Carter
    7/15/2020
  • review rating 5  Love my Results to Dr. Jacobson has a very smooth hand for surgery And I only the felt real pain in the first couple hours but that’s normal but other than that I’m so happy with my breast augmentation I live Nearby Scottsdale Most of them want money for a consultation And when I called they made things seem so complicated but Dr. Jacobson’s website get straight to the point about pricing for ever surgery is what I really liked about it so the night before I have seen his website I told my fiancé just to take me there to Check it out and When I did meet with Dr.Jacobson I No I wanted him to do my breast argumentation Am I couldn’t be happier with my results staff is super nice as well especially Kimberly she’s the best

    thumb Mercedes Ely
    7/03/2020
  • review rating 5  I love Dr. Jacobsen. He really listened to what I wanted and offered his professional opinion on what options were best for me. I am very very happy with the result of my surgery. I am so grateful for his expertise. His bedside manner is also very caring. I had a great experience from start to finish. Kimberly was excellent to work with in the office and there is only a short wait each time on each visit. I'm in and out and super happy.

    thumb Sarah Prenzno
    6/16/2020
  • review rating 5  Dr. Jacobsen or Dr. J as he prefers to be called is the most awesome character to know; he and his professional family!! Kind, soft spoken, informative, well educated and his surgical skills like no other! He brought me hope when I felt none left, at 48 I had fallen after having open heart surgery, losing my sternum due to sepsis and for the past 2 years dealing with Dr.s with attitudes and complex issues and NO bedside manners. I needed a medically necessary breast reduction surgery my infectious disease Dr. overheard my last plastic surgeon at the time literally screaming at me and walked out so she referred me to Dr. J and I am ever so grateful!! With my surgery completed and the weight removed I have less pain and can move a bit more freely allowing me so much more freedom in my life again!! THANK YOU DR. J, Kimberly, Charley and Oliver..xoxo forever in my heart you'll be..there will never be enough words to show my gratitude to you all for you have done for me!! I look forward to our visit in 2 months..So Oliver call me...

    thumb Jenni Lou
    6/16/2020
  • review rating 5  I am still in awe at how easy and wonderful my experience was here. I went in on Tuesday for a consultation and was back in on Friday for my actual procedure . Dr. Jacobsen was so nice and gentle and so was the rest of the staff. This is how every single office should be ran. From start to finish it was amazing ! Def recommend

    thumb Kiarra Dade
    5/24/2020
  • review rating 5  Thanks Dr. Jacobsen and staff. Warming atmosphere friendly informative and caring doctor. This was my first visit and doctor took the time to explain and answer my questions. Nothing was rushed. Staff greeted me nicely with smiles and patience. It took me courage to show up since I’m nervous about having a surgery to begin with. They helped me feel welcomed and relaxed. Thank goodness their office portal was working so no double work to provide my medical information and resigning papers.

    thumb Marylin Giron
    1/25/2020
  • review rating 5  I had many complications with my body healing from surgery, and Dr. Jacobsen demonstrated patience, resourcefulness, vigilance, and compassion. Here are a few specific things he did to help with my healing: he had me email him twice a day with pictures of my incisions so he could monitor, provide feedback and directions, and adjust his care for me as needed; he was always quick to respond to my emails and questions; he met me in his office on a Saturday during a holiday weekend to care for me during an important time in my healing; he provided regular and specific directions to my husband as he cared for me at home with the complications. His compassion and reassuring nature were valued as I put my confidence in his expertise to help me through this difficult time. I appreciate him greatly and give him the highest rating with no hesitations. His staff were also extremely helpful. Don't be bothered about calling the office and leaving a message (when someone doesn't answer) or emailing the office; they are very quick to respond with a phone call or email and this is part of their daily business routines, which allows them to care for their patients in person AND to those reaching out to them for miscellaneous reasons. This was different at first for me but I quickly adjusted, understanding their reasons and seeing their quick responses to me. The staff also worked seamlessly with my insurance company, a medical equipment company who came to my home three times a week to monitor and help with the healing process, and with the needed paperwork for my employment. I was always treated with respect, sensitivity, compassion, and excellent care.

    thumb D Robinson
    1/21/2020

Get started today!

Dr J and his staff are committed to providing you with exceptional and compassionate care. On behalf of our entire team, we invite you to request a consultation to talk to Dr J about your goals, expectations and aspirations. We can’t wait to find out how our 20-plus years of experience in cosmetic and functional plastic surgery can help change your life, and make you a happier, healthier person.

Dr. William Jacobsen
Plastic Surgery
2525 East Arizona
Biltmore Circle, Ste 2450
Phoenix, AZ  85016

Phone: 602-212-0100
Fax: 602.279.1701
info@drjsoffice.com

Our Procedures & Treatments

Dr J considers every surgery an opportunity to express his vision with his patients, and believes in natural, beautiful results that leave you feeling confident and beautiful, but most importantly, feeling like yourself. From extremely rare and complex surgical cases, to cosmetic surgery, Dr J has the experience, compassion and understanding to help you achieve your surgical goals.

Request an Appointment

Copyright © 2019 Dr. William M. Jacobsen Plastic Surgery. Website, SEO & Branding by mdBrand®.
Click to Hide Advanced Floating Content
/**/