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En Bloc Capsulectomy, Southern California
En bloc capsulectomy with Tim Sayed MD, a double board-certified plastic surgeon who has built his Southern California practice around breast implant removal. In an en bloc removal, the implant and the scar-tissue capsule come out together as one sealed unit, so the capsule is never opened inside you. This page explains the technique, when it is and is not the right choice, and how Dr. Sayed performs it at his San Diego and Orange County offices.
En bloc
Implant and capsule out as one sealed unit
2
Board certifications
20+
Years in practice
4.6
Google rating
At a glance
En bloc capsulectomy is a specific way of removing breast implants, not a separate operation from explant. The question it answers is what happens to the capsule, the shell of scar tissue your body built around the implant. Done en bloc, the capsule is separated from your tissue while the implant stays sealed inside it, and the whole thing is delivered as one closed specimen. That matters most when the implant may have ruptured, when a textured device carries a small cancer association, or when a patient wants the certainty that nothing was left behind.
What it is
An outpatient breast implant removal in which the capsule is dissected free and lifted out with the implant still sealed inside it, rather than opened around the implant.
En bloc vs. total
En bloc keeps the capsule closed as it comes out. A total capsulectomy still removes the whole capsule but opens it around the implant. Both remove all of the capsule; en bloc keeps the contents sealed.
When it fits
Most often chosen for ruptured silicone, textured or recalled implants, breast implant illness concerns, and capsular contracture. It is Dr. Sayed's default whenever the capsule can be freed safely.
Pathology
The intact capsule and any fluid are sent to pathology after every removal, so a pathologist can check for abnormal cells, including BIA-ALCL. You receive the report about a week later.
Cost and recovery
Commonly about $9,000 to $14,000 all in, more with a lift or fat transfer. Desk work in about a week, drains out within a week or two, full exercise around six weeks.
Your surgeon
Tim Sayed MD, MBA, FACS, double board-certified, operating from offices in San Diego (University City) and Newport Beach (Airport Area).
Why en bloc
Patients who ask for en bloc removal across Southern California tend to fall into a handful of groups. In each one, keeping the capsule sealed as it comes out answers a specific clinical concern rather than serving as a marketing phrase.
A silent silicone rupture can spread gel into the capsule without any outward sign. Removing the implant and capsule as one closed unit keeps loose gel from contacting the surrounding breast tissue during surgery.
When the capsule has thickened and hardened, it is already a defined, graspable layer. That often makes en bloc removal more manageable, and it removes the contracted tissue that caused the firmness and distortion in the first place.
Patients who attribute fatigue, joint pain, brain fog, or rashes to their implants frequently want every trace of the implant and its capsule gone. En bloc removal delivers that, and the sealed specimen goes to pathology for examination.
Certain textured implants, including recalled Allergan Biocell devices, carry a small but real association with BIA-ALCL, a lymphoma that develops in the fluid or scar capsule around the implant. For these patients, removing the capsule intact and sending it for pathology is the careful path.
Some patients simply want the reassurance that the implant and the entire capsule are gone in one piece. When the anatomy allows it safely, en bloc removal delivers exactly that.
Capsules that have calcified over many years, or breasts with prior revisions and scarring, are often best taken as a sealed unit so fragments are not left in the pocket. Dr. Sayed plans these cases carefully in advance.
The honest answer to the first question is the one that matters most. A surgeon who removes the capsule intact whenever it is safe, and who can explain clearly when it is not, is giving you the full operation rather than a label. Dr. Sayed walks through each of these in the consultation.
The technique
En bloc is not always possible, and that is not a failure. When the back wall of the capsule is paper-thin and fused to the ribs, peeling it off in one piece can risk entering the chest cavity. In those cases the safe move is to remove as much as possible en bloc and complete the rest as a total capsulectomy. The whole capsule still comes out; it simply does not come out sealed. Safety comes before the label every time.
The single most important thing to understand about breast implant removal is what happens to the capsule, and the terms are often blurred. En bloc means the capsule is freed from your tissue and lifted out with the implant still sealed inside it, so the contents never open in the pocket. Total capsulectomy removes the entire capsule as well, but opens it around the implant instead of keeping it closed. Partial capsulectomy leaves some capsule behind on the chest wall. The table below lays out how they differ and when each one fits.
| Comparison | En bloc capsulectomy | Total capsulectomy | Partial capsulectomy |
|---|---|---|---|
| What is removed | Implant and entire capsule together, capsule unopened | Entire capsule, but opened and removed around or after the implant | Only part of the capsule; the rest is left on the chest wall |
| Best suited to | Ruptured silicone, breast implant illness concerns, textured implants, capsular contracture | Thin or adherent capsules where en bloc is not safe, most routine removals | Thin, healthy capsules when a new implant is going straight back in |
| Contents stay sealed | Yes. The capsule stays closed, so silicone, fluid, and biofilm are far less likely to contact your tissue | Partly. The capsule is opened, so contents may be exposed | No |
| Capsule to pathology | Yes, as one intact specimen | Yes | Sometimes |
| Dr. Sayed's approach | His default whenever the capsule can be freed safely | His fallback if en bloc would risk the chest wall | Rarely, and only when the capsule is thin and a new implant is planned |
Why does keeping the capsule sealed matter? An older silicone implant may have ruptured without any symptom. A capsule can hold biofilm, calcification, or gel fragments. Taking it out closed keeps those contents from spreading across your tissue during the removal, and it delivers one clean specimen to pathology. That is the clinical reasoning behind en bloc, stated plainly and without overpromising what any single technique can guarantee.
Breast implant illness and BIA-ALCL
Pathology is easy to overlook, but it is one of the strongest reasons to remove the capsule intact. After every capsulectomy, Dr. Sayed sends the capsule and any fluid to a pathologist, who examines the tissue and reports back in about a week. Most reports describe ordinary scar tissue. The point is that the tissue is actually looked at, not discarded.
Breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL, is a rare but real cancer of the immune system that develops in the fluid or scar tissue around certain textured implants. It is highly treatable when found early, and in most cases surgery to remove the implant and the complete capsule is the treatment. Testing the fluid and capsule tissue is how it is diagnosed. The FDA tracks these cases and maintains current guidance on textured implants and BIA-ALCL.
This is where en bloc and pathology work together. Removing the capsule as one sealed unit and sending that intact specimen for examination gives the pathologist the whole capsule to evaluate, and it keeps any fluid contained until it can be tested. Dr. Sayed reviews the report with you at a follow-up visit and explains what it means in plain language. Reassuringly, most reports are normal.
The procedure
En bloc capsulectomy with Dr. Sayed is performed under general anesthesia in an accredited surgical facility and takes about two to three hours, longer when a lift or fat transfer is added. He operates himself at every step, and the plan is set with you before the day of surgery rather than decided in the room.
01
Dr. Sayed reviews your implant records, any imaging, and your reasons for removal, then examines your tissue and tells you plainly whether en bloc is likely to be feasible and what the breast will look like afterward.
02
Whenever possible he reuses your original inframammary scar. If a lift is planned, the capsule is delivered through the lift incisions, so no extra scar is added for the capsulectomy.
03
With the implant still sealed inside, the capsule is freed from the breast tissue, the muscle, and the chest wall as one unit. If the back wall is fused to the ribs, Dr. Sayed stops short of the chest cavity and completes that portion as a total capsulectomy, keeping safety first.
04
The intact specimen is photographed for your records and sent to pathology. You receive the report about a week later, and Dr. Sayed reviews it with you.
05
If it is part of your plan, Dr. Sayed repairs the pectoralis muscle where helpful, performs a lift, or grafts fat from the abdomen or flanks into the upper breast to restore softness and shape.
06
Small drains are placed to keep fluid from collecting in the space where the implant and capsule sat, and usually come out within the first week or two. You leave in a surgical bra with a written recovery plan and Dr. Sayed's direct follow-up schedule.
En bloc capsulectomy is surgery under general anesthesia, and it carries the risks any breast operation does: bleeding, infection, a fluid collection (seroma or hematoma), changes in nipple or breast sensation, visible scarring, asymmetry, and the small risks of anesthesia. Because en bloc dissection works near the chest wall, there is also a small risk of entering the chest cavity, which is exactly why Dr. Sayed converts to a total capsulectomy rather than force an intact removal where the capsule is fused to the ribs.
Most of these are uncommon and manageable, and your consultation covers each one in plain language along with how your own health history changes the picture. Results vary from person to person, and Dr. Sayed will not promise an outcome he cannot predict.
En bloc removal is usually postponed if you are pregnant or breastfeeding, in the middle of significant weight change, or using nicotine and unable to stop for several weeks on either side of surgery. It is also not always the correct technique: when the capsule is thin and healthy and a new implant is going straight back in, a less extensive capsulectomy may be the better choice.
Patients who want to keep implants but correct a problem such as capsular contracture or malposition are often better served by breast augmentation revision. Dr. Sayed will tell you honestly if that path fits you better than a full capsulectomy.
Your options after removal
You do not have to settle this before you walk in. Dr. Sayed will show you what each path has looked like on women with tissue like yours, and recommend the lightest option that reaches your goal.
The capsulectomy is only half the plan. The other half is what the breast looks like once the implant volume is gone, and that depends on your own tissue, how much the implant stretched the skin, and where the nipple sits. En bloc removal pairs cleanly with each of the options below, and the capsule still comes out sealed in every one. For more on that decision, see breast implant removal and BII treatment. Here is how each option works with en bloc.
Read Dr. Sayed's guide to lift and fat grafting with removal
The simplest pairing, and the right one more often than patients expect. It works when the implants were modest for the frame, the skin still recoils when pinched, and the nipple sits at or above the fold. The capsule comes out sealed, nothing is added, and you keep your original scar.
Recovery is the shortest of the three, and the breast settles over three to six months toward its pre-augmentation size. The trade-off is patience: the first few weeks look deflated before the tissue relaxes.
Some patients with larger implants decide later that they want a lift. That can be done as a second stage once the tissue has settled, which also gives the skin time to recover before any lift is designed.
When an implant has stretched the skin or dropped the nipple below the fold, removing the volume alone leaves loose skin with nowhere to go. A breast lift tightens the envelope and repositions the nipple in the same operation, and the capsule is delivered through the lift incisions so no extra scar is added.
Dr. Sayed chooses the lightest lift that will do the job: a periareolar lift for modest repositioning, a lollipop or anchor lift when more skin must be removed. The en bloc dissection is unchanged; the lift simply shapes what remains.
It adds about an hour of surgery, a slightly longer recovery, and scars that fade over 12 to 18 months. For many patients with larger or long-standing implants, it is the difference between a deflated look and a natural one.
Fat grafting suits patients who are done with implants but miss softness at the top of the breast. Dr. Sayed harvests fat from the abdomen, flanks, or thighs with gentle liposuction, purifies it, and grafts it into the upper pole after the sealed capsule is out.
A portion of the grafted fat takes and stays, usually enough for a modest, natural gain in fullness, and the donor area gets a contour improvement in the process.
Fat transfer cannot replace a large implant one for one, it needs enough donor fat to work with, and it is sometimes staged a few months after the removal so the graft goes into healed, well-perfused tissue.
Nipple position. At or above the fold points to en bloc alone; below it points to a lift. This single measurement decides more than anything else.
Skin quality. A pinch test and a look at stretch marks tell him how much the envelope will shrink back on its own over six months.
Your own tissue versus the implant. A 200 cc implant on a woman with a full B cup of her own tissue behaves very differently from a 500 cc implant on a small frame.
Capsule and implant condition. A thick, calcified capsule or a ruptured implant can leave contour dips that fat grafting smooths better than a lift alone.
Your priorities. How you feel about scars, a second stage, donor-site liposuction, and budget all shape the plan. Nothing is decided for you.
Case studies
Dr. Sayed photographs and documents his en bloc cases so that you can see what removal looks like on real bodies, not illustrations. The galleries below are organized by the plan each patient chose. Every patient shown had the capsule removed and sent to pathology.
Gallery 01
The largest group in the gallery: women whose implants had stretched the skin or dropped the nipple, treated with sealed capsule removal and a lift through the same incisions. Note how the lifted breast sits higher and rounder without an implant.
Gallery 02
Smaller implants and good elasticity, with nothing added. These cases show the honest answer to the most common question Dr. Sayed hears: what will I look like with just the implants and capsule out?
Gallery 03
Women who wanted to stay implant-free but keep some softness at the top of the breast. Fat grafted from the abdomen or flanks fills the upper pole and smooths the contour where the implant used to sit.
Gallery 04
A gentler lift for women who need modest nipple repositioning and prefer to keep scarring to the areola border, with sealed capsule removal and the lift done in one operation.
Results vary from patient to patient, and photographs are shared with consent. Ask at your consultation to see cases that match your implant size, tissue, and goals.
Cost
When you compare quotes, ask whether the capsule is included, whether it comes out sealed, and whether it goes to pathology. Those three questions tell you what a price actually buys.
En bloc capsulectomy in Southern California commonly costs about $9,000 to $14,000 all in, covering the surgeon, anesthesia, the accredited facility, pathology, and follow-up. Adding a lift or fat transfer typically brings the total to about $14,000 to $19,000. These are planning ranges; your exact quote depends on your anatomy and the plan you choose together.
Keeping the capsule sealed. En bloc or total capsulectomy takes longer and demands more than simply pulling an implant out, which is reflected in surgeon and facility time.
Adding a lift or fat transfer. Each adds operating time and technical work, and each is quoted as part of a single combined fee rather than as a separate surgery.
Implant history. Older ruptured silicone, heavily calcified capsules, and prior revisions take more time to remove cleanly.
Insurance. Removal for a documented rupture, severe contracture, or BIA-ALCL may be partly covered. Removal for breast implant illness or a change of mind generally is not. Dr. Sayed's team provides documentation to support a claim.
Financing. Monthly payment plans through third-party medical lenders are available to qualified patients.
See Dr. Sayed's pricing overview | Explore financing options
Recovery
Most en bloc patients are up and walking the day of surgery, back at a desk in about a week, and cleared for full exercise around six weeks. Drains typically come out in the first week or two. The breast looks flat at first and fills back toward its natural shape over three to six months.
Surgery day
Outpatient, home within a few hours. Expect tightness and soreness managed with prescribed medication. Someone drives you home and stays the first night.
Days 2 to 7
Swelling and bruising peak and start to ease. Short walks several times a day. Drains are usually removed at your first visit. Many patients are at a desk by the end of the week.
Weeks 2 to 3
Daily routines return. Driving once you are off prescription pain medication. Surgical bra continues. No lifting, pushing, or chest exercise yet.
Weeks 4 to 6
Light cardio resumes, then full activity and upper-body training once Dr. Sayed confirms healing.
Months 3 to 6
Swelling resolves, the breast softens, and any lift or fat transfer settles into its final shape. This is your result.
Sleeping. On your back, upper body raised, for about three to four weeks. Side sleeping once Dr. Sayed clears it.
Drains. Small tubes that keep fluid from collecting where the implant and capsule sat. Most patients find them more awkward than uncomfortable, and the team shows you how to empty them.
Scars. Dr. Sayed reuses your original incision whenever he can. Scars fade over 12 to 18 months, and he will guide you on tape, silicone, and sun protection.
Working out. Walking from day one. Lower-body work at about three weeks, full training including chest and shoulders at about six.
How the breast looks early on. Flat or deflated in the first weeks is normal. Fullness and shape return as swelling fades and tissue relaxes.
Symptom changes. Many patients who removed implants for BII concerns describe improvement over weeks to months. Results vary, and Dr. Sayed will not promise what he cannot predict.
Your surgeon
For Dr. Sayed, Aesthetics Done Right means doing the full operation himself, telling you the truth about when en bloc is and is not possible, and being there for every visit afterward. This page was medically reviewed by Tim Sayed MD, MBA, FACS. Last updated October 2026.
Tim Sayed MD, MBA, FACS is a double board-certified plastic surgeon, certified by both the American Board of Plastic Surgery and the American Board of Surgery, and recertified in both. He trained at UCSF and at Harvard's Massachusetts General Hospital, and earned an executive MBA from Northwestern's Kellogg School.
Over more than 20 years in practice, breast implant removal has become the heart of his work. He performs en bloc capsulectomy as his default technique, converts to a total capsulectomy only when the chest wall makes intact removal unsafe, sends every capsule to pathology, and documents his cases so patients see honest results.
American Board of Plastic Surgery
Board certified and recertified
American Board of Surgery
Board certified and recertified
UCSF School of Medicine
MD and plastic surgery residency
Harvard, Mass General
General surgery training
Kellogg School of Management
Executive MBA, Northwestern
Alpha Omega Alpha
National medical honor society
Serving San Diego and Orange County
Dr. Sayed sees en bloc patients at two Southern California offices. His San Diego office sits in University City at 4510 Executive Drive, Suite 210, near Westfield UTC and minutes from La Jolla, Del Mar, and Carmel Valley. His Orange County office is at 3991 MacArthur Boulevard, Suite 320 in Newport Beach, by John Wayne Airport and Fashion Island, serving Corona del Mar, Costa Mesa, and Irvine. For city-specific detail, see the en bloc capsulectomy in La Jolla and en bloc capsulectomy in Newport Beach pages.
Southern California makes recovery easier. Walking is the best early activity, and the region's flat coastal paths and mild, dry weather make daily walks easy from the first week. The one caution is sun on a fresh scar: keep incisions covered or protected until Dr. Sayed clears direct exposure, since new scars can darken quickly in strong coastal sun.
Tim Sayed MD, Southern California
Offices
San Diego: 4510 Executive Drive, Suite 210, San Diego, CA 92121. Newport Beach: 3991 MacArthur Boulevard, Suite 320, Newport Beach, CA 92660.
Phone
(858) 247-2933
San Diego area
University City, UTC, La Jolla, La Jolla Shores, Torrey Pines, Del Mar, Carmel Valley, Pacific Beach
Orange County area
Newport Beach, Corona del Mar, Costa Mesa, Irvine, Huntington Beach, Laguna Beach
Bring your implant records, your questions, and whatever is on your mind. Dr. Sayed will examine you, tell you honestly whether en bloc is feasible, show you results from women with tissue like yours, and give you a written plan and quote.
Questions
En bloc capsulectomy is breast implant removal in which the scar-tissue capsule is freed from your tissue and lifted out with the implant still sealed inside it, so the capsule is removed in one closed unit rather than opened around the implant. It is Dr. Sayed's default technique whenever the capsule can be separated safely.
In en bloc removal the capsule comes out sealed with the implant inside it. In a total capsulectomy the entire capsule is still removed, but it is opened around the implant rather than kept closed. Both take out all of the capsule; en bloc keeps the contents contained, which matters most with a possible rupture or a textured implant.
Not always, and a surgeon who promises it in every case is overstating what surgery can do. When the back wall of the capsule is thin and fused to the ribs, removing it intact can risk entering the chest cavity. In those cases Dr. Sayed removes as much as possible en bloc and completes the rest as a total capsulectomy, so the whole capsule still comes out, safely.
Not always. If the implants were modest for the patient's frame, the skin still springs back, and the nipple sits at or above the breast fold, en bloc removal alone often gives a natural result. If the implant has stretched the skin or the nipple has dropped below the fold, a lift in the same operation usually gives a better shape. Dr. Sayed assesses this at consultation and recommends the least surgery that meets your goals.
There is no proof that the sealing technique itself changes symptoms. What patients with BII concerns usually want is complete removal of the implant and the entire capsule, and en bloc is one clean way to achieve that while delivering an intact specimen to pathology. Dr. Sayed focuses on removing all of the capsule and examining it, rather than on the label alone.
For a patient with textured implants, removing the implant and the complete capsule is the surgical approach when BIA-ALCL is diagnosed, and pathology on the fluid and capsule is what confirms the diagnosis. En bloc keeps the specimen intact for that examination. The FDA does not recommend removing textured implants in women without symptoms, so this is a decision to make with your surgeon.
Yes, every time. The capsule and any fluid are sent to a pathologist, who examines the tissue and reports back in about a week. Most reports describe ordinary scar tissue. If anything unexpected is found, Dr. Sayed reviews it with you and arranges the next step.
Usually yes. Dr. Sayed places small drains to keep fluid from collecting in the space where the implant and capsule sat, which helps the tissue heal and lowers the risk of a seroma. They typically come out within the first week or two.
Whenever possible, Dr. Sayed removes the capsule through your original augmentation scar, usually in the fold beneath the breast, so no new scar is added. If a lift is part of the plan, the capsule comes out through the lift incisions. Scars fade over 12 to 18 months with sun protection and scar care.
Most patients are back at desk work in about a week, have their drains out within the first week or two, return to light cardio at about four weeks, and are cleared for full exercise at around six weeks. Swelling continues to settle, and the breast softens into its final shape over three to six months.
For the first few weeks the breasts usually look flat or deflated. Over three to six months, as swelling resolves and the tissue relaxes, they settle toward their size and shape before augmentation. The final look depends on your own breast tissue, your skin quality, and the size of the implants removed. If a lift or fat transfer is part of the plan, it reshapes the breast or restores some fullness.
En bloc capsulectomy commonly runs about $9,000 to $14,000 all in across Southern California, including the surgeon, anesthesia, facility, and pathology. Adding a breast lift commonly brings the total to about $14,000 to $19,000. Financing is available, and insurance may contribute when removal is medically necessary.
Yes. When the skin has stretched or the nipple has dropped, Dr. Sayed performs a breast lift in the same operation and delivers the sealed capsule through the lift incisions, so no extra scar is added. The en bloc dissection is unchanged; the lift reshapes what remains.
He is double board-certified in plastic surgery and general surgery, trained at UCSF and Harvard's Massachusetts General Hospital, and has more than 20 years in practice with breast implant removal at the center of it. He performs en bloc as his default, sends every capsule to pathology, and tells you honestly when intact removal is not the safe choice.
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