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En Bloc Capsulectomy, La Jolla and San Diego
Maybe you have already decided: you want everything out, the implant and the whole scar-tissue capsule around it, removed together in one sealed piece. That approach has a name, en bloc capsulectomy, and for Dr. Tim Sayed it is the standard, not an add-on. A double board-certified plastic surgeon in San Diego, he has built his practice around removing implants. This page explains what en bloc means for you, when it fits and when it does not, and how he performs it at his University City office, a few minutes from La Jolla.
En bloc
Your implant and capsule out as one sealed unit
2
Board certifications
20+
Years in practice
4.6
Google rating
At a glance
En bloc is not a separate surgery. It is your implant removal, done thoroughly. The term describes one thing: what happens to your capsule, the shell of scar tissue your body built around the implant. Done this way, Dr. Sayed frees that capsule from your own tissue with the implant still sealed inside, and the two come out together as one closed specimen. It matters most in three situations: an implant that may have quietly ruptured, a textured implant tied to a small cancer risk, or simply wanting to be sure nothing was left behind.
What it is
A same-day surgery that lifts your capsule out with the implant still sealed inside it, instead of cutting the capsule open around the implant first.
En bloc vs. total
Both take out your whole capsule. The difference is that en bloc keeps it closed on the way out, while a total capsulectomy opens it around the implant. If a rupture or a textured implant is in play, keeping it sealed matters.
Is it for you
You are a likely candidate if you have a ruptured or textured implant, symptoms you link to your implants, or a hard, contracted capsule. Dr. Sayed uses en bloc whenever your capsule can be freed safely.
Pathology
Your capsule and any fluid go to pathology after surgery, so a pathologist can check for abnormal cells, including BIA-ALCL. You get the report back about a week later.
Cost and recovery
Usually about $9,000 to $14,000 all in, more if you add a lift or fat transfer. Back at a desk in roughly a week, drains out within a week or two, full workouts at around six weeks.
Your surgeon
Tim Sayed MD, MBA, FACS, double board-certified, seeing patients at 4510 Executive Drive in University City, minutes from La Jolla.
Why en bloc
Most women who come to Dr. Sayed in San Diego asking for en bloc are in one of the situations below. In each, keeping the capsule sealed as it comes out answers a real medical concern, not a sales pitch.
You may never feel a silicone implant rupture. The gel can work its way into the capsule with nothing showing on the surface. When the implant and capsule come out together as one closed piece, that loose gel has no chance to reach your breast tissue during surgery.
Once your capsule has thickened and tightened, it is already a firm, defined layer you can feel. That often makes it easier to remove en bloc, and taking it out removes the very tissue that was squeezing and distorting your breast.
If you are dealing with fatigue, aching joints, brain fog, or skin changes and suspect your implants, you probably want every trace of them gone. En bloc does that, and your capsule still goes to pathology to be examined.
If your implants are textured, including the recalled Allergan Biocell line, they carry a small but real link to BIA-ALCL, a lymphoma that develops in the fluid or scar capsule around the implant. Removing that capsule intact and sending it to pathology is the careful choice.
Sometimes the reason is simply certainty. You want to know your implant and your entire capsule left your body in one piece. When your anatomy allows it safely, en bloc gives you exactly that.
If your capsule has calcified over the years, or you have had revisions and scarring, taking it as a sealed unit helps keep fragments from being left in the pocket. Dr. Sayed maps these cases out carefully before you ever reach the operating room.
That first question tells you the most. The surgeon you want removes the capsule intact wherever it is safe and says plainly where it is not. Dr. Sayed will go through each of these points with you at your consultation.
The technique
En bloc is not always possible, and that is no one's failing. If the back wall of the capsule has worn thin and fused to your ribs, taking it off whole risks opening the chest. If that is your anatomy, the right move is to remove as much as en bloc allows and finish the rest as a total capsulectomy. Your whole capsule still comes out; it simply does not come out sealed. Safety always comes before a tidy specimen.
Before you choose anyone, get clear on what will happen to your capsule, because the terms blur together constantly. En bloc capsulectomy frees the capsule from your tissue with the implant still sealed inside, and nothing opens in the pocket. A total capsulectomy also removes the whole capsule, but opens it around the implant. A partial capsulectomy leaves some capsule behind against the chest wall. The table below lays the three side by side and shows where 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 |
So why does keeping it sealed matter to you? A silicone implant from years ago may have ruptured with no warning. The capsule can hold biofilm, calcium deposits, or bits of gel. Take it out closed and none of that spreads into your tissue during surgery, and pathology receives one clean piece. That is the real reason, said plainly, without pretending any single approach can promise you everything.
Breast implant illness and BIA-ALCL
Pathology is easy to overlook, but it is one of the best reasons to remove the capsule in one piece. Once your surgery is done, Dr. Sayed sends the capsule, and any fluid with it, to a pathologist. Your results come back in about a week, and most of the time they show ordinary scar tissue. The value is that your tissue is actually examined, not thrown away.
BIA-ALCL is a separate concern. The full name, breast implant-associated anaplastic large cell lymphoma, is an uncommon but real cancer of the immune system. It develops in the fluid or scar tissue around certain textured implants. Found early, it responds very well to treatment, which is usually surgery to remove the implant and the whole capsule. Testing the fluid and capsule tissue is how it is diagnosed. The FDA tracks these cases and keeps current guidance on textured implants and this lymphoma.
This is where en bloc and pathology work together. Remove the capsule as one sealed piece, send that whole specimen in, and the pathologist gets the complete capsule, with any fluid held in until it can be tested. Dr. Sayed goes over your results with you at a follow-up visit and explains them in plain language. The reassuring part: for almost everyone, the report comes back normal.
The procedure
Your surgery is done under general anesthesia in an accredited San Diego facility and takes roughly two to three hours, longer if you are adding a lift or fat grafting. Dr. Sayed performs every stage himself, and you finalize your plan together before surgery day, so nothing is left to decide once you are asleep.
01
Dr. Sayed goes through your implant records, any imaging, and your reasons for removal, examines your tissue, and tells you plainly whether en bloc is likely to work for you and what your breast will look like afterward.
02
Whenever he can, he reuses your original scar in the breast fold. If you are having a lift, your capsule comes out through the lift incisions, so no extra scar is added for the capsulectomy itself.
03
With your implant still sealed inside, your capsule is separated from your breast tissue, your muscle, and your chest wall as one unit. If the back wall is fused to your ribs, Dr. Sayed stops short of the chest cavity and finishes that part as a total capsulectomy. Safety first, every time.
04
Your intact specimen is photographed for your records and sent to pathology. You get 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 chest muscle where it helps, performs your lift, or grafts fat from your abdomen or flanks into the upper breast to bring back softness and shape.
06
Small drains go in to stop fluid from pooling where your implant and capsule used to sit, and they usually come out within a week or two. You go home in a surgical bra with a written recovery plan and Dr. Sayed's own follow-up schedule.
This is a real operation under general anesthesia, and it carries what any breast surgery does: bleeding, infection, a fluid collection such as a seroma or hematoma, changes in how your nipple or breast feels, visible scars, some unevenness, and the usual risks of anesthesia. Because the dissection works right against your chest wall, there is also a small chance of entering the chest. That is exactly why Dr. Sayed switches to a total capsulectomy rather than force a one-piece removal where the capsule has fused to the ribs.
Most of these are uncommon and treatable, and your consultation covers each one in plain terms, along with how your own health history shifts the picture. Your results, and how much any symptom eases, vary from person to person, and Dr. Sayed will not promise you an outcome he cannot predict.
Your surgery is usually put off if you are pregnant or breastfeeding, in the middle of a major weight change, or using nicotine and unable to stop for several weeks before and after. En bloc is also not always the right technique for you: if your capsule is thin and healthy and a new implant is going straight back in, a less extensive capsulectomy may serve you better.
If you want to keep implants but fix a problem like contracture or malposition, you may be better served by breast augmentation revision, and Dr. Sayed will tell you so honestly rather than talk you into a full capsulectomy.
Your options after removal
You do not have to decide any of this before you arrive, or by yourself. Dr. Sayed will show you what each path has looked like on women whose tissue is like yours, and point you toward the lightest option that gets you where you want to be.
Removing the capsule is only half of your plan. The other half is how your breast looks once the implant volume is gone, which depends on how much of your own tissue is left, how far the implant stretched your skin, and where your nipple sits now. En bloc works with every option below, and the capsule comes out sealed in all of them. For more on that decision, see breast implant removal and BII treatment in La Jolla. Here is how each option works with en bloc.
Read Dr. Sayed's guide to adding a lift or fat grafting
This is the simplest path, and it is the right one more often than you would guess. It works when your implants were modest for your frame, your skin still springs back when you pinch it, and your nipple sits at or above the fold. The capsule comes out sealed, nothing is added, and the only scar you keep is the one you already have.
Your recovery is the shortest of the three, and your breast settles over three to six months back toward its pre-implant size. The trade-off is patience, since the first few weeks look deflated before your tissue relaxes.
If you have larger implants, you might decide later that you want a lift after all. You can have that done as a second stage once your tissue has settled, which also gives your skin time to recover before any lift is designed.
If an implant has stretched your skin or dropped your nipple below the fold, removing the volume alone leaves loose skin with nowhere to go. A breast lift takes up that slack and raises the nipple in the same operation, and the capsule comes out through the lift incisions, so you get no extra scar.
Dr. Sayed picks the lightest lift that will do the job for you: a periareolar lift for small adjustments, a lollipop or anchor lift when more skin has to come out. Your en bloc dissection does not change; the lift simply reshapes what is left.
It adds about an hour in surgery, a slightly longer recovery, and scars that fade over 12 to 18 months. If you have larger or long-standing implants, it is often the difference between a deflated look and a natural one.
Fat transfer is for you if you are done with implants but miss the softness at the top of your breast. Dr. Sayed takes fat from your belly, flanks, or thighs with gentle liposuction, purifies it, and places it into the upper breast once the sealed capsule is out.
Some of that grafted fat settles in and stays, usually enough for a modest, natural gain in fullness, and your donor area gets a little contouring as a bonus.
Fat transfer will not replace a large implant volume for volume, you need enough donor fat to work with, and it is sometimes staged a few months after your removal so the graft goes into healed tissue with a good blood supply.
Where your nipple sits. At or above your fold points to en bloc alone; below it points to a lift. This one measurement decides more than anything else.
Your skin quality. A pinch test and a look at any stretch marks tell him how much your envelope will tighten on its own over six months.
Your tissue versus your implant. A 200 cc implant on a woman with a full B cup of her own tissue behaves nothing like a 500 cc implant on a small frame.
Your capsule and implant condition. A thick, calcified capsule or a ruptured implant can leave contour dips that fat grafting smooths better than a lift on its own.
What matters to you. How you feel about scars, a second stage, donor-site liposuction, and your budget all shape the plan. None of it is decided for you.
Case studies
Dr. Sayed photographs and documents his en bloc cases so you can see what removal looks like on real bodies, not drawings. The galleries below are sorted by the plan each patient chose, and every woman shown had her capsule removed and sent to pathology.
Gallery 01
This is the biggest group in the gallery. These are women whose implants had stretched the skin or dropped the nipple, treated with sealed capsule removal and a lift through the same incisions. Look at how the lifted breast sits higher and rounder with no implant in place.
Gallery 02
These are smaller implants with good skin elasticity and nothing added. The cases answer the question Dr. Sayed hears most: 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 a little nipple repositioning and would rather keep scarring to the areola border, with sealed capsule removal and the lift done in a single surgery.
Results differ from one patient to the next, and every photo is shared with consent. At your visit, ask to see cases that match your implant size, your tissue, and your goals.
Cost
When you compare quotes, ask three things: is the capsule included, does it come out sealed, and does it go to pathology. The answers tell you what a price actually buys you.
In San Diego, en bloc capsulectomy generally comes to about $9,000 to $14,000 all in, covering your surgeon, anesthesia, the accredited facility, pathology, and follow-up. Add a lift or fat transfer and the total usually moves toward $14,000 to $19,000. Treat these as planning ranges; your own number depends on your anatomy and the plan you settle on together.
Keeping your capsule sealed. En bloc or total capsulectomy takes longer and asks more than simply sliding an implant out, and that shows up in surgeon and facility time.
Adding a lift or fat transfer. Each one adds operating time and technical work, and each is quoted as part of one combined fee rather than a separate surgery.
Your implant history. Older ruptured silicone, heavily calcified capsules, and prior revisions all take more time to remove cleanly.
Insurance. If your removal is for a documented rupture, severe contracture, or BIA-ALCL, part of it may be covered. Removal for breast implant illness or a change of mind usually is not. Dr. Sayed's team gives you 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
You can expect to be up and walking the day of your surgery, back at a desk in about a week, and cleared for full workouts at around six weeks. Your drains usually come out within the first week or two. Your breast will look flat at first, then fill back toward its own 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
Your swelling and bruising peak and begin to settle. Take short walks several times a day. Your drains usually come out at your first visit, and many patients are back at a desk by the end of the week.
Weeks 2 to 3
Your daily routine comes back. You can drive once you are off prescription pain medication. Keep wearing your surgical bra, and hold off on lifting, pushing, or chest exercise.
Weeks 4 to 6
You can ease back into light cardio, then full activity and upper-body training once Dr. Sayed confirms you have healed.
Months 3 to 6
Your swelling resolves, your breast softens, and any lift or fat transfer settles into its final shape. This is your result.
Sleeping. On your back with your upper body raised for about three to four weeks. You can sleep on your side once Dr. Sayed clears it.
Drains. These are small tubes that keep fluid from collecting where your implant and capsule used to be. Most patients find them more awkward than painful, and the team shows you how to empty them.
Scars. Dr. Sayed reuses your original incision whenever he can. Your scars fade over 12 to 18 months, and he will guide you on tape, silicone, and sun protection.
Working out. You can walk from day one. Lower-body work comes back around three weeks, full training including chest and shoulders around six.
How your breast looks early. Flat or deflated in the first weeks is normal. Fullness and shape return as swelling fades and your tissue relaxes.
Symptom changes. Many patients who removed implants over BII concerns describe feeling better over weeks to months. Results vary, and Dr. Sayed will not promise you what he cannot predict.
Your surgeon
For Dr. Sayed, Aesthetics Done Right means performing your whole operation himself, being honest with you about where en bloc works and where it does not, and standing by you at every follow-up. This page was medically reviewed by Tim Sayed MD, MBA, FACS. Last updated October 2026.
Tim Sayed MD, MBA, FACS holds certification from two surgical boards, the American Board of Plastic Surgery and the American Board of Surgery, recertified in each. He trained at UCSF and Harvard's Massachusetts General Hospital, and he earned an executive MBA at Northwestern's Kellogg School.
In more than 20 years of practice, removing implants has become the heart of his work. En bloc is his default. He switches to a total capsulectomy only where your chest wall makes a one-piece removal unsafe. Every capsule he removes goes to pathology, and he documents his cases so the results you see are honest.
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 La Jolla and San Diego
You will find Dr. Sayed's San Diego office in University City at 4510 Executive Drive, Suite 210, just off Genesee Avenue by Westfield UTC and only minutes from La Jolla Village, La Jolla Shores, and Torrey Pines. It is an easy drive on I-5 from Del Mar, Carmel Valley, Pacific Beach, Encinitas, or Carlsbad. For the wider regional picture, see en bloc capsulectomy in Southern California, or, if Orange County is closer for you, en bloc capsulectomy in Newport Beach.
The San Diego coast is an easy place to heal. Walking is your best early activity, and La Jolla's flat shoreline paths and mild year-round weather make daily walks easy. The one thing to watch is sun on a fresh scar: keep your incisions covered or shielded until Dr. Sayed clears you for direct exposure, since new scars can darken quickly in strong coastal sun.
Tim Sayed MD, San Diego office
Address
4510 Executive Drive, Suite 210, San Diego, CA 92121
Phone
(858) 247-2933
Nearby
University City, UTC, La Jolla Village, La Jolla Shores, Torrey Pines, Pacific Beach
Also serving
Del Mar, Carmel Valley, Rancho Santa Fe, Encinitas, Carlsbad, and Coronado
Drive times to the office
La Jolla Village
5 min
University City / UTC
4 min
Del Mar
12 min
Carmel Valley
13 min
Carlsbad
35 min
Encinitas
25 min
Bring in your implant paperwork, your questions, and whatever is weighing on you most. Dr. Sayed will examine you, tell you honestly whether a one-piece removal is realistic, show you results from women with tissue like yours, and send you home with a written plan and quote.
Questions
It is implant removal in which your capsule, the scar tissue around the implant, is freed from your own tissue with the implant still sealed inside, so the capsule comes out as one closed piece instead of being opened around the implant. It is Dr. Sayed's default whenever the capsule comes away safely.
With en bloc, the capsule comes out closed with the implant inside it. With a total capsulectomy, the whole capsule still comes out, but it is opened around the implant rather than kept sealed. Both remove all of the capsule. En bloc keeps the contents sealed in, which matters most if you may have a rupture or a textured implant.
No, and anyone promising it in every case is overstating what surgery can do. If the back wall of the capsule is thin and fused to your ribs, removing it whole risks opening the chest. In that case Dr. Sayed removes as much as he can en bloc and finishes the rest as a total capsulectomy, so your whole capsule still comes out, safely.
Not always. If your implants were modest for your frame, your skin still springs back, and your nipple sits at or above the breast fold, en bloc removal alone often gives you a natural result. If the implant has stretched your skin or your nipple has dropped below the fold, a lift in the same operation usually gives a better shape. Dr. Sayed assesses this at your consultation and recommends the least surgery that meets your goals.
There is no evidence that the sealing step by itself changes symptoms. If you are worried about BII, what you most likely want is complete removal of the implant and the entire capsule, and en bloc is one clean way to get there while giving pathology a whole specimen. Dr. Sayed focuses on removing all of the capsule and examining it, not on the label.
If your implants are textured, removing the implant and the whole capsule is the surgical treatment once BIA-ALCL is diagnosed, and pathology on the fluid and capsule is what confirms the diagnosis. En bloc keeps that specimen whole for examination. The FDA does not call for removing textured implants when you have no symptoms, so this is a decision to make with your surgeon.
Yes, every time. Your capsule and any fluid go to a pathologist, the tissue is examined, and your report comes back in about a week. For most people, it shows ordinary scar tissue. If anything unexpected shows up, Dr. Sayed goes over it with you and sets up your next step.
Usually, yes. Dr. Sayed places small drains to keep fluid from collecting in the space where your implant and capsule used to sit, which helps your tissue heal and lowers your risk of a seroma. They typically come out within the first week or two.
Wherever he can, Dr. Sayed removes your capsule through your original augmentation scar, usually the one in the fold under your breast, so you are not given a new one. If a lift is part of your plan, the capsule comes out through the lift incisions. Your 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 your breasts will usually look flat or deflated. Over three to six months, as swelling resolves and your tissue relaxes, they settle toward their size and shape before augmentation. How they look in the end 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 your plan, it reshapes the breast or restores some fullness.
In San Diego, en bloc capsulectomy comes to about $9,000 to $14,000 all in, covering your surgeon, anesthesia, facility, and pathology. Add a breast lift and the total usually reaches roughly $14,000 to $19,000. Financing is available, and insurance may contribute where your removal is medically necessary.
Yes. If your skin has stretched or your nipple has dropped, Dr. Sayed performs your breast lift in the same operation and delivers your sealed capsule through the lift incisions, so you get no extra scar. Your en bloc dissection stays the same; the lift reshapes what is left.
He is board-certified in both plastic surgery and general surgery, trained at UCSF and Harvard's Massachusetts General Hospital, with more than 20 years in practice and implant removal at the center of it. En bloc is his default, every capsule goes to pathology, and he will tell you honestly where a one-piece removal is not the safe choice.
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