Breast Implant Removal (Explant): What to Expect

At a glance

| Question | Short answer | |---|---| | What is explant surgery? | Removing breast implants, with or without part or all of the capsule (scar tissue) around them | | Do implants last forever? | No. The FDA says they aren't lifetime devices; ASPS says they're usually exchanged or removed about every 10 to 15 years | | Is the capsule always removed? | No. ASPS says a soft capsule often doesn't need removal; your surgeon decides based on your case | | How long is surgery? | About 30 minutes to 2.5 hours (ISAPS) | | Anesthesia? | General anesthesia or IV sedation (ASPS); ISAPS also lists local with sedation | | Back to work? | Within 1 to 2 weeks for most people (ISAPS) | | Exercise? | After 6 to 8 weeks (ISAPS), as your surgeon allows | | Final results? | Healing can take up to a year (ASPS) | | Should I remove implants without symptoms because of BIA-ALCL? | The FDA doesn't recommend removal in patients without symptoms |

Why people have implants removed

ASPS lists these common reasons and candidates:

- **Capsular contracture**, when the scar tissue around an implant hardens and tightens - **Pain** or discomfort from the implants - **A leak or rupture** found on imaging. Silicone implant ruptures are often "silent," with no symptoms; FDA says MRI is the most effective way to detect one, and ultrasound is an acceptable alternative for screening when you have no symptoms - **Implants that feel too heavy**, or changes in how they look - **Simply no longer wanting implants**

The FDA lists capsular contracture, reoperation and implant removal among the most common local complications of breast implants.

**Good candidates**, per ASPS, are generally healthy, at a stable weight, don't smoke and have realistic expectations about how the breasts will look afterward.

Your surgical options

**1. Implant removal only.** The surgeon takes out the implant and leaves the capsule. The FDA says this needs less dissection and may carry less risk of bleeding and damage to surrounding tissue.

**2. Partial or total capsulectomy.** The surgeon removes part or all of the capsule along with the implant. ASPS says the capsule is often soft and doesn't need to come out, but it can harden and cause pain, which is a common reason to remove both the implants and the scar tissue. The surgeon may also remove silicone that has leaked from an implant.

**3. En bloc removal.** The implant and the capsule are removed together as one piece. The FDA describes this as removal of the implant and the entire capsule ("en-bloc resection"). It is a more extensive operation.

**4. Removal plus another procedure.** ISAPS says implant removal may be combined with a capsulectomy, a breast lift (mastopexy), fat transfer or new implants.

Which option fits depends on why you're having surgery, the condition of the capsule and what you want the breasts to look like afterward. Ask your surgeon to explain why they recommend one approach over another.

BIA-ALCL and breast implant illness

**BIA-ALCL** (breast implant-associated anaplastic large cell lymphoma) isn't breast cancer; it's a type of non-Hodgkin lymphoma, found in most cases in the scar tissue and fluid near the implant, though in some cases it can spread through the body. The FDA says the risk is higher with textured implants, and symptoms such as persistent swelling, a mass or pain often appear years after surgery. For a confirmed diagnosis, the FDA says treatment involves removing the implant and the surrounding capsule, a more extensive surgery. **The FDA doesn't recommend removing implants in people without symptoms** because of BIA-ALCL. The FDA also notes reports, in the scientific literature and in medical device reports, of squamous cell carcinoma and other lymphomas in the scar tissue around implants.

**Breast implant illness (BII)** is a term some patients use for symptoms such as fatigue, "brain fog," joint and muscle pain, hair loss, anxiety and depression. The FDA says BII isn't a formal diagnosis and there are no specific tests for it. Some patients report their symptoms improved after removal, but the FDA says the cause of these symptoms isn't clear. Talk through your symptoms and expectations with your surgeon and your other doctors before deciding.

Keep a record of your implant's manufacturer and model (your patient device card or operative notes). The FDA says this information helps if questions come up later.

Before surgery

ASPS says your surgeon may ask you to:

- Get lab tests or a medical evaluation - Take or adjust certain medications - Quit smoking - Avoid aspirin, anti-inflammatory drugs and herbal supplements that can increase bleeding

Surgery is done in a hospital or a licensed ambulatory surgical facility. Arrange for someone to drive you home and stay with you the first night.

The procedure

ASPS says the surgeon places an incision along the lower fold of the breast (the inframammary fold) or around or below the areola. After removing the implant and any capsule, often using a combination of techniques, the surgeon closes the incision with sutures, skin adhesives, tapes or clips.

Recovery

- **First days:** you'll have dressings, possibly small drains, and a support bra or compression garment (ASPS). - **Work:** ISAPS says most people return within 1 to 2 weeks. - **Exercise:** ISAPS says after 6 to 8 weeks; follow your surgeon's timeline. - **Swelling and shape:** initial healing takes several weeks, and final results can take up to a year (ASPS). - **Get urgent care** for shortness of breath, chest pain or an unusual heartbeat (ASPS).

What results look like

After removal without replacement, the FDA says you may have dimpling, puckering, sagging or a concave chest wall, and large implants or implants placed above the muscle may leave a bigger cosmetic change. ASPS says the breasts may look flatter or droopier, with irregularities or indentations. A lift or fat transfer can address some of this, at the same time or later. ASPS also notes that another surgery may be needed and that, rarely, a mastectomy may be needed when free silicone has spread through the breast tissue.

Some insurers don't cover removal, even when it's done for a complication (FDA). Check your coverage before surgery.

Risks

ASPS lists the risks of implant removal, including:

- Anesthesia risks, bleeding (hematoma) and infection - Fluid buildup (seroma) and fat necrosis - Changes in nipple or skin sensation - Asymmetry, loose skin, scarring, discoloration and swelling - Poor healing, persistent pain or skin loss - Blood clots (deep vein thrombosis) and heart or lung complications - An unsatisfactory result or the need for revision

See also What Are the Risks of Plastic Surgery?

Questions to ask your surgeon

- Are you certified by the American Board of Plastic Surgery? (What is board certification?) - Do you recommend removing the capsule in my case, and why? - Will you send the capsule or any fluid for testing? - What will my breasts likely look like without implants? Should I consider a lift or fat transfer? - Where will the surgery be done, and what anesthesia will you use? - How long until I can go back to work and exercise? - What happens if I'm unhappy with the result?

More: What Questions Should You Ask a Plastic Surgeon?