Breast Implant Removal (Explant Surgery)
Breast implant removal — or explant surgery — is surgery to take out silicone or saline implants. Implants can be a good option for many women, but in some cases you may decide to have implants removed because:
you aren’t happy with how the breast implants look or feel
you’ve had corrective surgeries but still have issues with the implants
you’ve decided that you would rather not have breast implants
it’s medically necessary to remove the breast implants
Reasons for breast implant removal
Some people never get used to the sensation of having breast implants. Breast implants can feel cold. The skin over the implant also can look wrinkled. Other people simply decide they no longer want breast implants, and may prefer to try:
flap reconstruction after implant removal
Complications that commonly come up as reasons for breast implant removal include:
Dynamic distortion (also called animation deformity): When the implant has been placed under the chest (pectoralis) muscle, it can move in unnatural-looking ways when you flex your chest muscle. It may pop upward or outward or shift out of place.
Capsular contracture: Because the body sees the implants as foreign objects, it forms a layer of scar tissue around them — also called a capsule. Sometimes this tissue can harden, causing pain and a distorted appearance.
Pain and limited range of motion: Some people have back, shoulder, and chest pain with implants.
Implant displacement: Over time, implants can shift out of place, either moving apart from each other or so close together that they distort your cleavage (a condition called symmastia).
Frequent infections: Bacterial infections can develop inside the scar capsule around the breast implants.
Implant rupture: Implants can rupture and leak over time as they get older. Implants can also rupture if there is a traumatic injury to the chest.
Implant extrusion: Sometimes implants can push through the skin that covers them.
Learn more about breast implant risks and complications.
There are also rare but serious complications that may make explant surgery medically necessary:
Being diagnosed with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare type of T-cell lymphoma (cancer of the immune system) that can develop in the scar tissue capsule and fluid surrounding a breast implant. In some cases, it can spread throughout the body. BIA-ALCL has been linked with textured implants and, in July 2019, led to a global recall of Biocell textured breast implants and tissue expanders manufactured by Allergan.
Developing breast implant illness (BII), a term that refers to a wide range of symptoms that can develop after having reconstruction with breast implants. Symptoms include joint and muscle pain, breathing problems, rashes, and sleep disturbances. BII is also sometimes referred to as autoimmune/inflammatory syndrome induced by adjuvants (ASIA). People with any type of breast implant can develop BII.
An increased risk of certain autoimmune disorders, which means the body’s immune system starts attacking healthy tissues. Research has linked silicone implants to Sjögren’s syndrome (common symptoms include dry eyes and dry mouth), scleroderma (the skin and connective tissues become hard and tighten), and rheumatoid arthritis (swelling and inflammation in the joints).
Research has also found a link between silicone implants and a higher-than-average risk of melanoma (a serious form of skin cancer) and stillbirth. 1
The U.S. Food and Drug Administration (FDA) has received reports of squamous cell carcinoma and various lymphomas, unrelated to BIA-ALCL, that have developed in the capsule around breast implants. Although instances are currently considered rare, the FDA is letting healthcare providers and people who have or are considering breast implants know. 2
For more information about BIA-ALCL and BII, read our Special Report: Breast Implant Illness and BIA-ALCL.
Breast Implant Illness: What Do We Know Right Now?
Sep 17, 2019What to expect with breast implant removal
Breast implant removal requires general anesthesia and can take anywhere from one to three hours, depending on your situation and whether you are having one or two implants removed. The surgery can take longer if you’re having aesthetic flat closure or flap reconstruction immediately afterward.
Before breast implant removal surgery, your surgeon may recommend imaging studies of the implant, such as MRI or ultrasound, to check for a rupture or evidence of illnesses such as BIA-ALCL.
In addition to removing breast implants, explant surgery involves additional procedures to remove the layer of scar tissue around the implant, also known as the capsule, and any allograft material, a soft tissue substitute that often holds an implant in place.
Capsulectomy is a surgical procedure that removes scar tissue surrounding a breast implant.
Experts recommend two types of capsule removal surgery for anyone having explant surgery.
Total capsulectomy: During a total capsulectomy, the plastic surgeon usually removes the breast implant first and then removes the capsule in pieces. Sometimes it’s necessary for the surgeon to peel pieces of the capsule from the chest wall and surrounding tissues.
En bloc capsulectomy: During an en bloc capsulectomy, the plastic surgeon makes an incision under the breast and removes the breast implant and the capsule in one piece (en bloc means as a whole).
En bloc capsulectomy may make sense for the following reasons:
If a silicone implant has ruptured, en bloc capsulectomy prevents any silicone from leaking into the surrounding tissues. Without breast imaging, it can be difficult to tell if silicone implants have leaked since the gel leaks out slowly. Surgeons sometimes find evidence of a leak during breast implant removal surgery.
If there is mold, bacteria, or fungus — also known as biofilm — growing between the breast implant and the capsule, en bloc capsulectomy prevents the biofilm from contaminating the surrounding tissues.
You have been diagnosed with or suspect you may have BIA-ALCL, or you have textured implants associated with BIA-ALCL risk.
You have symptoms of BII or have an autoimmune disease that you suspect may be related to your implants — although in these cases, a total capsulectomy can also be a good option.
Having an en bloc capsulectomy may not be possible if the scar capsule around the implant is extremely thin or stuck to the chest wall and ribs. Surgeons can’t guarantee being able to perform an en bloc capsulectomy until they begin the breast implant removal surgery. When you talk to your plastic surgeon before surgery, make sure you both agree on the surgical plan if an en bloc capsulectomy isn’t possible for you.
There is also a procedure called a partial capsulectomy. As its name suggests, a partial capsulectomy loosens and removes just some of the scar tissue around a breast implant. A plastic surgeon might remove only part of the capsule as a strategy for improving capsular contracture and leave the breast implant in place.
Most experts agree that, if you’re having explant surgery, it’s best to remove all of the scar tissue using a total capsulectomy or an en bloc capsulectomy. It’s important to know that if you’re having your implants removed because of pain or distortion (and not because of a rupture or symptoms of illness), you can still ask for an en bloc capsulectomy.
Also, even if they’re planning on a total or en bloc capsulectomy, sometimes surgeons leave a small amount of the capsule behind if:
a portion of the scar tissue is stuck to the chest wall and ribs and removing it would risk making a hole in the chest wall, which can cause the lung on the same side to collapse
the scar tissue appears flexible and healthy and there are no signs of inflammation, infection, BIA-ALCL, or BII and you have plans to have flap reconstruction (a surgeon can use the remaining portion of the capsule to support the reconstructed breast)
Your plastic surgeon should work with you to make sure you get the type of capsule removal procedure that makes the most sense for your situation. Your individual situation and overall health are important factors in choosing the right procedure for you.
Your surgeon may have to reposition or repair the chest muscle during breast implant removal surgery, especially if the implant was inserted beneath the chest muscle. Surgeons typically have to surgically reattach the chest muscle to the chest wall using dissolvable stitches.
Plastic surgeons usually send the capsule, any additional tissue or fluid they remove, and any chest cavity swabs to a lab for pathology and culture testing. Tests look for cancer and any abnormal cells, as well as any bacteria, fungus, inflammatory cells, and foreign materials, such as silicone and polyurethane. You can talk to your surgeon to confirm whether this testing is going to be done.
Any fluids should be tested for CD30, a protein found in higher-than-normal amounts on lymphoma cells, particularly in BIA-ALCL. If the CD30 test is positive, the tissue is also usually tested for anaplastic lymphoma kinase (ALK) — a protein that helps control cell growth. It’s important to know that lymphoma cells related to BIA-ALCL do not make the ALK protein and test negative for that protein.
Your health insurance plan might not cover these tests. Your surgeon might still recommend them if you have symptoms of BIA-ALCL or BII, or if the surgeon is concerned about the implant and capsule. Of course, you can request testing for your own peace of mind.
Many surgeons take photos of the implant and capsule to show you whether you had an en bloc capsulectomy or a total capsulectomy. You can ask the surgeon to return the implant to you. In some cases, surgeons store the implant securely, but this is not standard practice.
Depending on your situation, your surgeon may recommend taking antibiotics after explant surgery.
Breast implant removal recovery
Generally, recovery from explant surgery is similar to recovery from mastectomy. Recovery time can last from two to six weeks or longer, depending on whether your surgeon removed one or two implants, and whether you had aesthetic flat closure or flap reconstruction immediately afterward.
It’s important to follow your plastic surgeon’s instructions for recovery after surgery:
how to keep your incisions clean
what medicines you need to take
what activities you need to avoid and for how long
when to schedule a follow-up appointment with your plastic surgeon
Your surgeon may place drains underneath your skin to drain excess fluid or blood, which can come out after a few days. Some surgeons recommend wearing a supportive bra during the first few weeks after your breast implant removal surgery. Ask your surgical team what they recommend for you.
Many women decide to have aesthetic flat closure or flap breast reconstruction done at the same time as explant surgery. Your plastic surgeon can help you determine the best timing for these procedures.
Risks and complications of breast implant removal
Your plastic surgeon should explain the risks and possible complications of breast implant removal surgery. The most common complications include:
seroma, a buildup of fluid under the skin
hematoma, or bruising as a result of blood pooling under the skin
wound-healing issues for those who’ve had radiation to the area
a collapsed lung, also called a pneumothorax
changes in the contour or appearance of the skin over the breast after explant surgery
Does health insurance cover breast implant removal?
According to the most recent statistics from the American Society of Plastic Surgeons, the average cost of breast implant removal is several thousand dollars.
The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires all group health plans that pay for mastectomy to also cover reconstructive procedures. This means that breast implant removal surgery and whatever you choose next — such as flat closure or flap reconstruction — should be covered, as long as the initial mastectomy is deemed medically necessary. However, it’s important to work with your plastic surgery practice to make sure your health insurance plan understands that your current surgeries are medically necessary and not just cosmetic.
Health insurance companies often do not recognize BII and breast implant-related autoimmune diseases as true diagnoses. When communicating with health insurance companies, you and your surgeon should focus on the functional issues you are having with your implants (capsular contracture, pain, limited range of motion, or asymmetry).
Finding a plastic surgeon with breast implant removal experience
It’s important to find a plastic surgeon:
with experience performing breast implant removal surgery — preferably in people who’ve had breast reconstruction with implants
who listens to your needs, answers all your questions, and takes all your concerns seriously
who explains the breast implant removal procedure to you, and discusses the surgery’s benefits, risks, and possible complications
who is willing to put your specific wishes in writing as part of your surgical consent form
If you need help finding a plastic surgeon, the following resources may be useful:
American Society of Plastic Surgeons (ASPS): The ASPS has a directory of plastic surgeons that you can search by procedure and location.
Breast Implant Illness: This informational website offers a list of breast implant removal surgeons in many countries worldwide.
Healing Breast Implant Illness: This organization has compiled a list of breast implant removal surgeons in the United States, Canada, and several other countries, based on recommendations from people who participate in its Facebook group of more than 135,000 members.
Not Putting on a Shirt: This flat advocacy organization has an international directory of flat-friendly surgeons who offer both breast implant removal surgery and aesthetic flat closure (for those who prefer to go flat).
It makes sense to schedule initial consultations with a few plastic surgeons you’re considering so you can ask each of them any questions you may have. Some people find it helpful to take the surgical report from their implant reconstruction surgery, as well as reports from any corrective surgeries they may have had.
Here are some questions you may want to ask plastic surgeons during initial consultations:
How many breast implant removal surgical procedures do you perform in a month? Do these include explants after breast implant reconstruction and not just after cosmetic surgery (breast augmentation)?
Do you have experience performing en bloc capsulectomies? What about total capsulectomies?
In what situations would you not be able to remove all of the capsule scar tissue?
Do you usually send the breast implants and other tissue you remove to pathology? What tests do you typically order? Can I get the full pathology report of any findings?
Do you typically return breast implants to your patients?
Do you take photos of the implants, capsules, and chest cavity after performing breast implant removal surgery? Can I see those photos?
What do you do when you need to repair a patient’s chest (pectoralis) muscle? How much longer is the surgery? Is there a way to know before breast implant removal surgery if my chest muscle needs to be repaired?
Do you expect to encounter any special challenges in my case, and if so, how do you plan to manage them?
How many of your patients have chosen breast implant removal surgery because of BII or autoimmune conditions linked to breast implants? Have their symptoms improved after breast implant removal?
Can I speak with any of your patients who’ve had breast implant removal surgery?
Are you able to perform flat closure or flap reconstruction at the same time as breast implant removal surgery? Would you recommend this for my situation?
Do you have any before-and-after photos of your patients who’ve had breast implant removal surgery followed by flat closure or flap reconstruction?
1. Coroneos C J, Selber J C, Offodile II A C, et all. US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 Patients. Annals of Surgery. 2019. 269(1):30-36. Available at: https://doi.org/10.1097/sla.0000000000002990
2. U.S. Food and Drug Administration. Breast Implants: Reports of Squamous Cell Carcinoma and Various Lymphomas in Capsule Around Implants: FDA Safety Communication. Available at: https://www.fda.gov/medical-devices/safety-communications/breast-implants-reports-squamous-cell-carcinoma-and-various-lymphomas-capsule-around-implants-fda
This information made possible in part through the generous support of www.BreastCenter.com.
— Last updated on January 17, 2025 at 6:01 PM