Breast implants, whether placed for cosmetic enhancement or reconstructive purposes, are not permanent devices. The procedure to remove them is formally known as explantation, and it is a common surgical option for many individuals. Explantation involves removing the saline or silicone implant from the breast pocket, often performed in an outpatient setting. This process addresses the physical presence of the implant for those who no longer wish to have them. The decision to pursue explantation is highly personal and can be driven by a variety of medical and aesthetic factors.
Primary Indications for Removal
The reasons for choosing explantation generally fall into two distinct categories: medical necessity due to complications or a personal desire for change. One of the most common medical complications is capsular contracture, where the body’s natural formation of a fibrous scar tissue capsule around the implant tightens and hardens. This can lead to pain, discomfort, and a visible distortion of the breast shape, often necessitating removal of both the implant and the surrounding hardened tissue.
Implant rupture or leakage is another clear medical indication for explantation, as a breach in the shell can release either saline solution or silicone gel into the surrounding tissue. A more serious, though rare, concern is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a cancer of the immune system that forms within the fluid or capsule around the implant, primarily associated with textured implants. Treatment for BIA-ALCL requires the removal of the implant and the entire capsule.
Many patients also seek explantation for non-medical reasons, such as a desire to return to a more natural size or shape, or dissatisfaction with the long-term aesthetic results. A growing number of individuals report a constellation of non-specific symptoms, including fatigue, joint pain, and cognitive issues, often referred to as Breast Implant Illness (BII). While BII is not yet a formally recognized medical diagnosis, many patients report significant symptom improvement following implant removal.
Surgical Techniques for Explantation
The explantation procedure involves several surgical approaches, determined by the patient’s specific anatomy and the reason for removal. The simplest method is a straight implant removal, sometimes called a simple explantation, where the surgeon accesses the implant pocket and removes only the device itself. This technique is typically reserved for uncomplicated cases where the surrounding scar tissue capsule is thin and soft.
In most explantation cases, particularly those involving capsular contracture, rupture, or BII symptoms, a capsulectomy is also performed. This is the removal of the fibrous capsule that naturally forms around the implant. A capsulectomy can be performed as a total capsulectomy, meaning the entire capsule is removed, though often in multiple pieces.
The most complex approach is an en bloc capsulectomy, a technique where the implant and the surrounding capsule are removed together as a single, intact unit. This is the preferred method when treating BIA-ALCL or a ruptured silicone implant to minimize the potential for cancer cells or silicone to be left behind. The incision for explantation is usually placed in the same location as the original augmentation incision, such as the inframammary fold or around the areola. Depending on the complexity and whether a capsulectomy is needed, the procedure can range from 1.5 to 3 hours under general anesthesia.
Post-Explantation Recovery and Aesthetic Results
Following the explantation procedure, patients typically experience some swelling and bruising, with initial recovery involving limited arm movement and discomfort for the first few days. Many patients can return to light, desk-based work within one to two weeks, though strenuous exercise is usually restricted for four to six weeks. Surgical drains may be temporarily placed to manage fluid buildup in the breast pocket, though this depends on the extent of the surgery performed.
A primary concern for patients is the aesthetic outcome, as the removal of the implant results in an immediate loss of volume and potential skin laxity. The breasts may appear deflated, flattened, or have an increased degree of ptosis, or sagging, which is more pronounced with larger original implants or poorer skin elasticity.
To address these aesthetic changes, explantation is often combined with a secondary procedure. A mastopexy, or breast lift, removes excess skin and reshapes the remaining breast tissue. Another technique to restore volume and contour is fat grafting, which involves harvesting a patient’s own fat cells from areas like the abdomen or thighs and injecting them into the breast. Fat transfer provides a softer, more natural feel and is often combined with a mastopexy. Patients can typically expect 60 to 80% of the transferred fat to survive long-term, and some may choose a second fat grafting session to achieve additional volume.