Explant surgery is the procedure to remove breast implants previously placed for augmentation or reconstruction. The decision to undergo this surgery is often driven by aesthetic changes, personal choice, or medical concerns such as implant rupture or capsular contracture. While the procedure is clearly defined, the financial commitment is highly variable, making the final cost a complex figure to determine. This article will break down the components of the explant cost, examine the variables that cause the price to fluctuate, and explore how insurance coverage may affect the patient’s out-of-pocket expense.
Understanding the Typical Explant Cost Range
The out-of-pocket price for explant surgery, excluding any concurrent breast lifts, typically falls between $5,500 and $14,000, depending heavily on the complexity of the removal. This range is a combination of three primary components that constitute the initial bill. The largest portion is the surgeon’s fee, which can average between $3,000 and $10,000, covering their time, expertise, and pre- and post-operative care.
The second expense is the anesthesia fee, which typically ranges from $800 to $2,000 and covers the services of the anesthesiologist and the necessary medications. This fee is directly proportional to the time spent under general anesthesia; a longer, more complex surgery will drive this cost higher. The facility fee, which can add $1,000 to $5,000, covers the use of the operating room, surgical equipment, nursing staff, and surgery center overhead.
For a straightforward implant removal without the surrounding scar tissue capsule, the cost is often between $5,500 and $7,800. If the surgeon must perform a total capsulectomy to remove the entire capsule, the price increases to a range of $7,500 to $10,000. The most involved technique is an en bloc capsulectomy, where the implant and capsule are removed as a single, intact unit. This procedure is the most expensive, often reaching $10,000 to $14,000 due to the significant increase in surgical time and technical difficulty.
Key Factors That Change the Final Price
The final price paid for the explant is affected by the geographical location where the surgery takes place. Surgeons practicing in major metropolitan areas or high-cost-of-living states tend to have higher facility and surgeon’s fees compared to those in rural regions. The surgeon’s experience and reputation also significantly influence their professional fee; specialists with extensive experience in explantation often command premium rates.
The complexity of removing the implant’s scar tissue capsule is a primary driver of cost variation. A simple removal involves leaving the capsule behind, but medical reasons often necessitate a capsulectomy. An en bloc capsulectomy is more time-intensive and therefore more costly than a standard total capsulectomy.
The age and type of the implants affect the final price by influencing the procedure’s duration. Older or ruptured silicone implants, especially those with silicone leakage or extensive calcification, require more time and precision to remove safely. This directly increases the charges for both the surgeon and the anesthesiologist.
Navigating Insurance Coverage and Medical Necessity
Whether the patient pays the full out-of-pocket cost depends on if the procedure is deemed medically necessary or purely cosmetic by their insurance provider. Explant surgery performed for aesthetic reasons is generally not covered, requiring the patient to pay the full cosmetic price. Insurance coverage becomes a possibility when the removal is necessary to treat a specific, documented medical condition related to the implants.
Conditions that may qualify for coverage include a confirmed implant rupture or severe capsular contracture, often classified as Baker Grade III or IV. Documentation of symptoms related to Breast Implant Illness (BII) may also be accepted by some carriers, though the required level of proof varies. To secure coverage, the patient’s medical records must support the diagnosis, and the surgeon must submit the procedure for pre-authorization.
The billing process relies on specific diagnostic codes from the International Classification of Diseases (ICD-10). These codes, which cover mechanical complications like capsular contracture or implant rupture, are used to signal medical necessity to the insurer. If the removal is approved, the patient remains responsible for standard out-of-pocket expenses such as their annual deductible, co-insurance percentages, and any applicable co-pays.
Costs Associated with Post-Explant Procedures
Individuals often combine explant surgery with an additional procedure to address cosmetic changes that follow implant removal, such as skin laxity or volume loss. These concurrent procedures are almost always classified as cosmetic and are billed separately, significantly increasing the overall expense. The most common add-on is a mastopexy, or breast lift, which removes excess skin and reshapes the remaining breast tissue to elevate the nipple position.
Combining an explant with a lift can raise the total cost into the range of $11,500 to $16,000 or more. Fat grafting is also an option, where fat is harvested from another part of the body and injected into the breasts to restore lost volume and improve contour. Since these procedures are not considered medically necessary, insurance will not cover their cost, even if the explant portion was covered.