Breast explantation is a surgical procedure focused on the removal of previously placed breast implants (silicone or saline). It is commonly performed as an outpatient procedure under general anesthesia. Explantation is typically accompanied by the removal of the surrounding scar tissue, which addresses common complications and patient concerns.
Defining Breast Explantation
Breast explantation is the term for surgically removing breast implants, though the procedure is often more complex than simple device extraction. The body naturally forms a layer of fibrous scar tissue around the implant, known as the breast capsule. The complete explantation process often includes a capsulectomy, which is the removal of this capsule.
The distinction between simple implant removal and explantation with capsulectomy is important. Simple removal involves taking out the implant and leaving the capsule behind, which may be appropriate in uncomplicated cases. However, most surgeons recommend a capsulectomy, especially when complications or health concerns are the primary motivation for surgery.
A capsulectomy involves dissecting the scar tissue away from the surrounding breast tissue and chest wall. Removing the capsule eliminates potential sources of chronic inflammation or issues related to the implant’s presence. Without a capsulectomy, the remaining scar tissue may continue to cause symptoms or complicate future monitoring.
Primary Motivations for Implant Removal
Patients seek breast implant removal for medical complications, systemic health concerns, or aesthetic preferences. One common medical issue is capsular contracture, where the capsule hardens and tightens around the implant. This complication leads to discomfort, pain, and visible distortion, often making the breast feel abnormally firm.
Another frequent reason for explantation is implant rupture or leakage, which can occur over time. A ruptured silicone implant may cause the gel to leak into the surrounding capsule, necessitating the removal of the capsule along with the implant to prevent further tissue exposure. Implant malposition, where the device shifts out of its original pocket, also causes an unsatisfactory appearance and is a reason for removal.
A growing number of women pursue explantation due to symptoms they attribute to Breast Implant Illness (BII). BII is a collection of systemic symptoms that include:
- Chronic fatigue
- Joint pain
- Cognitive dysfunction or “brain fog”
- Hair loss
While BII does not currently have a definitive diagnostic test, many patients report significant symptom resolution after the implants and capsules are removed.
Beyond medical issues, many individuals desire a return to their natural anatomy or find that their aesthetic preferences have changed. The long-term maintenance required for implants, including the need for periodic replacement surgery, is also a factor. Dissatisfaction with the size or appearance of the breasts can lead to the decision to explant.
The Surgical Procedure and Techniques
The explantation surgery typically lasts between two and four hours, depending on the complexity and whether additional procedures are performed. The surgeon usually makes the incision along the existing scar lines from the original augmentation, often in the inframammary fold beneath the breast. This approach minimizes new visible scarring.
The decision of how to remove the capsule is a primary factor in the surgical technique. A total capsulectomy removes the entire capsule; the implant is often removed first through an incision, and the remaining scar tissue is then dissected and removed in pieces. This method ensures all scar tissue is extracted from the breast pocket.
The en bloc capsulectomy is a specialized technique where the surgeon removes the implant and the surrounding capsule as a single, intact unit. This method is often requested by patients with ruptured silicone implants or those concerned about BII, as it contains the implant and contents, minimizing contact with surrounding tissues. Performing an en bloc procedure requires a larger incision and is more challenging than a simple total capsulectomy.
Many patients choose a concurrent procedure to improve the aesthetic result after volume loss. A breast lift (mastopexy) is the most common adjunct procedure, removing excess skin and tightening the remaining breast tissue to reshape the breast. Fat grafting, which transfers a patient’s own fat to the breast, can also restore some volume and improve contour irregularities.
Expectations for Recovery and Post-Surgical Changes
Following explantation, patients should expect a recovery period involving rest and limited activity. Pain and discomfort are managed with prescription medication and are most noticeable during the first week. Temporary surgical drains may be placed beneath the skin to collect excess fluid, and are typically removed within a few days.
Patients are advised to avoid strenuous activity, heavy lifting, and upper body exercises for four to six weeks to allow internal tissues to heal fully. The breasts will experience swelling and bruising, which subside over the first few weeks. The final aesthetic result often takes approximately three months to become apparent as the tissues settle.
Patients must manage expectations regarding the post-explant appearance of their breasts. Without the implant volume, the breasts will appear smaller, and the skin may show laxity or deflation, especially if large implants were worn for a long time. The extent of skin sagging depends on factors like the original implant size, skin elasticity, and the presence of any concurrent lifting procedure.
For patients who underwent explantation for BII symptoms, the timeline for resolution varies widely. Many report an immediate and sustained improvement in systemic symptoms soon after surgery. Full resolution of some symptoms may take several months as the body recovers and rebalances after the removal of the implants and capsule.