A breast explant is surgery to remove breast implants that were placed during a previous augmentation or reconstruction. The procedure can also include removing the scar tissue capsule that naturally forms around each implant. In 2023, over 41,000 breast explant procedures were performed in the United States, reflecting a steady rise in women choosing to have their implants taken out for both personal and medical reasons.
Why People Choose Explant Surgery
The reasons fall into two broad categories: elective and medical. On the elective side, some women simply become unhappy with how their implants look, especially as their body changes with age or weight fluctuations. Others find that a larger bust no longer fits their lifestyle, whether that means interfering with exercise or contributing to back pain. And some decide the ongoing maintenance is more than they bargained for, since implants require regular imaging checkups and often need to be replaced after 10 to 15 years.
Medical reasons tend to be more urgent. Capsular contracture is one of the most common. Your body treats every implant as a foreign object and builds a fibrous capsule of scar tissue around it. Normally this capsule is thin and flexible, but in some women it hardens, tightens, and squeezes the implant, causing chronic pain and visible distortion. Other medical indications include implant rupture (particularly silicone gel implants that leak outside the capsule), recurrent infections, and interference with cancer treatment or mammography.
Breast Implant Illness
Breast implant illness, often called BII, has become the most widely accepted term for a pattern of unexplained, whole-body symptoms that develop after implant placement. There is no blood test or imaging study that confirms the diagnosis, and no proven biological mechanism has been established. That said, the symptom pattern is consistent enough that it has drawn serious research attention.
A large meta-analysis pooling data from over 10,000 patients found the most commonly reported symptoms were joint complaints (39%), fatigue (27%), muscle pain or weakness (25%), and cognitive dysfunction like brain fog or memory trouble (22%). When researchers looked only at patients who were specifically asked about each symptom, fatigue topped the list at nearly 45%, followed by sleep disturbance (39%), dizziness (28%), and cognitive issues (26%).
The encouraging finding: roughly 82% of patients reported symptom improvement after having their implants removed. On average, patients went from about 13 symptoms before surgery down to 7 afterward, a reduction of about 55%. Three out of four studies in the analysis showed reductions of greater than 65%. Results varied widely from person to person, but the overall trend was statistically and clinically meaningful.
BIA-ALCL: A Rare but Serious Risk
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare cancer of the immune system, not breast cancer, that develops in the scar tissue capsule around an implant. As of June 2024, the FDA had received 1,380 reports of BIA-ALCL worldwide. Nearly all confirmed cases have been linked to textured-surface implants. One line of textured implants (Allergan Biocell) was pulled from the market at the FDA’s request. If you have textured implants and develop new swelling, pain, lumps, or asymmetry long after your surgical incision has healed, those symptoms warrant evaluation.
Types of Capsule Removal
Removing the implant itself is straightforward. The bigger surgical decision involves what to do with the scar tissue capsule surrounding it. There are three main approaches.
- Partial capsulectomy: Only the portion of the capsule causing problems (usually a thickened or contracted front section) is removed. This is the least invasive option and is common when the capsule is thin, healthy, and not suspected of harboring disease.
- Total capsulectomy: The entire capsule is removed, though not necessarily in one piece. Surgeons may recommend this for patients with a history of textured implants, concerns about BII, or when the capsule is heavily calcified or contracted.
- En bloc removal: The implant and its surrounding capsule are removed together as a single, intact unit, borrowing a technique from cancer surgery. This approach is considered medically necessary when there is a capsular malignancy like BIA-ALCL. Some patients without cancer request it as well, though surgeons note the term is technically an oncologic one and may not always be feasible depending on capsule location and thickness, particularly where the capsule sits against the chest wall or ribs.
What to Expect During Recovery
Explant surgery is performed under general anesthesia. The length of the procedure depends on whether you’re having a simple implant removal, a capsulectomy, or additional reshaping work, but most cases are significantly shorter than reconstruction surgeries that can stretch beyond several hours.
Many patients go home the same day with one or two surgical drains in place. These small tubes collect fluid from the surgical site and are typically removed one to three weeks later, once output drops below about 2 tablespoons per day for two consecutive days. Leaving drains in longer than three weeks raises infection risk, so your surgeon will monitor output closely. Once a drain comes out, the small hole it leaves closes within a few days and fully heals in three to four weeks.
During the initial recovery period, you should avoid showering for the first 48 hours after surgery, avoid lifting anything over 10 pounds, and avoid driving until cleared. Wearing loose, comfortable clothing or a supportive camisole with built-in pockets for drain bulbs helps keep everything secure. Most people return to light daily activities within one to two weeks, though full healing of internal tissues takes longer.
Combining Explant With a Breast Lift
After implants are removed, the overlying skin and breast tissue may not retract to a shape you’re happy with, especially if you had large implants for many years. A mastopexy (breast lift) can be performed at the same time as the explant to reshape the remaining tissue, reposition the nipple, and restore upper fullness. Surgeons accomplish this by redistributing your natural breast tissue into the space the implant occupied, then tightening the skin envelope. The tradeoff is additional scarring, typically a vertical scar running from the nipple downward, though these tend to fade significantly over the first year.
Not everyone needs or wants a lift. Factors like your natural breast volume, skin elasticity, implant size, and how long the implants were in place all influence how your breasts will look after removal alone. Your surgeon can help you weigh the options during a consultation.
Insurance Coverage
Insurance coverage for explant surgery depends on whether the procedure is considered medically necessary. Elective removal for cosmetic preference is generally not covered. Medical indications that typically qualify include silicone implant rupture (especially when gel has leaked outside the capsule), severe capsular contracture with pain, contracture that interferes with mammography, BIA-ALCL, implant extrusion through the skin, recurrent infections, and having recalled textured implants like Allergan Biocell. Skin reactions to implants that haven’t responded to standard treatments can also qualify.
En bloc capsulectomy, the most extensive surgical approach, is typically covered only when there is a confirmed capsular malignancy. Policies vary between insurers, so checking your specific plan’s criteria before scheduling surgery is worth the effort. If your situation falls into a gray area, a letter of medical necessity from your surgeon documenting your symptoms, imaging findings, or implant history can strengthen your case for approval.