Explant surgery is the removal of breast implants, whether silicone or saline. People choose this procedure for a range of reasons, from complications like hardened scar tissue to simply no longer wanting implants. The surgery can involve removing just the implant or taking out the surrounding scar capsule as well, depending on the situation.
Why People Choose Explant Surgery
The most common medical reason for explant surgery is capsular contracture, a condition where the scar tissue that naturally forms around any implant begins to harden and tighten. Surgeons grade this on a four-point scale. At the mild end, the breast looks and feels natural. At the severe end, the breast is visibly distorted, feels firm to the touch, and often causes pain. Grades three and four typically prompt removal.
Other medical reasons include implant rupture (where the shell tears and the filling leaks), shifting or displacement of the implant, calcium deposits forming around the shell, and a rare cancer called BIA-ALCL that develops in the scar tissue surrounding an implant. The FDA recommends that ruptured implants be removed regardless of whether they’re silicone or saline.
Not every explant is driven by a complication. Some people simply decide they no longer want implants. Others find that pregnancy, breastfeeding, aging, or weight changes have altered the shape of their augmented breasts in ways they don’t like. For these patients, removal is an elective choice rather than a medical necessity.
Breast Implant Illness
A growing number of people seek explant surgery because of a collection of whole-body symptoms they attribute to their implants, commonly called breast implant illness (BII). The FDA does not recognize BII as a formal medical diagnosis, and no specific test can confirm it. But the pattern of symptoms is well documented in device reports. Among women who filed reports with the FDA, fatigue was the most common complaint at 41%, followed by joint pain at 31%, anxiety at 23%, brain fog at 23%, hair loss at 20%, depression at 17%, rashes at 17%, and unexplained weight changes at 17%.
Many women report that some or all of these symptoms improve after their implants are removed, though outcomes vary. The lack of a formal diagnostic framework means insurance coverage for BII-related explants can be difficult to secure.
Types of Explant Procedures
There are several approaches to removing breast implants, and the differences matter because they affect what tissue comes out and how the surgery is performed.
A simple implant removal takes out the implant alone, leaving the scar capsule in place. This is the least invasive option but is generally reserved for straightforward cases with no complications.
A total capsulectomy removes both the implant and the surrounding scar capsule, but in separate steps. The surgeon opens the capsule, takes out the implant, then dissects the capsule tissue away from the chest wall. This is appropriate when the capsule itself is thickened, calcified, or otherwise problematic.
An en bloc capsulectomy removes the implant and capsule as a single intact unit, without opening the capsule at any point. The goal is to prevent anything inside the capsule (silicone gel, bacteria, or fluid) from contacting the surrounding tissue. This technique is more demanding and takes longer, but many patients specifically request it. From an insurance standpoint, major insurers like Aetna consider en bloc removal medically necessary only when capsular malignancy (cancer in the scar tissue) is confirmed.
In some cases, a portion of the capsule has fused to the rib cage or chest muscle and cannot be safely removed. The surgeon will leave that tissue in place as a safety precaution, performing a partial capsulectomy instead.
What Recovery Looks Like
Most explant procedures are done under general anesthesia and take one to three hours depending on the technique used. Surgical drains are typically placed to prevent fluid buildup. These small tubes exit through the skin near the incision and collect fluid into a bulb you’ll need to empty and measure throughout the day.
Drains stay in until output drops below about two tablespoons per day for two consecutive days. For most patients, that means one to three weeks. Leaving drains in longer than three weeks raises the risk of infection. Showering is off limits for the first 48 hours after surgery, and again for 24 hours after each drain is removed. The drain site itself closes within a few days and fully heals in three to four weeks.
The broader recovery timeline depends on the extent of the surgery. Simple implant removal has a shorter recovery than an en bloc capsulectomy. Most people can return to light daily activities within a week or two, but strenuous exercise and heavy lifting are typically restricted for four to six weeks. Swelling, bruising, and soreness are normal in the first couple of weeks. Some fluid collection (seroma) or bruising (hematoma) can occur near the surgical site. Small collections usually resolve on their own, while larger ones may need to be drained.
How Breasts Look After Removal
This is one of the biggest concerns for people considering explant surgery, and the honest answer is: it depends. Several factors shape the outcome, including how long the implants were in place, the size of the implants relative to your natural tissue, your skin elasticity, and whether you’ve gone through pregnancy or significant weight changes since augmentation.
Some women end up with a breast shape they’re satisfied with and minimal loose skin. Others find their breasts look deflated, saggy, or uneven without the implant filling them out. Dimpling, puckering, or a concave appearance on the chest wall is possible, particularly after large implants or long-term wear. That said, it’s rare for breasts to appear completely flat after explant surgery alone.
If appearance is a priority, many surgeons recommend combining explant with a breast lift (mastopexy) in the same operation. The lift removes excess stretched skin and tightens the remaining tissue, creating a more defined shape. Fat grafting, where fat is taken from another area of your body and injected into the breasts, is another option for restoring some volume. Some patients eventually choose smaller implants down the line.
Insurance Coverage
Whether insurance covers explant surgery depends on why you’re having it done. Medically necessary indications, like a ruptured implant, confirmed BIA-ALCL, or significant capsular contracture, are most likely to be approved, though they’re still subject to medical review. The FDA’s position that ruptured implants should be removed supports coverage claims in those cases.
Cosmetic explants, where you simply want the implants out, are generally not covered. BII-related removals fall into a gray area because the condition lacks formal diagnostic criteria. En bloc capsulectomy specifically tends to be denied unless cancer is involved, since insurers view the standard capsulectomy as sufficient for most other indications. Out-of-pocket costs for explant surgery vary widely depending on the technique, whether a lift is included, and geographic location, but typically range from several thousand to over ten thousand dollars.