The number of women choosing to have their breast implants surgically removed, a procedure known as explantation, is growing rapidly worldwide. This significant trend reflects a shift in patient priorities, moving away from permanent cosmetic alterations toward personal health and body autonomy. The surge is driven by diverse factors, including device failure, systemic health conditions, regulatory concerns, and evolving ideas about beauty.
Localized Implant Complications
Many decisions to explant are driven by physical problems occurring directly at the site of the implant. A frequent issue is capsular contracture, which occurs when the body’s natural scar tissue capsule surrounding the implant tightens and squeezes the device. This excessive fibrotic reaction can cause the breast to feel abnormally firm, leading to distortion, visible rippling, and chronic pain. Severe contracture (Baker Grade III and IV) often necessitates surgical intervention because the breast becomes hard, painful, and visibly misshapen.
Implants are medical devices not designed to last a lifetime, and their integrity is not guaranteed indefinitely. The risk of implant rupture increases over time; some studies suggest up to 50% of implants lose integrity after ten years. Ruptures are classified as intracapsular (contained within the scar capsule) or extracapsular (filler escapes into surrounding tissue). While a saline rupture is obvious due to deflation, a silicone rupture can be “silent” and only detectable through imaging. These mechanical failures, along with malposition or shifting of the implant, are common reasons for choosing permanent removal rather than replacement.
Systemic Health Concerns and Breast Implant Illness
A major factor fueling the explantation trend is a constellation of systemic symptoms attributed to the devices, commonly referred to as Breast Implant Illness (BII). BII is not currently recognized as a formal medical diagnosis but describes a wide array of generalized health complaints reported by women with implants. These symptoms can be debilitating and affect multiple body systems, distinguishing them from localized issues like rupture or contracture.
Reported symptoms often include chronic fatigue, joint and muscle pain, cognitive difficulties described as “brain fog,” and neurological issues. Other complaints encompass hair loss, skin rashes, anxiety, depression, and symptoms resembling autoimmune disorders. The prevailing hypothesis suggests BII may be linked to an autoimmune or chronic inflammatory response triggered by the foreign material of the implant. Many patients who undergo explantation, which often includes removing the surrounding scar capsule, report significant improvement in their symptoms within the first few months post-surgery.
Specific Cancer Risk Associated with Implants
A specific, rare cancer linked to certain devices has prompted many women to seek prophylactic removal. This condition is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a form of non-Hodgkin’s lymphoma. BIA-ALCL is not a cancer of the breast tissue but rather a cancer of the immune system cells that forms in the fluid or the scar capsule surrounding the implant.
The risk of developing BIA-ALCL is primarily associated with textured-surface breast implants, which have a rougher surface. Data revealed the risk was significantly higher with certain manufacturer products, leading the U.S. Food and Drug Administration (FDA) to request a worldwide recall of specific textured implants in 2019. The risk is considered low, with a lifetime risk for those with textured implants estimated to be between 1 in 3,817 and 1 in 30,000. For patients diagnosed with BIA-ALCL, removal of the implant and the surrounding capsule is often a curative treatment.
Evolving Aesthetics and Lifestyle Factors
Not all explant surgeries are driven by complications; many women make an elective choice based on changing preferences and life circumstances. As beauty standards evolve, a desire for a more “natural” silhouette has become common. This leads some to decide their implants no longer align with their personal aesthetic, reflecting a desire to embrace their body’s natural form.
Physical changes over time, such as aging, weight fluctuations, or pregnancy, can cause dissatisfaction with the long-term appearance of implants, leading to sagging or disproportion. Implants can also present a practical inconvenience for women with highly active lifestyles or physically demanding routines, feeling restrictive or uncomfortable during exercise. Ultimately, many women decide to remove the devices because they no longer wish to have a foreign object inside their body, prioritizing holistic wellness and self-acceptance.