Breast Implant Removal (Explant Surgery)

What Is Breast Implant Removal (Explant Surgery)?

A significant number of women with breast implants continue to use them for the rest of their lives. However, for some patients, the decision to have the implant removed may arise over time.

The reason for this decision is not always a complication.

In my own practice, I encounter patients who want to have their breast implants removed for different reasons. Some say they now want a more natural look. Others state that their lifestyle has changed after breast augmentation surgery years ago and they no longer want to carry implants. In a smaller number of patients, implant removal may be necessary due to capsular contracture, implant rupture, or other problems requiring revision.

The important point to know here is:

Breast implant removal surgery is not just about removing the implant.

How the breast will look after implant removal, how the capsule will be managed, whether a breast lift is needed, and the patient’s aesthetic expectations are important parts of the surgical plan.

In this article, I will share in detail when breast implant removal surgery may be necessary, my approach to the capsule, and what I explain to my patients during this process.

Why Are Breast Implants Removed?

The decision to remove breast implants can be made for different reasons in each patient.

The most common reasons I encounter are as follows:

Implant removal is not always an emergency. Often, this decision is planned together with the patient, taking into account current findings and expectations.

Why Do Some Patients Choose Removal Years Later?

The reason for wanting implant removal is not always a complication.

In my own practice, some patients, especially those who have had implants for many years, express that they now want a more natural life.

Some women who wanted fuller breasts at a young age say that their lifestyle has changed years later and they no longer want to carry implants.

There is no single right or wrong answer to this.

Aesthetic expectations can change over time.

My job is to correctly understand the patient’s current expectations and create the most appropriate surgical plan for them.

Is a Breast Lift (Uplift) or Fat Transfer Needed After Implant Removal?

No.

This is one of the questions I’m asked most often.

How the breast tissue will look after implant removal can vary depending on:

• existing breast volume,
• skin elasticity,
• implant size,
• how many years the implant has been in place,
• pregnancy and weight changes,

In some patients, the breast may retain a largely natural appearance after the implant is removed.

However, in patients with significant sagging, a breast lift—often called an uplift in the UK—may be considered in the same procedure. In selected patients with sufficient donor fat who want limited volume support, fat transfer may also be considered; neither option is required for everyone or automatically performed in the same session.

I evaluate this decision individually for each patient.

My goal is not only to remove the implant but also to ensure the patient is satisfied with their breasts after surgery.

You can read more about when a breast lift may be considered in the dedicated guide.

Is Capsulectomy Always Needed During Implant Removal?

This is one of the most frequently asked questions by patients.

A thin capsule formed by the body surrounds each implant. When this normal tissue tightens and causes pain or a change in breast shape, it is called capsular contracture.

This capsule is a normal healing tissue that the body creates to surround the implant.

My approach is to try to remove as much of the capsule as possible.

However, patient safety is always the priority here.

Especially if the implant was previously placed under the muscle, the back of the capsule may be quite tightly attached to the chest wall and ribs.

Trying to completely remove this area by unnecessarily forcing it may pose more risk than benefit in some patients.

Therefore, in some cases, I prefer to remove only the part of the capsule that can be safely removed, not the entire capsule.

Because what is important to me is not just removing the capsule, but completing the surgery in the safest way for my patient.

When Is En Bloc Capsulectomy Considered?

One of the concepts I’ve encountered most frequently on social media and the internet in recent years is “en bloc capsulectomy” .

Therefore, many patients come to me directly with this question:

“Doctor, will you remove my implant en bloc?”

I think there is a significant conceptual confusion here.

First of all, it should be stated that:

En bloc capsulectomy is not a standard method that should be performed in every implant removal surgery.

Current international consensus statements are also quite clear on this matter. The term “en bloc capsulectomy” refers to removal of the capsule in one piece with a margin of surrounding intact tissue; its principal indication is suspected or confirmed implant-associated malignancy. There is no scientific recommendation that every patient should undergo en bloc in routine implant removal surgeries.En bloc capsulectomy refers to removal of the capsule in one piece with a margin of surrounding intact tissue. There is no scientific recommendation suggesting that en bloc should be performed on every patient in routine implant removal surgeries. The Aesthetic Society

En Bloc, Total and Partial Capsulectomy: What Is the Difference?

Dr Mete’s Approach to Capsule Management

In my own practice, I often carefully remove the implant first.

One of the most important reasons for this is that, especially in implants that have been around for 15-20 years, we may occasionally encounter tears or silicone gel leakage. In this case, safely removing the implant first, carefully cleaning any remaining silicone gel, and then removing the capsule in a controlled manner offers a safer surgical approach in my opinion.

In this case, I believe a safer surgical approach involves first safely removing the implant, carefully cleaning away any remaining silicone gel, and then carefully removing the capsule.

Every patient’s surgery is different.

Therefore, the technique to be applied is shaped according to the condition of the implant, the structure of the capsule, and the findings encountered during the surgery.

My priority is always the patient’s safety, not the name of the technique. Is it always possible to remove the entire capsule?

Is It Always Possible to Remove the Entire Capsule?

Not always.

Especially in patients who have previously had implants placed under the muscle , the posterior surface of the capsule may be quite tightly attached to the ribs and chest wall.

Trying to completely remove this area by force may create unnecessary risks in some patients.

For this reason, I try to remove the capsule as much as possible.

However, I do not think it is right to force the part of the capsule that is tightly attached to the chest wall just to completely remove it.

My approach is to remove the capsule, which can be safely removed, and not expose the patient to unnecessary surgical risks.

In addition, even removing the front surface of the capsule is sufficient for the implant space to close over time in most patients.

In contrast, leaving the entire capsule in place may leave a larger space inside, which may lead to fluid accumulation in some patients.

Therefore, the decision is re-evaluated for each patient during surgery.

How Is Implant Removal Considered When Breast Implant Illness (BII) Is Suspected?

One topic frequently discussed in recent years, particularly on social media, is Breast Implant Illness (BII).

Some patients;

• chronic fatigue,
• muscle and joint pain,
• brain fog,
• difficulty concentrating,
• various rheumatological complaints

Some patients associate symptoms such as these with their implants.

Currently, there is no complete consensus in the scientific community regarding the definition and diagnostic criteria of this condition. The patients’ complaints are real; however, how these symptoms are related to implants is still being investigated. Therefore, it is recommended that other possible diseases be ruled out first during the evaluation and that the decision be made together with the patient. PubMed Central (PMC)

In my own practice, I have not yet encountered a patient who wanted to have their implant removed for this reason.

However, if I encounter such a situation, I will conduct a detailed evaluation in accordance with current scientific guidelines and create a treatment plan accordingly.

Recovery Process After Breast Implant Removal Surgery

The recovery process after breast implant removal surgery may vary depending on the surgery performed.

The recovery process is not the same for a surgery where only the implant is removed and for surgeries where implant removal, capsulectomy, and breast lift are performed together.

Generally, the first few days;

• Tightness in the breasts,
• Mild pain,
• Edema,
• Tenderness upon movement,

are normal.

I recommend that my patients use a supportive, wire-free bra in the first few weeks, avoid strenuous physical activity, and not miss their check-ups.

It is not correct to immediately assess the final shape of the breast after implant removal.

It may take several months for the edema to subside, for the tissues to recover, and for the new breast shape to settle, especially in patients who have also undergone breast lift surgery.

What Does the Breast Look Like After Breast Implant Removal?

This is one of the questions I’m asked most often.

There is no single answer to this.

The appearance after implant removal;

• implant size,
• how many years the implant has been in place,
• This can vary depending on the existing breast tissue.
• skin elasticity,
• pregnancy and weight changes,

While some patients retain a surprisingly natural appearance of their breasts, others may experience significant volume loss or sagging.

Therefore, one of the most important issues we discuss at length with my patients before surgery is what kind of appearance to expect after the implant is removed.

If necessary, it may be possible to achieve a more aesthetic and natural result by planning a breast lift in the same session.

Can a New Implant Be Placed in the Same Procedure?

This is no longer simply implant removal; it falls within breast augmentation revision surgery.

In some patients, the old implant is removed and a new implant is placed in the same procedure.

In some patients, the implant is completely removed and a new implant is not used.

This decision is made entirely based on the patient’s expectations, existing breast structure, and the reason for implant removal.

How Is Breast Implant Removal Tailored to the Patient?

My Surgical Approach

I never view breast implant removal surgery as simply removing the implant.

For me, the most important thing is to plan from the outset how the patient’s breasts will look after the implant is removed.

Therefore, in the preoperative evaluation, not only the implant but also;

• I evaluate the breast tissue,
• skin elasticity,
• nipple position,
• degree of sagging,
• the patient’s aesthetic expectations,

together.

While in some patients only removal of the implant is sufficient, in others a more natural result can be achieved with breast lift.

I also do not apply a single method to every patient regarding the capsule.

I try to remove the capsule as much as possible. However, especially with implants placed under the muscle, I do not find it correct to force the capsule, which is tightly attached to the chest wall, just to completely remove it.

For me, the most important priority in surgery is always the patient’s safety.

How Is the Decision to Remove Breast Implants Made?

Breast implant removal surgery is not just about removing the implant.

For a successful outcome, the following should be considered:

• the reason for implant removal,
• the condition of the capsule,
• the structure of the breast tissue,
• skin elasticity,
• the patient’s expectations,

all together.

In my own practice, I evaluate each patient individually and create a completely personalized surgical plan.

While in some patients only implant removal is sufficient, in others it is possible to achieve much more natural and aesthetic results with breast lift or other surgical procedures.

The important thing is not only to remove the implant, but also to ensure that the patient is satisfied with their breasts after the surgery.