Explant surgery is the removal of breast implants, sometimes along with the scar tissue capsule that naturally forms around them. It’s one of the most common plastic surgery procedures in the United States, with roughly 68,000 performed in 2024 across both cosmetic and reconstructive patients. People pursue explant for a wide range of reasons, from painful scar tissue hardening to concerns about systemic symptoms to simply no longer wanting implants.
Why People Choose Explant Surgery
The most common medical reason for removing breast implants is capsular contracture, a condition where the scar tissue capsule around the implant tightens and hardens. Your body forms this capsule around any implanted device as a normal immune response, but in some people it contracts enough to cause pain, visible distortion, or a noticeably different appearance from one breast to the other. Capsular contracture is graded on a four-point scale: grade I means no noticeable tightness, while grade IV means the breast is hard, painful, and visibly distorted. If contracture progresses far enough, it can even rupture the implant.
Other medical reasons include implant leaking or rupture, calcium buildup around the implant, and shifting of the implant out of position. In rare cases, textured implants are associated with a type of cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which develops in the scar tissue surrounding the implant. Removing large implants can also relieve chronic neck or back pain.
Many people also choose explant for personal or lifestyle reasons. Some simply no longer want implants, or their preferences have changed over time.
Breast Implant Illness
A growing number of people seek explant because of symptoms they attribute to their implants, commonly referred to as breast implant illness (BII). This is not a formal medical diagnosis, and no specific test can confirm it, but the FDA tracks thousands of reports from patients describing systemic symptoms after breast augmentation or reconstruction.
The most frequently reported symptoms paint a picture of widespread inflammation and immune disruption. Fatigue tops the list, appearing in about 41% of reports. Joint pain follows at 31%, then anxiety (23%), autoimmune-related symptoms (23%), brain fog (23%), hair loss (20%), depression (17%), rashes (17%), and unexplained weight changes (17%).
Research published in the Aesthetic Surgery Journal followed BII patients after explant and found that 94% reported improvement in at least some of their symptoms by six months, with a 68% reduction in the total number of symptoms reported. At one year, 88% still showed at least partial improvement. Notably, symptom improvement occurred regardless of whether the surgeon removed part or all of the surrounding capsule. The cause of these symptoms and their exact relationship to implants remains unclear, but for many patients, removal brings measurable relief.
Types of Explant Procedures
Explant surgery isn’t one-size-fits-all. The key decision is how much tissue to remove beyond the implant itself.
- Implant removal only: The surgeon removes the implant and leaves the capsule in place. This is the simplest approach and involves the shortest recovery.
- Total capsulectomy: The surgeon removes the implant first, then removes the surrounding capsule in pieces, sometimes peeling sections from the chest wall and nearby tissue.
- En bloc capsulectomy: The surgeon removes the implant and the entire capsule together as a single intact unit through an incision under the breast. This technique is often preferred when there’s concern about rupture, BIA-ALCL, or contamination of surrounding tissue, since it avoids exposing the body to the capsule’s contents.
The right approach depends on the reason for removal, the condition of the implant, and the thickness and integrity of the capsule. En bloc is more technically demanding and not always possible, particularly if the capsule is very thin or tightly adhered to the chest wall.
Breast Lift and Reconstruction Options
One of the biggest concerns people have about explant is how their breasts will look afterward. Simply removing implants often leaves breasts that appear deflated, widened, and displaced to the sides. The longer implants have been in place and the larger they are, the more pronounced this effect tends to be.
Many surgeons recommend combining explant with a breast lift (mastopexy) to reshape the remaining tissue. The ideal candidate for this combined approach has enough natural breast tissue to create a pleasing shape after the implant is gone, along with supple, healthy skin. People with very little remaining breast tissue, a history of radiation, or severe capsular contracture may need alternative approaches like fat transfer (using your own fat from another area) or staged reconstruction over multiple procedures.
Not everyone opts for additional procedures. Some people are comfortable with the natural result after removal, especially if their implants were relatively small or they had a good amount of breast tissue to begin with.
Preparing for Surgery
Preparation typically involves updated breast imaging. Your surgeon will want to review recent mammograms, ultrasounds, or MRI studies to understand what’s happening around the implant and rule out any unrelated concerns.
If you smoke, expect to be asked to stop at least a month before surgery. Smoking significantly increases the risk of poor healing, particularly skin and tissue complications near the incision. Even a remote history of smoking may influence which techniques your surgeon considers safe. You’ll also need to review your medications, since blood thinners and certain supplements can increase bleeding risk.
What Recovery Looks Like
The first 24 hours are focused entirely on rest. You’ll likely feel soreness and tightness across your chest, which is normal. Drains may be placed during surgery to prevent fluid from accumulating in the empty space left by the implants. You’ll wear a compression bra or supportive garment to minimize swelling and support the tissue as it heals.
During the first week, pain is managed with prescribed medication, and you’ll need to avoid any lifting or straining. Most people notice gradual improvement in swelling and discomfort over the first month. Light daily activities can usually resume within a few weeks, but strenuous exercise and heavy lifting are off the table for longer, typically six weeks or more depending on the extent of surgery. If a capsulectomy or breast lift was performed alongside the removal, recovery will trend toward the longer end.
Risks and Complications
Explant surgery carries the standard risks of any operation under anesthesia, including infection, bleeding, blood clots, and poor wound healing. There are also risks specific to this procedure. Seroma, where fluid collects in the space the implant occupied, is one of the more common complications and sometimes requires drainage. Hematoma (a collection of blood under the skin) can also occur.
Changes in nipple or skin sensation, including numbness, are possible and sometimes permanent. Scarring varies depending on the incision approach and your body’s healing tendencies. Asymmetry between the two breasts is another possibility, particularly if the capsules or implants differed in condition. Some people are unsatisfied with the cosmetic outcome and pursue revision surgery later.
Fat necrosis, where fatty tissue beneath the skin dies, is a less common but recognized complication. Persistent pain and prolonged swelling can also occur, though for patients who had capsular contracture, many report that their pain improves almost immediately after removal.