Explant surgery is the medical term for breast implant removal. It involves surgically taking out one or both breast implants, often along with the scar tissue capsule that naturally forms around them. Nearly 68,000 explant procedures were performed in 2024 alone, split roughly between cosmetic patients (about 41,000) and reconstructive patients (about 27,000), making it one of the more common breast surgeries performed today.
People seek explant surgery for a range of reasons: physical symptoms they attribute to their implants, hardening of the scar tissue around the implant, implant rupture, a rare cancer linked to certain implant types, or simply a change in personal preference. The specifics of the procedure, recovery, and results depend heavily on why the implants are coming out and how much tissue needs to be removed.
Why People Choose Explant Surgery
The most straightforward reason is mechanical failure. Implants can rupture or deflate over time, and saline or silicone implants are not considered lifetime devices. Many surgeons recommend monitoring or replacing implants every 10 to 15 years.
Capsular contracture is another common trigger. Your body naturally forms a fibrous capsule around any implant, but sometimes that capsule tightens and hardens, squeezing the implant and causing visible distortion, firmness, or pain. When contracture progresses to the point of discomfort or noticeable shape changes, surgical removal of the implant and capsule is typically the recommended treatment.
A growing number of people pursue explant surgery because of systemic symptoms they developed after getting implants. This collection of symptoms is widely known as breast implant illness, or BII. Common complaints include fatigue, joint and muscle pain, brain fog, difficulty concentrating, hair loss, rashes, dry eyes and mouth, and depression. The FDA received nearly 2,500 reports of BII-consistent symptoms in a single year (November 2018 to October 2019), and in October 2021, the agency began requiring boxed warning labels on breast implants to alert patients to the possibility of these symptoms before surgery. BII is not yet an official medical diagnosis, and whether implants directly cause these symptoms remains debated, but many patients report significant improvement after removal.
The most serious indication is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare cancer of the immune system linked primarily to textured-surface implants. As of June 2024, the FDA had received 1,380 case reports worldwide. When BIA-ALCL is suspected or confirmed, explant surgery becomes an urgent medical necessity rather than an elective procedure.
Types of Explant Procedures
Not all explant surgeries are the same. The key difference lies in how much of the surrounding capsule tissue your surgeon removes, and the right approach depends on the reason for removal.
A simple explant removes the implant itself but leaves the capsule largely in place. This is the least invasive option and may be appropriate when the capsule is thin, healthy, and the implants are being removed for personal preference rather than a medical concern.
A total capsulectomy removes the implant and the entire surrounding capsule, including the portion attached to the chest wall (the posterior wall). This is a more involved surgery and is commonly performed for capsular contracture or when BII symptoms are present, since some patients and surgeons believe removing the full capsule gives the best chance of symptom relief.
An en bloc resection takes this a step further. The surgeon removes the implant and capsule as a single, intact unit without opening the capsule during removal. This technique is essential for BIA-ALCL cases, where the goal is to avoid spilling any cancerous cells. En bloc resection also includes removal of any associated masses and involved lymph nodes. Leaving the posterior capsule wall behind is associated with higher recurrence rates, with the chest wall being a frequent site of disease return after incomplete removal. For benign conditions, surgeons sometimes perform capsulectomy in a piecemeal fashion, but for lymphoma, keeping the specimen intact and achieving clean margins is critical.
What Happens During Surgery
Explant surgery is performed under general anesthesia and typically takes one to three hours, depending on the complexity. Your surgeon usually makes an incision along the existing scar from your original augmentation (often in the crease beneath the breast or around the areola), then carefully separates and removes the implant and capsule tissue according to the planned technique.
If you’re having a total capsulectomy or en bloc resection, the surgery takes longer because the posterior capsule must be carefully peeled from the chest wall muscles. Your surgeon will likely place surgical drains beneath the skin to collect excess fluid and blood. These drains typically stay in for one to three weeks, until the daily fluid output drops below about 1.5 tablespoons.
Some patients opt to have a breast lift (mastopexy) performed at the same time as their explant. This is most often recommended when there is existing breast drooping, or when the surgeon anticipates that removing the implant will leave noticeable excess skin. When an implant comes out, the lower breast fold tends to shift upward and the skin envelope shortens vertically, which can leave the breast looking deflated. A simultaneous lift reshapes the remaining tissue and removes excess skin to create a more natural contour.
Recovery and What to Expect
Full recovery from explant surgery generally takes two to six weeks, though the timeline varies based on the extent of the procedure and whether one or both implants were removed. For the first one to three weeks, you’ll need to rest and avoid heavy lifting, strenuous exercise, and excessive arm or shoulder movement.
The early days involve managing drains, wearing a supportive surgical bra, and dealing with swelling and soreness. Most people can return to desk work within one to two weeks, but physical jobs and exercise require a longer break. Your surgeon will typically clear you for full activity around the six-week mark.
One of the most common concerns after explant surgery is dissatisfaction with breast appearance. Without the implant filling the space, your breasts will look different. Sagging, drooping, asymmetry, and a deflated appearance are all common outcomes, particularly if the implants were large or had been in place for many years. For some people, this is an expected trade-off they’re prepared for. Others choose a concurrent breast lift or fat grafting to address these changes.
Risks and Complications
Explant surgery carries the standard risks of any surgical procedure, along with some specific to implant removal. Bleeding, infection, and scarring are always possibilities. Seroma, a collection of fluid in the space where the implant used to sit, is particularly common since the body needs time to adapt to the empty pocket. Numbness or changes in nipple sensation can occur and may be temporary or permanent. Asymmetry between the two breasts is also possible, especially if the implants or capsules were different sizes or the tissue responds differently on each side.
For patients removing implants due to BII, it’s worth noting that symptom improvement is not guaranteed. Many people report feeling dramatically better within weeks or months, but the lack of a formal diagnostic framework means outcomes are variable and not fully predictable.
Capsule Tissue and Pathology Testing
When the capsule is removed, your surgeon may send it to a pathology lab for analysis. This is standard practice when there is any suspicion of BIA-ALCL, but it can also be done as a precaution in routine cases. The pathologist examines the tissue for signs of malignancy, chronic inflammation, or infection. If BIA-ALCL is confirmed through pathology, further treatment planning with an oncologist may follow, though the majority of cases caught early and treated with complete en bloc resection have excellent outcomes.