Medically reviewed by
Assoc. Prof. Dr. Ayhan Işık Erdal, MD, FACS, FEBOPRAS
Plastic, Reconstructive & Aesthetic Surgeon
· Last reviewed
Removing implants is an increasingly common request. The question isn't whether it's possible — it always is — but whether to do it with or without capsule removal, with or without a lift, and what to expect cosmetically. These are decisions that depend on what you want and on your specific tissue findings.
Explantation simply means removing breast implants. It can be:
Each combination is a different operation with different recovery and different cosmetic result.
This is the central decision for most patients seeking explant. The factors:
A useful predictor: if the breast looks "good" when you push the implant up with your hand and let the breast tissue settle, the result without a lift will likely be acceptable. If the breast looks empty and saggy with the implant displaced, a lift will likely improve the result.
"En bloc" means removing the implant together with its surrounding capsule as a single intact unit, without rupturing the capsule during dissection. The capsule and implant come out together.
This is technically more demanding than partial capsulectomy and significantly more demanding than capsule-preserving explant. The capsule must be carefully dissected from surrounding tissue without tearing it. Additional drains may be needed.
| Indication | En bloc? | Why |
|---|---|---|
| Confirmed or suspected BIA-ALCL | Yes — required | Cancer cells localised in capsule; intact removal is therapeutic |
| Implant rupture with siliconoma | Often yes | Contains silicone within intact capsule |
| Grade IV capsular contracture | Sometimes | Diseased capsule; complete removal benefits |
| Asymptomatic patient, healthy capsule | Patient choice | Not medically necessary; patient preference for peace of mind |
| Breast implant illness (BII) concern | Patient choice | Evidence is mixed; many surgeons accommodate request |
Dr. Erdal will explain whether en bloc is medically necessary for your specific case, whether it's reasonable as patient preference, or whether partial capsulectomy is the more appropriate approach.
Three predictable outcomes:
The result usually settles for 6-12 months. Initial post-op appearance is not the final result — significant retraction occurs over the first 3-6 months.
Standard explant without capsulectomy:
Explant with capsulectomy adds:
Explant with concurrent lift adds:
Operative time: 90 min for simple explant; 3-4+ hours for explant + capsulectomy + lift.
Recovery is faster than primary augmentation when no lift is performed. With lift, recovery extends to standard breast lift timeline.
It depends on original implant size, length of time implants were in place, and your skin elasticity. With small original implants (<300 cc), short duration (<5 years), and good skin tone, deflation is usually minimal. With larger implants and longer duration, some looseness is expected — concurrent lift addresses this if desired.
Only in specific cases: confirmed BIA-ALCL, suspicious capsule findings, or grade IV contracture with implant rupture. For most other indications, en bloc is a patient preference rather than medical necessity. The capsule itself is not toxic in the absence of these specific findings; partial capsulectomy or capsule preservation are also reasonable approaches.
Yes — single-stage explant plus lift is the standard approach when both are needed. Two-stage approaches (explant first, lift months later) are reserved for very large implants where significant tissue retraction is expected.
If using only the original incision (inframammary or peri-areolar), no new scars are created. If a lift is added, additional scars are created — pattern depends on lift type (vertical, anchor, peri-areolar). Discussed pre-operatively.
Some women report systemic symptoms (fatigue, joint pain, brain fog, autoimmune-like complaints) that they attribute to their implants. Evidence base is mixed — some patients improve markedly after explant, others don't. Honest discussion before surgery: if symptoms don't improve, what then? Explant for BII symptoms is a reasonable choice if the patient understands outcomes are variable.
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