For plastic surgeons, breast augmentation is considered part of the “bread and butter” of our business. And yet, we rarely spend as much time talking about breast implant removal surgery.
Is breast implant removal painful? Will it leave a flat chest behind? Will it take as long to heal as the original surgery? As usual, it will all depend on what each patient wants and needs.
Just like with anything in plastic surgery, the reasons for seeking an explant surgery (or implant removal) are as varied as the people themselves. Some of the most common reasons people come to me to have their breast implants removed are:
Whether silicone- or saline-filled, breast implants are ultimately human-made devices. They’re not meant to last forever. Their exact expiration date will vary depending on the model and quality.
On average, they’re meant to last 10 years. The American Society of Plastic Surgeons recommends changing them after a maximum of 15 years. At this point, you may just want to change the appearance of your breasts, try a new breast size, or get rid of the implants altogether.
Sometimes one or both implants may slide into a different position than initially intended. Some “sliding” is natural and expected. Usually, we take this into account during the initial surgery, but we can never predict it with 100% accuracy. Changes in weight and breastfeeding can also cause displacement.
As a result, many women find that their implants are a bit too “to the sides” of the chest, or that they drop oddly in certain positions. Sometimes, we can correct this without removing the implant — but it may be easier to remove them and start anew.
Sometimes mistakenly known as “encapsulation,” capsule contractures are a painful complication of breast augmentation surgery.
Whenever we insert anything man-made into the body, the body will try to “encapsulate” and create a thin layer of scar tissue around it. This is as true for orthopedic pins as for breast implants — and it’s actually a good thing. This capsule will isolate the implant from the surrounding breast tissue. It will also help keep the implant in place, providing a firmer appearance.
However, sometimes this capsule hardens too much. Then, it starts to press on the implant, causing pain or changing its shape. When this happens, the only way to fix it is by taking the implant out out and removing the capsule — a procedure called a capsulectomy. In some cases, such as when the implant is ruptured and the capsule is contracted, we may decide to proceed with an en-block capsulectomy. During this procedure I remove the capsule and its contained implant all at once without opening the capsule.
This is when the implant bursts or breaks for any reason. If the ruptured implant is saline, the rupture can be immediately visible to the naked eye: one breast will look deflated, and you may see a slight asymmetry or feel a bump. A silicone implant rupture can go unnoticed because the silicone may either still retain its shape or become trapped in surrounding soft tissues. This is called a “silent rupture.”
There are two types of rupture: intracapsular and extracapsular. In intracapsular ruptures, the implant will still be held in place by the capsule, so it won’t be as noticeable. If there are no significant signs or symptoms, some patients take a wait-and-see approach to surgery. Extracapsular ruptures, on the other hand, are often more symptomatic and the recommendation is to remove the implant as soon as possible.
Breast implant illness is a complex and difficult condition caused by the way the body’s immune system reacts to the implant. Though it’s fortunately rare, it can severely derail your quality of life. Symptoms may include:
Currently, there is only one way to treat it, and that’s by removing both the implants and the surrounding capsule.
Breast implant removal may refer to three different procedures:
Naturally, each of these procedures will be done slightly differently, and recovery times will vary accordingly.
This is the simplest of the lot. Under ideal circumstances — if the original implant was a high-quality, smooth silicone piece, we know there was no implant rupture, and there is no hardening or pain — this can be a very short surgery.
We simply make an incision on or around the breast and take out the implant. Then, we will ensure the areola and nipples are at the right place and close the incision.
The implant removal procedure can be done as an outpatient procedure (no overnight stay) and without general anesthesia. Sometimes it’s enough to simply numb the breast with local anesthesia, however, we may add IV sedation to make sure you’re comfortable.
Ideally, the removal incision should be in the same place as the original breast augmentation incision site. In this way, we can prevent a new scar altogether.
Often, simply removing the implant will leave behind a very abrupt change. Even when dealing with a small implant (let’s say, a B cup), patients can expect some sagging or even an indentation.
Therefore, explant surgery is often paired with a breast lift, or even a fat transfer — that is, we take fat cells from a different part of the body through liposuction, and we graft them in the breast to “fill it.”
Next in the complexity ladder is to remove and replace the implant on the same day, leaving the capsule intact. Once again, the gold standard here is to use the same incision as before, rather than cause a brand-new scar.
If your past set of implants never gave you any trouble, we will also try to place the implant in the same capsule as the previous one.
This is often not possible for patients with capsular contracture, as it would naturally fail to relieve the pain, soreness, or other symptoms. In these cases, we may either remove the old capsule before placing the new implant, or we may place the implant somewhere else — for example, if the original set was below the muscle, we can now place it over the muscle.
Usually, a removal and replacement procedure is not much longer than a regular breast augmentation. You can also expect the recovery to be very similar.
A capsulectomy involves removing the entire capsule around the implant, which is much harder and more invasive. As a result, I generally only perform it when we need to do it.
Why? Essentially, it creates a lot more trauma on the body. Instead of simply sliding the implant out, we will need to cut the capsule away from the rest of the breast tissue. This causes more pain and more bleeding. Not every patient is a candidate to under a removal, capsulectomy, replacement, and a lift all at once.
This procedure can only be done under general anesthesia. Likewise, the recovery period will also be much longer.
A capsulectomy may become necessary if:
The explant recovery timeline will depend on the exact procedure you’re getting but will follow similar steps.
If you didn’t have a capsulectomy, and if we did it under local anesthesia, you will leave awake and walking — but may still be dizzy and tired, so someone will have to drive you home. We will give you some pain medication for when the anesthesia wears off completely.
If you opted for general anesthesia, nausea may keep you from eating or drinking anything right away. You will likely need someone to stay with you for the first day.
Either way, you’ll go home with a set of well-bandaged sutures and special compression garments for your chest. If you also had a capsulectomy, you may need a drainage tube to prevent any excess fluid build-up.
At this point, your incision sites will still feel very sore. You will still need to take it slow when getting up or walking for long periods.
If you work a desk job and had a simple removal (with no replacement), you may be able to go back to work after a couple of days. If you had a replacement, you may need a little longer. In the event of a capsulectomy, it may take up to a week to return to a regular, non-active routine.
Anywhere between one week and 10 days, you will have to come back to the office for a follow-up appointment. Here, we will take a look under your bandages, look for signs of infection, and remove any stitches or drainage tubes.
Provided the healing process is going forward as normal and you no longer require prescription pain medication, you will be able to drive about a week after surgery. However, you will still need to:
Full recovery from removal or removal and replacement may take between four and six weeks. At this point, you may also see something very close to the “final result” as your body will have adjusted to its new size.
The capsulectomy recovery time may take an extra week or two.
Dr. Sepideh Saber is a board-certified plastic surgeon with extensive experience in reconstructive and cosmetic procedures. In addition to her state-of-the-art training at Stanford Univeristy, she also offers an empathetic healthcare model, where both patient and doctor work together to design the best solution for any case.
To request a consultation, call (877) 205-4100 or schedule a consultation online.
The practice of Dr. Saber is located in Encino, CA for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.