Reasons for Explantation
Implant removal (explantation) is chosen for various reasons: medical complications (rupture, capsular contracture, BIA-ALCL diagnosis, implant malposition); systemic symptoms attributed to implants (Breast Implant Illness); preference for natural appearance; or simply a change in personal aesthetic goals. The FDA has reported increasing numbers of explantation procedures since the 2010s, partly driven by greater awareness of Breast Implant Illness and BIA-ALCL concerns.
The Explantation Procedure
Simple explantation removes the implant through the original incision. Capsulectomy (removal of the surrounding scar capsule) may be performed concurrently: partial capsulectomy removes problematic areas of the capsule; total capsulectomy removes it entirely. En bloc capsulectomy — removing the implant and entire capsule as a single unit without opening the capsule — is specifically indicated when BIA-ALCL is suspected or confirmed, to avoid seeding any abnormal cells. This technique requires more extensive surgery.
What to Expect Afterwards
After explantation, the breast consists of whatever natural tissue remains, now enclosed in a stretched and often redundant skin envelope. The degree of ptosis depends on implant volume, time in place, and skin elasticity. Many patients undergo concurrent or subsequent mastopexy. Some choose fat transfer to restore modest volume. Recovery from explantation alone is typically faster than augmentation due to the absence of pocket creation or tension on sutures.
Breast Implant Illness and Explantation
A significant proportion of patients reporting Breast Implant Illness symptoms choose explantation with complete capsulectomy. Patient-reported outcomes after this procedure are generally positive, with many reporting improvement in the systemic symptoms that prompted the decision. Formal clinical research into BII remains ongoing, and the mechanism is not fully established.
